[Chronic factitious disorder in an adolescent girl].
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The self-presentations of a patient suffering from factitious disease are investigated. The data are transcriptions of audiotaped therapeutic interactions. By use of linguistic methods it is shown that the patient presents herself as a suffering victim and at the time as a powerful agent. The empirical result relates very well to a psychoanalytic explanation of the disease. Based also on empirical indications from the data we are thus assuming that our result can be generalized. This would mean the patients suffering from factitious disease can be typically characterized by the tensions resulting from self-images which normally are mutually exclusive. Psychogenetic explanations of the disease therefore should not only concentrate on the patient's role of a suffering victim (e.g.: the desire of hospitalization).
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Exfoliative cheilitis is an uncommon lip lesion usually of great concern to the patient and quite refractory to treatment. The available literature was surveyed, and 3 cases have been described to illustrate various aspects of the condition. The difficulty of treating such lesions has been discussed, and a proposition put forward that the lesions are of a factitious nature.
Based on german authors literature this contribution describes important features of facticious disorders. By demonstrating a single case, succeeding in a biographical reconstruction of the unconscious simulation of complaints, recent assumptions on this group of patients are discussed. Thereupon hints are seen voting against the common assumption of poor therapeutic prognosis.
The case of a woman aged 31 years with numerous contacts with the health care system is reported. The patient presented an extremely varied pattern of complaints with pain as one of the most frequently recurring reasons for admission. During the past 12 to 13 years, the patient was admitted to inpatient units on numerous occasions and was submitted to numerous examinations, most of which revealed normal findings. This article lists a number of possible background causes which might permit a career like this to develop. Measures for prevention of similar "case-stories" in future are discussed.
The UK media has recently devoted much attention to the role of expert witnesses in child protection cases. One or two particular pediatricians who have given expert testimony have been the subject of personal vilification and professional investigation. These cases raise questions about the use of medical expert testimony when there is real uncertainty in the scientific community and the emotional stakes are high. Do doctors use scientific evidence to make diagnoses in the same way that the courts use evidence to make judgments? The cases also raise questions about the personal credibility and trustworthiness of experts: should we allow ourselves to be seen as personally powerful witnesses? Are we responsible for how we are seen by the jury? In this article, these questions are addressed, with the conclusion that distress and anxiety about child maltreatment influences all the players in the justice process and may interfere with the process of justice.