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PubMed2001

[Psychosomatic dermatology - state of the art].

Based on the current literature, the paper gives an overview of the state of knowledge in psychosomatic dermatology. The authors propose the following classification: (1.) Dermatologic problems as a consequence of psychic disorders (e.g. factitious disorder, trichotillomania, dysmorphophobia, delusions of parasitosis etc.); (2.) Multifactorial dermatologic disorders, which can be substantially influenced by psychological factors (e.g. atopic dermatitis, psoriasis, chronic urticaria etc.); (3.) Psychic disorders developing as a consequence of disfiguring or life-threatening dermatoses (e.g. adjustment disorder, depressive disorder, anxiety disorder); (4.) Comorbidity with other psychiatric disorders. Psychosomatic dermatology developed from an anecdotal initial stage to more systematic research with larger numbers of patients, employing control groups and psychometric instruments. During the last decade, research focused on psychophysiological and psychoneuroimmunological mechanisms which influence dermatologic disorders. This course of development and the current state of knowledge are presented for atopic dermatitis and psoriasis.

Anxiety Disorders↗
PubMed1998

[Artifactual disorders--between deception and self-mutilation. Experiences in consultation psychiatry at a university clinic].

During a 18-year-period 93 patients (f = 76, m = 17) with a factitious disorder were identified in the psychiatric consultation service of a university hospital (incidence: 0.62%). 50% of women were working in medical professions whereas only 6% of men. Chronic courses of illness were prevailing, but at least one quarter of female patients showed an intermittent type. There was a classical Munchhausen syndrome in 11% of patients. Depressive and anxiety disorders (10%, 4%) were to be respected as psychiatric comorbidity. Ca 25% of the patients suffered from a somatic illness in addition to the factitious disorder, and one third of the women had symptoms of psychosomatic, especially of eating disorders. Previous somatoform disorders, deliberate self harm and attempts of suicide were to be noted in the psychiatric history of many patients. There were frequent traumatizing events (foster home, disturbing family disharmony, physical and sexual abuse, early losses, serious illnesses) in the early biography. Various psychosocial stressors could be identified in the actual eliciting situation. The results are discussed in respect of epidemiology, development and clinical phenomenology of factitious disorders, psychodynamics and psychopathology of deception and self harm, and therapeutic options in the psychiatric consultation service.

Adult↗
PubMed1981

The medical care abuser: differential diagnosis and management.

The differential diagnosis of patients who are abusive of or seem addicted to medical care is discussed using the approach outlined in the new Diagnostic and Statistical Manual III of the American Psychiatric Association. These are generally chronic disorders and their managements, using the substance abuse/addiction model, are aimed at protecting both patients and physicians from unnecessary, expensive, and potentially lethal medical interventions. The disorders considered include somatization disorder (Briquet's syndrome), psychogenic pain disorder (psychalgia), hypochondriasis, factitious disorder, and malingering.

Adult↗
PubMed1982

Defining malingering.

Malingering, also called shamming illness or goldbricking, is the false and fraudulent simulation or exaggeration of physical or mental disease or defect, performed in order to obtain money or drugs or to evade duty or criminal responsibility, or for other reasons that may be readily understood by an objective observer from the individual's circumstances, rather than from learning the individual's psychology. Malingering is seen in apparently normal children, students, test subjects, spouses, and adults. It is not a mental disorder. Malingering may coexist with the antisocial personality disorder, with various factitious disorders, such as the Ganser Syndrome and the Munchausen Syndrome, with the hysterias and with traumatic neuroses and other mental disorders. A review of definitions and a medicolegal discussion are presented. Malingering is an act, which is distinguished from a legal or mental status. Failure to distinguish act from status accounts for the wide disparities in definitions of malingering.

Factitious Disorders↗
PubMed1991

Psychogenic "HIV infection".

The case of a man who falsely represented himself as being HIV positive is reported. In less than one year he was admitted twice with symptoms suggestive of HIV infection. The diagnoses malingering and factitious disorder were consecutively made. Early recognition of Factitious Disorder is essential to prevent patients from harmful diagnostic procedures or surgical treatments. Psychiatric treatment is best focused on management and care rather than cure. Psychogenic "HIV infection" might become more common than acknowledged up to now. Physicians should consider the occurrence of psychogenic "HIV infection," part of the symptomatology may be psychogenically determined, or indeed frankly simulated.

AIDS Serodiagnosis↗
PubMed1985

Patients with medically unexplained symptoms: DSM-III diagnoses and demographic characteristics.

