[INTRO].

Did you ever fake being sick as a kid? Maybe you were just such a goody-two-shoes that your parents didn't think you'd actually lie.

Maybe you had it down to a science: run the thermometer under hot water in the bathroom sink, do some jumping jacks, get hot and sweaty, and then climb back under the covers and put on your cutest pout. Or maybe you were lucky enough to actually get your Hogwarts letter and you always kept a Skiving Snackbox or two on hand. If so, I'm super jealous.

In any case … why'd you do it? To get out of a test? To avoid that big presentation?

Because your parents always made you a giant ice cream sundae on days when you were feeling lousy? That's what's known as malingering: faking symptoms of illness for some sort of clear material benefit. But for people with factitious disorder, faking illness isn't quite so straightforward: they fake symptoms of illness and take on the role of a sick person, but they do it without obvious external motivation.

Historically and in pop culture, it's usually called Munchausen syndrome, after a 17th century baron who had a thing for embellishing stories. People with this disorder do all sorts of things to pull off the ruse: they might lie about their medical history, fake test results, even cause physical harm to themselves to make it look like they have a disease or condition. They can end up doing things that are pretty extreme, which is probably why the disorder has shown up in almost every medical drama on TV.

But for the people living with it, the consequences can be a lot more severe than like a scathing tongue-lashing from Dr. House. In one study that followed 20 people living with factitious disorder, four of the subjects died because of disorder-related behavior.

And even if people with factitious disorder don't harm themselves in the process of faking their symptoms, they can still be harmed by unnecessary medical procedures or find themselves bankrupted by medical bills and missing work. There's a variant of this disorder that's even worse: people diagnosed with factitious disorder imposed on another fake symptoms in another person, usually a child or an adult dependent. In those cases, the first step is to protect the victim, usually by removing them from the care of the person with the disorder.

By now, you're probably wondering why would anyone go to such lengths to seem sick. Well, psychologists have wondered that, too. It's worth noting that most of the research on factitious disorder comes from case studies.

It's hard to find subjects for an empirical study, because if patients won't admit they're faking — and most of them won't — the only way to really prove it is with their medical records. And that violates patient confidentiality. Still, a lot of cases have been documented, and the consensus among researchers is that the goal is to assume what they call a “sick role.” Think about the last time you were sick.

How did your friends and family treat you? I'm sure feeling sick wasn't fun, but the way other people treated you was probably kinda nice. We have different social expectations for people who are ill.

They're often given more attention and sympathy, and other people try to help them out. That treatment is what people with factitious disorder seem to crave. People with the disorder are also generally experiencing psychological distress, and faking physical symptoms can be a way to get attention and care.

But even though faking the symptoms might be conscious, the motivation behind it and that psychological distress are usually unconscious. Case studies show that a lot of people with factitious disorder experienced childhood trauma, illness, loss, or neglect. It is possible to treat factitious disorder.

Seeing a therapist to talk about the underlying distress can help. The biggest problem is diagnosing the disorder in the first place. It's a tricky balance: obviously doctors don't want to perform risky procedures on people who don't need them … but they also don't want to withhold them from people who do.

There are clues to watch out for, though. For example, people with factitious disorder often have hopped from doctor to doctor. They tend to be pretty calm about scary symptoms, and they're willing to undergo some serious procedures.

And a lot of the time, all those tests and procedures … just don't do much to help. Of course, there are also people who fit that description who are not faking. So, it's complicated.

Even once it's clear that they have factitious disorder, confronting patients doesn't always work. Studies have shown that only 15-20% of people with factitious disorder will admit that they're faking. Most of them just go find another doctor.

The best approach seems to be to offer an alternative that will encourage the patient to seek psychological help without having to admit that they faked their symptoms. They're told that while the doctors work on their condition, a psychologist might also help them get better. That way, their therapist can work with them on understanding the underlying distress that caused them to seek the “sick role” in the first place.

And hopefully, eventually, they will stop needing to fake it. Thanks for watching this episode of SciShow Psych, and thanks to our patrons on Patreon for helping us make this show. To learn more, and get cool rewards like access to a monthly livestream with the crew, you can go to patreon.com/scishow.

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