Since you didn't post any options to fill in the blanks with - and I wasn't able to find them online-, I will give a detailed answer based on information about this mental illness. This information will most likely help you answer this question.
Answer and Explanation:
In factitious disorder imposed on self, the individual is ______
...faking being sick. People with factitious disorder will try to deceive others into believing they have a physical or even psychological illness. They will, for instance, elevate their body temperature or put blood in their urine. There is no clear reason as to why they feel the need to do this, however.
In factitious disorder imposed on another, the individual is ______
... producing symptoms for someone else. When a person with factitious disorder imposes it on someone else, they will spread false information that that person is sick. The "sick" person is always someone under the care of the person who has factitious disorder.