Factitious Disorder: Detection, Diagnosis, and Forensic Implications

Few phenomena in medicine are more confounding than the diagnoses involving deception: malingering, Munchausen syndrome, Munchausen by proxy (MBP), and factitious disorder (Table 1). Physicians rely on patient reports of symptoms as a starting point for evaluation and treatment planning. They expect to be able to trust their patients' reports. When they are misled, deliberately or inadvertently, consciously or unconsciously, physicians are thrown off their game plan. Sometimes they are tempted to call factitious disorder "fictitious disorder"; however, in some cases, the ailments are real but self-induced.