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PubMed1986

Dual factitious disorder.

The DSM-III classification of factitious disorders encourages artificial separation into disorders with physical and those with psychologic symptoms. Despite documented examples of similar patients who present with psychiatric complaints, Munchausen's syndrome is usually considered a form of chronic factitious physical disorder. Three patients with both factitious physical and psychologic symptoms are presented. These patients illustrate the importance of focusing on the fundamental behavior of assuming the patient role, rather than on the specific category of symptoms. We recommend that the category of symptoms be used as a modifying statement, rather than defining separate disorders.

Adult↗
PubMed1983

Factitious disorders in a teaching hospital.

To obtain an overview of factitious disorders in hospitalized patients we surveyed the cases found in our hospital during a 10-year period. Forty-one disorders were identified including one that was fatal and others that were chronic, severe, and life-threatening. The disorders fell into four subgroups: self-induced infections, simulated illnesses, chronic wounds, and surreptitious self-medication. These subgroups had implications for prognosis and management. The patients included 39 women and 2 men, average age 33 years, 28 working in medical jobs. With three possible exceptions, none of the patients had Munchausen's syndrome and were not malingerers or sociopaths. Most of these patients were immature, passive, and hypochondriacal; none had major mental disorders. Thirty-three patients were confronted with evidence that their disorders were self-induced; none signed out of the hospital or became suicidal. Although only 13 patients acknowledged causing their disorders, most improved after confrontation and 4 of the most chronic became asymptomatic. The cases differed from commonly held assumptions about factitious disorders.

Adolescent↗
PubMed2004

A case of factitious disorder involving menstrual blood smeared on the face.

This article presents a case of factitious disorder in which a female smeared menstrual blood on her face. The patient was admitted to our otolaryngology clinic complaining of bleeding from the mouth, nose, ears and eyes. This event reportedly occurred three to four times on a daily basis. She acknowledged nine prior admissions to different specialists over the last two years. Following psychiatric consultation, we diagnosed factitious disorder with predominantly physical signs and symptoms. She was started on Fluoxetine 20 mg/day and supportive interviews were organized. After diagnosis, we observed that her symptoms decreased over two months. The symptoms did not reoccur three to nine months after treatment. This case report outlines two important features. The first is that a case of this type has not been reported before, and the second feature is that this case demonstrates the effect of cultural factors greatly different from those seen in classical factitious disorder.

Adult↗
PubMedDate not supplied

Factitious disorder in a manic patient: case report and treatment considerations.

A case of factitious disorder with physical symptoms is described in a patient with manic-depressive illness. The coexistence of factitious disorder and bipolar disorder has not been previously reported. Clinicians should search for an underlying affective disorder in patients who fabricate signs and symptoms of physical illness, since mania may simulate or contribute to the production of factitious behavior.

Adult↗
PubMedDate not supplied

Factitious disorders mimicking systemic lupus erythematosus.

Factitious disorders are one of the most difficult challenges to the sagacity of the physician. Self-inflicted injuries and diseases have been recognized since Biblical times. In the Middle Ages, hysterics were known to place leeches in their mouths to simulate hemoptysis and to abrade their skin to reproduce skin conditions. Münchausen syndrome, originally described in 1951, is the term applied to persons who seek medical care by feigning illness in the absence of any organic medical or surgical disease. Since the first report of the syndrome, many case reports have documented the performance of unneeded operations and the administration of dangerous drugs to these patients. Rheumatologic manifestations in this syndrome are rare, and include septic arthritis, osteomyelitis, destructive arthropathy, reflex sympathetic dystrophy and systemic lupus erythematosus (SLE). We reviewed the English literature for the past 29 years and found only 8 patients with Münchausen syndrome who simulated SLE. It is interesting to consider the damage mechanisms (some of the patients satisfied 4 or more of the criteria for the classification of SLE) and how a complex disease with a broad spectrum of manifestations such as lupus can be simulated, the only limits being the patient's knowledge and imagination.

Adolescent↗
PubMed1989

Diagnostic legitimacy of factitious disorder with psychological symptoms.

The authors question the clinical status of factitious disorder with psychological symptoms as a mental disorder. In particular, they argue that unresolved issues regarding the motivational basis of this disorder and the lack of clearly delineated inclusion, exclusion, and outcome criteria seriously compromise its diagnostic legitimacy. Two case reports are presented to illustrate these difficulties. Future studies should consider these empirical and conceptual difficulties in refining the diagnosis of factitious disorder with psychological symptoms for DSM-IV.

Adult↗
PubMed2002

The impact of factitious disorder on the physician-patient relationship. An epistemological model.

