Due to the behaviors involved, diagnosing factitious disorder is very difficult. If the healthcare provider finds no physical reason for the symptoms, they may refer the person to a psychiatrist or psychologist (mental health professionals who are specially trained to diagnose and treat mental illnesses). Psychiatrists and psychologists use thorough history, physical examinations, laboratory tests, imagery, and psychological testing to evaluate a person for physical and mental conditions. Once the person's history has been thoroughly evaluated, diagnosing<unk>  requires a clinical assessment. Clinicians should be aware that those presenting with symptoms (or persons reporting for that person) may exaggerate, and caution should be taken to ensure there is evidence for a diagnosis. Lab tests may be required, including complete blood count (CBC), urine toxicology, drug levels from blood, cultures, coagulation tests, assays for thyroid function, or DNA typing. In some cases CT scan, magnetic resonance imaging, psychological testing, electroencephalography, or electrocardiography may also be employed. A summary of more common and reported cases of factitious disorder (Munchausen syndrome), and the laboratory tests used to differentiate these from physical disease is provided below: Disease Mimicked Method of Imitation Laboratory/Diagnostic Confirmation Bartter syndrome * Surreptitious intake of diuretics *<unk> -induced vomiting * High performance liquid chromatography (HPLC) analysis of urine * Urine chloride analysis Catecholamine-secreting tumor Injection of epinephrine into urine or blood stream Adjunct analysis of increased Chromogranin A Cushing’s syndrome Surreptitious steroid administration HPLC to differentiate endogenous and exogenous steroids Hyperthyroid Surreptitious thyroxine administration Blood tests for free T4 and thyroid stimulating hormone Hypoglycaemia Exogenous insulin or insulin secretagogues Simultaneous blood analysis of insulin, C-peptide, proinsulin, and insulin secretagogues Sodium imbalance Intake large quantities of salt Measure fractional sodium excretion to differentiate intentional salt overload from dehydration. Chronic diarrhea * Watered down stool samples * Laxative abuse * Measure fecal osmolarity * Urine analysis to screen for laxatives using gas chromatography or mass spectrometry Induced vomiting Although many alternatives possible, ipecacuanha ingestion HPLC measurement of serum or urine for elevated creatine kinase, transaminases and ipecacuanha Proteinuria Egg protein injection into bladder, albumin (protein) addition to urine samples Urine protein electrophoresis analysis Haematuria Blood introduction to urine samples, deliberate trauma to the urethra Imaging to rule out insertion of a foreign body, monitor sample collection, analysis of red blood cell shape in samples There are several criteria that together may point to factitious disorder, including frequent hospitalizations, knowledge of several illnesses, frequently requesting medication such as pain killers, openness to extensive surgery, few or no visitors during hospitalizations, and exaggerated or fabricated stories about several medical problems. Factitious disorder should not be confused with hypochondria, as people with factitious disorder syndrome do not really believe they are sick; they only want to be sick, and thus fabricate the symptoms of an illness. It is also not the same as pretending to be sick for personal benefit such as being excused from work or school. People may fake their symptoms in multiple ways. Other than making up past medical histories and faking illnesses, people might inflict harm on themselves by consuming laxatives or other substances,<unk> -inflicting injury to induce bleeding, and altering laboratory samples". Many of these conditions do not have clearly observable or diagnostic symptoms and sometimes the syndrome will go undetected because patients will fabricate identities when visiting the hospital several times. Factitious disorder has several complications, as these people will go to great lengths to fake their illness. Severe health problems, serious injuries, loss of limbs or organs, and even death are possible complications.
Factitious disorder imposed on self
Factitious disorder imposed on another
Mass psychogenic illness
Malingering of post-traumatic stress disorder
Psychological trauma
Jurosomatic illness
Functional somatic syndrome
Problematic social media use