SYMPTOMS OF FACTITIOUS DISORDER IN ADULTS OR ADOLESCENTS. Reasons for suspecting factitious disorder include:

• The individual's history is vague and inconsistent; or the individual has a long medical record with many admissions at different hospitals in different cities.
• The patient has an unusual knowledge of medical terminology or describes the illness as if they are reciting a textbook description of it.
• The patient is employed in a medical or hospital-related occupation.
• Pseudologia fantastica, a Latin phrase for "uncontrollable lying," is a condition in which the individual provides fantastic descriptions of events that never took place.
• The patient visits emergency rooms at times such as holidays or late Friday afternoons when experienced staff are not usually present and obtaining old medical records is difficult.
• The patient has few visitors even though he or she claims to be an important person.
• The patient is unusually accepting of surgery or uncomfortable diagnostic procedures.
• The patient's behavior is controlling, attention-seeking, hostile, or disruptive
• The symptoms are present only when the patient thinks he or she is being watched.
• The patient is abusing substances, particularly prescription pain-killers or tranquilizers.
• The course of the "illness" fluctuates, or complications develop with unusual speed.
• The patient has multiple surgical scars, a so-called "gridiron abdomen," or evidence of self-inflicted wounds or injuries.

SYMPTOMS OF MUNCHAUSEN SYNDROME BY PROXY. Factors that suggest MSBP include:

• The victim is a young child; the average age of MSBP victims is 40 months.
• There is a history of long hospitalizations and frequent emergency room visits.
• Siblings have histories of MSBP, failure to thrive, or death in early childhood from an unexplained illness.
• The mother is employed in a health care profession.
• The mother has been diagnosed with depression or histrionic or borderline personality disorder.
• There is significant dysfunction in the family.

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