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

Abstract

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.