This paper presents a cognitive behavioural perspective on factitious disorder. The DSM-IV definition will be given and aetiological and epidemiological information will be presented, whilst noting the difficulty in collecting data from this group. The difficulty in engaging the patient will be addressed. In assessing the patient, the role of early experiences, the beliefs about their feigning of symptoms, the gains from this behaviour and the reaction of others will be considered. The similarities with somatization and malingering will be discussed. A model of this disorder based on the Beckian approach will be given as will an explanation of why this disorder may become chronic. A treatment strategy will be suggested looking at helping the patient understand their disorder, discussing with them the pros and cons of alerting others to their feigning behaviour, helping them get their needs met in a more appropriate way, looking at the risks involved in the behaviour, and addressing issues of abuse.

Factitious post-traumatic stress disorder, a variant of the psychological Munchausen syndrome, was first recognised in Vietnam war veterans but has not been described since. The case is described of a young man who claimed to have been involved in a fishingdisaster, feigning the symptoms to post-traumatic stress disorder to gain admission to hospital This appears to be a novel presentation of a Munchausen variant which has not been describedin connection with peace time disasters. It would appear that the psychopathology of factitious disorder, like that of other phenomena, such as delusions, is keeping pace with the views ofsocietyand current media concerns. This issue is discussed in the context of a review of recently reported variants of this interesting clinical syndrome.