Theoretical models for physician-patient communication in clinical practice are described in literature, but none of them seems adequate for solving the communication problem in clinical practice that emerges in case of factitious disorder. Theoretical models generally imply open communication and respect for the autonomy of the patient. In factitious disorder, the physician is confronted by lies and (self)destructive behaviour of the patient, who in one way or another tries to involve the physician in this behaviour. It is no longer controversial that the physician should communicate his consideration of a factitious disorder without insistence that the patient accepts this diagnosis. However, the balance between patient autonomy and open communication on the one hand, and the preservation of the patient's health, physician integrity and of a constructive physician-patient relationship on the other is easily disrupted. In this article, an epistemological model is described to facilitate a positive outcome of confrontation in treatment of factitious disorder. Analysing the problem in terms of systems theory will help the physician to assess what information is appropriate to use in which phase of the patient's treatment, while preserving the physician-patient relationship.

Communication↗
PubMed2005

Mathematical modeling of the course and prognosis of factitious disorders: a game-theoretic approach.

A mathematical model using simple concepts of repeated games is proposed to model the course and prognosis of factitious disorders. Although simple, the model seems capable of explaining the yet unknown mechanisms underlying the variable course of factitious disorders. One of the notable results of this study is the significant effect of involved physicians in the treatment process on the course of the disease. Particularly, the doctor's error rate in realizing whether the symptoms are real or factitious can considerably affect the course of the disease. This is the first paper to apply a mathematical model to factitious disorders.

Factitious Disorders↗
PubMedDate not supplied

Factitious disorders: reformulating the DSM-IV criteria.

The author criticizes and reformulates the DSM-IV criteria in a clinically and nosologically sensitive way. Criterion A, the intentional production of physical or psychological signs or symptoms, emphasizes symptoms and cannot accommodate pseudologia fantastica, voluntary false confessions, and impersonations. Criterion B, the motivation is to assume the "sick role," has no empirical content and fulfills no diagnostic function. The two criteria need reformulating in terms of lies and self-harm, respectively. Criterion C causes misdiagnosis by pushing factitious disorders into the somatoform and malingering categories and should be abandoned. The author discusses the implications for the etiology of conversion disorders and the classification of factitious disorders.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed2006

Serial factitious disorder and Munchausen by proxy in pregnancy.

Factitious disorder, including Munchausen syndrome, is seldom documented among pregnant patients but can have powerful consequences. We report on a 44-year-old woman who, over a period of two decades, self-induced labour and delivery in five consecutive pregnancies. She precipitated labour by rupturing her own amniotic sac with a fingernail or cervical manipulation, or misappropriating and self-administering prostaglandin suppositories from the hospital unit on which she worked as a nurse. Preterm deliveries resulted in fetal demise in one case and in neonatal intensive care treatment for two of the offspring. One of the surviving children has cerebral palsy attributable to the mother's factitious illness behaviour, which raises the spectre of Munchausen by proxy maltreatment. The patient sought attention and care through the ruses, which have never been uncovered by her obstetric and gynaecologic caregivers. Indeed, she underwent an unnecessary hysterectomy because of the illusion of heavy menstrual bleeding. Most recently, the patient has been engaging in surreptitious autophlebotomy to force blood transfusions.

Abortion, Induced↗
PubMed2005

[Somatoform and factitious disorders in clinical medicine].

Patients with "medically unexplained somatic symptoms" are frequent in every health care system. The bodily complaints may persist over a long period of time, cause serious subjective suffering and be associated with secondary psychiatric comorbidity and major disabilities in psychosocial life. The doctor-patient relationship is often hampered by emotional conflicts, leading to unsuccessful treatment, doctor-shopping and chronic courses of illness. A major subgroup of patients with somatoform disorders and a minor subgroup of patients with self-induced, i.e., factitious disorders must be differentiated, both showing a complex etiopathogenesis of their somatic symptoms. Patients with somatoform and factitious disorders present a special challenge within the health care system.

Clinical Medicine↗
PubMedDate not supplied

[Somatomorphic and factitious disorders. Our experience in a regional reference neuropaediatric department].

