Factitious Disorder: When Someone Fakes a Serious Illness — and Why | Ms. Sarah El Nabulsi
- Sarah El Nabulsi, M.Sc., M.A., M.A.
- Jul 13
- 5 min read
MBC1 — SABAH AL KHAIR YA ARAB · December 13, 2020
Ms. Sarah El Nabulsi, M.Sc., M.A., M.A., DHA Licensed Clinical Psychologist, joined the hosts of MBC1's Sabah Al Khair Ya Arab following a story that had captured public attention: a woman had falsely claimed to have brain cancer, shaved her head completely to support the deception, and used her fabricated diagnosis to fundraise — financing her wedding and multiple trips before the lie unravelled.
The hosts wanted to know: is this a mental illness? And if so, what kind?
The answer is more clinically specific than most people assume — and it matters.
First: What Is Factitious Disorder?
Factitious Disorder — historically known as Munchausen syndrome, after the eighteenth-century German nobleman Baron von Münchhausen, famous for his wildly exaggerated stories — is a recognised psychological condition classified in the DSM-5 under Somatic Symptom and Related Disorders. It affects approximately 1% of the population, with higher rates observed in clinical and hospital settings.
A person with Factitious Disorder deliberately fabricates, exaggerates, or induces physical or psychological symptoms — not for any external gain, but compulsively. They are driven by deep, underlying psychological needs, most significantly an intense need for the attention, care, and concern that illness tends to generate. The fabrication is not a rational calculation. It is a compulsion, and the person engaging in it has very limited control over the behaviour, even when they are aware, on some level, that what they are doing is not real.
This is what distinguishes Factitious Disorder as a genuine clinical condition. The suffering is real — even when the symptoms are not.
The Critical Distinction: Factitious Disorder vs. Malingering
This distinction is one of the most important in clinical assessment, and it is precisely what the public story of this woman requires us to make.
In Factitious Disorder, there is no external reward. No financial gain, no legal benefit, no practical advantage. The person is fabricating illness for internal psychological reasons — to meet a need for attention and care that they cannot meet in healthier ways.
Malingering is entirely different. When a person deliberately fakes or exaggerates illness in order to achieve a concrete external benefit — financial gain, avoiding legal consequences, obtaining medication, escaping responsibility — this is not a mental health disorder at all. It is a deliberate, calculated act. The DSM-5 is explicit on this distinction: malingering is specifically excluded from the category of mental health conditions.
The woman who shaved her head, claimed brain cancer, and used that story to fund a wedding and travel was — based on everything publicly known — engaging in malingering, not Factitious Disorder. She had a clear external motivation. She gained materially and concretely from the deception. That places her behaviour outside the clinical definition of the disorder.
What she may have is something different: Antisocial Personality Disorder, a condition characterised in the DSM-5 by a persistent pattern of deception, manipulation, disregard for others' rights, and willingness to break both moral and legal norms for personal gain. Individuals with this profile lie and manipulate not because they are compelled to, but because they are willing to — and they feel little to no remorse about the harm caused.
A Third Condition Worth Understanding: Conversion Disorder
Factitious Disorder also needs to be distinguished from Conversion Disorder — now termed Functional Neurological Symptom Disorder in the DSM-5. In Conversion Disorder, a person develops genuine, often severe neurological symptoms — including seizures, vision loss, paralysis, or difficulty speaking — that are not explained by any detectable neurological disease.
What makes Conversion Disorder clinically distinct from Factitious Disorder is that the symptoms are not intentional. The person is not fabricating or consciously producing them. They arise from an unconscious process — typically linked to unresolved psychological conflict or trauma — and the person experiences them as fully real. Treatment therefore looks entirely different from how we approach Factitious Disorder.
What Drives Genuine Factitious Disorder
When the condition is genuine, the person engaging in it cannot simply stop. They go from doctor to doctor, hospital to hospital — often at significant cost to public healthcare systems — because the attention and concern of medical professionals is precisely what they are seeking. In some cases, they are willing to undergo invasive investigations, and sometimes even operations, before the fabrication is identified — which, given how complex and mimicry-dependent the presentation is, can take years even for experienced clinicians.
The underlying drivers are almost always rooted in deep deficits in self-worth, a profound difficulty in forming and sustaining genuine emotional connections, and an inability to meet the fundamental human need for care and attention through ordinary means. Having someone concerned about you — sitting by your bedside, calling to check in, rallying around you — meets a need that these individuals have, for whatever reason, been unable to meet in any other way.
In some cases, the fabrication extends beyond the self. Factitious Disorder Imposed on Another — previously known as Munchausen by Proxy, and documented extensively in the child safeguarding and psychiatric literature — occurs when the person fabricates or induces illness in someone else, most commonly a child or dependent family member, in order to receive the secondary attention and sympathy directed at a caregiver. This is a safeguarding emergency and one of the most serious presentations within this diagnostic category.
Treatment
One of the most effective approaches to working with genuine Factitious Disorder centres on removing the reward that sustains the behaviour.
Since the person is using fabricated illness to meet their need for attention and care, the clinical task is to stop that strategy from working — not punitively, but systematically. This means working closely with the family and the people around the individual, helping them understand that responding to illness episodes with heightened concern and attention is inadvertently reinforcing the very behaviour they want to stop. Instead, attention and genuine warmth are directed toward the person's real behaviours, real achievements, and real presence — independent of any symptoms.
Alongside this, therapy focuses on building the foundations that make the disorder unnecessary: genuine self-worth, self-compassion, and the capacity to form authentic connections that provide care and belonging without requiring a medical crisis to activate them. The goal is not to shame the person out of the behaviour. It is to make the behaviour redundant by giving them something real in its place.
Getting help early matters enormously — not only for the individual, but for the people around them. A person with untreated Factitious Disorder may cause serious physical harm to themselves through unnecessary procedures. And in cases where the disorder extends to a family member, the risks to that person — particularly if they are a child — are severe.
About Ms. Sarah El Nabulsi
Ms. Sarah El Nabulsi, M.Sc., M.A., M.A. is a DHA Licensed Clinical Psychologist (License No. DHA-75083705) based in Dubai, and UAE Director of the Transcendental Meditation Organization. She has been featured on MBC, MBC1, Sky News Arabia, Dubai TV, and BBC Arabic, and is the founder of the online courses Anxiety 101 (Level 1) and Master Yourself (Level 2).
Comments