A nurse is caring for a school-age client in an outpatient clinic. The nurse should identify which of the client findings are manifestations of a factitious disorder? (Select all that apply.)

A. The child appearing withdrawn, avoiding eye contact, and looking down can be a behavioral manifestation seen in cases of factitious disorder imposed on another (previously called Munchausen syndrome by proxy). Children may appear fearful, anxious, or emotionally subdued, especially when the caregiver is present. B. Multiple hospitalizations over a short period of time (seven in 6 months) with no clear medical diagnosis is a major red flag. Repeated healthcare visits, extensive testing, and frequent admissions without objective findings are classic indicators of factitious disorder imposed on another. C. Unexplained abdominal pain with repeated negative evaluations is consistent with fabricated or induced symptoms. In this scenario, providers have been unable to find a medical cause despite ongoing complaints. D. Excessive thinking about health is more characteristic of somatic symptom disorder or illness anxiety disorder. In factitious disorder imposed on another, the caregiver is typically focused on portraying the child as ill, not necessarily expressing anxiety about their own health thoughts. E. Recent trauma is not identified in the scenario and is not a defining manifestation of factitious disorder. Trauma may contribute to other psychiatric conditions but is not a diagnostic feature here.