INTRODUCTION AND OBJECTIVES: Children often consult for fictional or very exaggerated symptoms, grouped together as factitious disorders (TF), disorders due to somatomorphic pain (TDS), disorders due to somatization (TS) and conversion disorders (TC). Patients and method. We studied cases of TF, TDS, TS and TC evaluated by the neuropaediatric department of the Hospital Miguel Servet de Zaragoza between May 1990 and August 2001. RESULTS: There were 134 children identified as having TF TDS TS TC: There were 91 girls (67.9%) and 43 boys (32.1%). They made up 2.47% of the 5,417 children included in the neuropaediatric data base. The mean age was 10 years and 9 months, ranging between 3 and 16 years with only 9 children aged under 7 years. The commonest syndromes were: paroxystic disorders, headache, other pain, paraesthesia, hypovision, and other visual alterations, paresias, tremors and other disorders of movement, disorders of gait, lack of air, hyperventilation and dysphagia. There was often more than one motive for consultation, with sometimes more than four. The commonest complementary tests done were: EEG, fundus oculi, cranial CAT scan, CPK, EMG/ENG, cranial MR, spinal MR, CSF and osseous gammography. No further studies were made of 12 children (9%). CONCLUSIONS: The TF TDS TS TC are a common cause of assessment in neuropaediatric practice. It should be suspected in cases of multiple symptoms in children aged over 6 years, usually in girls. It is often necessary to carry out various complementary tests to rule out organic disorders.

Adolescent↗
PubMed1999

Malingering, hysteria, and the factitious disorders.

The arguments contained within this paper take as their starting point the suggestion that malingering is related along three separate continua to the nosological entities of antisocial behaviour, hysteria and the factitious disorders. The paper is both an attempt to show how these continua can be underwritten and at the same time a discussion of the aetiology of the disorders in question. It will be argued that the aetiological accounts of hysteria and the factitious disorders found in the psychiatric literature fail to make room for an account of the nature of the relationships of these disorders with malingering and thereby fail to fulfil the most important constraint on the acceptability of explanations in this area. In discussing the factitious disorders in the light of this constraint it will be suggested that psychodynamic explanations are vacuous and folk-psychological explanations in principle unavailable. With regard to hysteria it will be suggested that an explanatory account which embraces all the required phenomena and accommodates the close relationship of the disorder to malingering must make use of cognitive-psychologically informed account of self-deception which treats hysterical beliefs as beliefs which are formed as a result of a failure to accurately appraise the subjectively available evidence.

Journal Article↗
PubMed2000

[Ingestion of metals and factitious disorders. Impulse control disorder presenting on a background of situational conflicts].

We describe the case of a 27-year-old woman who in addition to the symptoms of factitious disorder showed deliberate ingestion of foreign objects. The relationship between secret and open self-destructive behavior is discussed. Analysis of situational factors highlights the importance of interactional background for the manifestation of impulsive self-harm. Parallels are pointed out to foreign body ingestion in institutionalized persons. Therapeutic issues are discussed.

Adult↗
PubMed2001

[Precocious and polymorphic factitious disorder].

OBJECTIVE: Pathomimia is a mental disease more frequently diagnosed in women, characterised by a wide range of somatic or psychiatric symptoms, and a chronic course with severe complications. CASE REPORT: A 22-year-old woman was suffering from severe factitious disorders with thermopathomimia, dermopathomimia, self-injuries with induced abscess, Lasthenie de Ferjol syndrome, and psychiatric factitious disorder. A very precocious age at onset and a previous history of 37 surgical operations were found. DISCUSSION: This case history is particularly relevant in showing the clinical multiplicity of factitious disorders.

Adult↗
PubMedDate not supplied

Frequency of ICD-10 factitious disorder: survey of senior hospital consultants and physicians in private practice.

The authors surveyed physicians for frequency estimates of factitious disorder among their patients. Twenty-six physicians in independent practice and 83 senior hospital consultants in internal medicine, surgery, neurology, and dermatology participated. They completed a questionnaire including the estimated 1-year prevalence of factitious disorder among their patients. Frequency estimates averaged 1.3% (0.0001%-15%). The number of patients treated correlated negatively with frequency estimates. Dermatologists and neurologists gave the highest estimations. One-third of the physicians rated themselves as insufficiently informed. Frequency estimations did not differ by information level. The estimated frequency is substantial and comparable to earlier findings. Authors discuss clinical implications.

Cross-Sectional Studies↗
PubMed1994

Case of a 29-year-old nurse with factitious disorder. The utility of psychiatric intervention on a general medical floor.

A 29-year-old nurse was treated for septic arthritis of the knee. She was suspected of producing this infection and others. The consultation-liaison team intervened early, and the patient was treated in individual outpatient psychotherapy for 1 year. Her course was complicated by criminal behavior and a suicide attempt, prompting relocation to her home town. The patient demonstrated a strong need to be nurtured, as noted in other cases of factitious disorders. An overview of factitious disorders is presented, and guidelines for managing these difficult patients in the hospital are provided.

Adult↗