This study reports DSM-III diagnoses and demographic characteristics of 100 patients consecutively referred to a university hospital consultation-liaison service for evaluation of medically unexplained symptoms suggesting physical disorders. Thirty-seven percent of patients received diagnoses of somatoform, dissociative, or factitious disorders, and 14% were felt to have psychologic factors affecting physical conditions. Although black and male patients were less often referred for medically unexplained symptoms, once referred they were more likely than white and female patients to receive diagnoses of somatoform, dissociative, or factitious disorders. Among patients with somatoform disorders, those with conversion disorder and somatization disorder tended to be young women, whereas those with psychogenic pain disorder were older and equally likely to be male or female.

Adult↗
PubMedDate not supplied

Two cases of psychogenic purpura.

Psychogenic purpura, also known as recurrent painful bruising or autoerythrocyte sensitization syndrome (Gardner-Diamond syndrome) is usually associated with emotionally disturbed patients. It is a troublesome entity for both patient and physician since extensive work-ups yield no diagnosis. We describe two females in their early twenties with recurrent painful bruising and diverse accompanying symptoms which appeared after physical trauma. One of the patients developed a bruise after intradermal injection of her own blood (with no reaction to saline injection). One patient had a personality (borderline) disorder, the other a factitious disorder. Punch biopsies revealed a perivascular inflammatory infiltrate, erythrocyte extravasation and no vasculitis. Psychogenic hemorrhagic disorders are uncommon yet must be considered in the differential diagnosis of purpura. Patients are usually young emotionally troubled females who present painful recurrent bruises on extremities frequently after trauma or surgery. Autoimmune mechanisms and increased cutaneous fibrinolytic activity have been implicated, although further studies are needed. Correct diagnosis is important to avoid aggressive and even mutilating treatments, and an adequate comprehension of these purpuras is important for the attending physician.

Adult↗
PubMed1997

Factitious renal colic.

OBJECTIVES: We reviewed our experience with patients with factitious disorders who presented with renal colic to identify their common characteristics and to quantify the cost burden placed on the health care system as a result. METHODS: We retrospectively reviewed the medical records of two Philadelphia area hospitals from 1989 to 1995 to find patients with factitious disorders who presented with renal colic. A control group of patients with nephroureterolithiasis was also identified. RESULTS: We identified 12 patients who presented with renal colic and had a final diagnosis of Munchausen's syndrome or malingering. The incidence of factitious renal colic was 0.6%. Eighty-three percent of these 12 patients were men, had an average age of 32 years, and made a total of 18 hospital visits. Ninety-two percent claimed an intravenous contrast allergy, 25% claimed an allergy to a specific narcotic, and 39% of the hospital visits ended with the patient voluntarily discharged against medical advice. Thirty-three percent were treated elsewhere for similar complaints. Only the number of intravenous contrast allergies and the number of patients leaving against medical advice were statistically different from the control group. The total cost for all factitious visits was $52,452, with a mean cost per visit of $2914. The average bill of those patients who received retrograde pyelograms was $3046 greater than for those who did not. CONCLUSIONS: Factitious disorders should be considered when evaluating patients with an intravenous contrast allergy and renal colic. These patients are likely to leave against medical advice and place a significant cost burden on hospitals.

Adult↗
PubMed1989

Clinical characteristics of the Munchausen syndrome. A review and 3 new case histories.

The term Munchausen syndrome was introduced by Asher in 1951 for the description of patients who tell fantastic stories and deliberately seek repeated hospitalizations at different hospitals for simulated or self-induced acute illnesses. The syndrome has been repeatedly criticized and several other eponyms have been suggested. In DSM-III-R the designation chronic factitious disorder is used synonymously with Munchausen syndrome. On the basis of 3 new case reports and a statistic processing of literature case histories, this paper suggests that when using the original criteria by Asher, the syndrome constitutes a subtype of chronic factitious disorders, specially characterized by factitious illness, peregrination, pseudologia fantastica and dramatic admission circumstances. Further, most of the criticism of the syndrome may be a result of the great variability in definitions and diagnostic criteria used by different authors. Other clinical characteristics of the patients as well as psychopathologic and psychodynamic considerations are briefly discussed.

Adult↗
PubMed1986

Insulin-induced factitious hypoglycemic coma.

