Factitious Disorders: the Baron's legacy

Our understanding of factitious disorders has expanded from that of medical and surgical exotica into that of a much broader psychiatric disorder. Patients can be divided into a nuclear group (classical Munchausen), a larger non-nuclear and less socially deviant group, and children involved by proxy. There are many aetiological theories, ranging from the psychoanalytic to the organic, and at least some cases are learned at home. Physicians and other professionals must be familiar with the general features of these disorders and have some idea of the potential breadth of presentation. Diagnosis is based on a high index of suspicion, some knowledge of the literature, and sound history taking, including the collection of substantiating evidence (e.g. reports from other treating agencies or from relatives). Management is controversial. Prolonged psychotherapy may help some adult cases. Child safety issues are paramount in the case of factitious disorder by proxy. Pseudoseizures are given special attention.