Factitious disorders

Reports of factitious disorders, Munchausen's syndrome, and self-induced il lness exist throughout medical history. In practice, disease simulation rep resents a spectrum of behaviors that range from relatively common and benig n (e.g., pleading illness to avoid an unwanted social obligation) to rare a nd malignant forms (e.g., Munchausen's syndrome and factitious disorder by proxy). Factitious disorders are differentiated from malingering by the goa l that motivates the individual's behavior. The only apparent goal in facti tious illness is to gain the sick role; the goal in malingering is to gain rewards, such as compensation, or to avoid the unwanted, such as military s ervice or jail. This article summarizes clinically relevant information on factitious disorders for primary care physicians.