Hypoglycemia due to the ingestion of oral hypoglycemic agents or injection of insulin is a common way for chronic factitious disorder to present to physicians. Despite this fact, factitious hypoglycemic coma is rare. Because hypoglycemia is potentially fatal, with numerous sequelae, physicians need to be aware of its occurrence and method of detection. A case of chronic factitious disorder presenting as hypoglycemic coma is presented and its implications discussed.

Adult↗
PubMed1992

[Artificial diseases (self-induced diseases)--a review].

Factitious disorders have gained greater significance in all medical specialties during recent years, and continue to pose difficult problems. At present factitious disorders can be divided into four sub-types, the pretence and/or production of somatic and/or psychic medical symptoms being central to all. Apart from disturbance of ego structure the self and the body image (self) a specific disturbance of the doctor-patient relationship is of pathognomonic value. An integrated therapeutic approach (combination of palliative measures, somatic therapy and psychotherapy) seems to be most successful. In the differential diagnosis, factitious diseases have to be delineated from many other diseases in which self-destructive behaviour may occur.

Adult↗
PubMed1991

Classification system for factitious syndromes in the hand with implications for treatment.

We evaluated 29 patients with factitious disorders in the hand who received Worker's Compensation benefits. Three types of factitious hand disorders based on physical presentation were self-mutilation and wound manipulation, edema, and finger and hand deformities. Two distinct psychological diagnoses present were factitious disorder with physical symptoms and conversion disorder. The Minnesota Multiphasic Personality Inventory revealed two personality profiles: emotionally dependent and angry and hostile. Behavioral treatment was implemented. The emotionally dependent group responded well, with 80% returning to work. The angry and hostile group had a much poorer response, with 21% returning to work. None of the self-multilating patients returned to work. We recommend a combined evaluation by a physician, a psychologist, and a hand therapist to achieve a definitive diagnosis for these disorders. The identification of psychological profiles assists in ascertaining which patients will be responsive to behavioral treatment.

Accidents, Occupational↗
PubMed1986

[Factitious disease. Observations on 44 cases at a medical clinic and recommendation for a subclassification].

From 1971 to 1985, 44 cases of self-induced factitious disorders were observed in the Medical Department of a University Hospital. The diseases were often severe, one patient even died. The various symptoms and diseases presented by the patients, the methods of producing them, and the diagnostic and therapeutic aspects of these cases are described. Patients were analysed with regard to age, sex, profession, psychosocial adaptation, number and duration of hospitalisations, presentation of complaints, behaviour on the ward, relation to the doctor, self-destructive tendencies, readiness to suffer and possible motivations. According to the criteria of the DSM-III, seven patients were malingerers (DSM-III: V 65.20) and 37 had a "chronic factitious disorder with physical symptoms" (DSM-III: 301.51). However, the findings in the patients of the latter group strongly suggest that they form an extremely heterogeneous population. Therefore we propose a subclassification of the DSM-III category 301.51 as follows: Type A. Muenchausen syndrome in the proper sense; dramatic deception of mainly acute illness; pseudologia fantastica; social maladaptation, chaotic life situations; many, mostly short hospitalisations; many interventions; at first well adapted, later hostile; mostly men. Type B. Self-induced, mainly chronic illness; behaviour adequate, highly compliant; often little emotion, contrasting with the sometimes severe illness; socially adapted; history remarkably blank with regard to psychosocial stress; several often longlasting hospitalisations and many interventions; almost exclusively younger women from (para-)-medical professions. Type C. Willfull interference with the healing of wounds, cutaneous ulcers, abscesses or dermatological artefacts; history with marked personal losses or severe chronic medical problems; at first well adapted, later hostile, passive/aggressive; women prevail. A conversion syndrome (DSM-III: 300.11) was not observed. In contrast to malingering, the basis of the disorder in types A, B and C is unconscious in origin, thus similar to the conversion syndrome. Contrary to the latter, however, the production of physical symptoms is under voluntary control. The proposed subclassification represents a hypothesis for testing which might facilitate the analysis of the basic personality disorder, so far lacking. The investigation of the psychopathology of these patients and their treatment is difficult if not impossible because most refuse psychiatric exploration and therapy. Consequently follow-up studies and data on the prognosis are rare.

Adolescent↗
PubMedDate not supplied

[Classification of secret self-injury behavior and development of an alternative proposal].

The existing efforts towards a classification of autodestructive behaviors are critically discussed. In this context the nowadays usual method of operationally defining clinical appearances is confronted with the traditional method of psychopathological phenomenology. Starting from this point of view the author suggests an alternative pattern for the classification of factitious disorders.

Factitious Disorders↗