Abstract
Factitious disorders (FDs) are well known to a majority of physicians; however, the corresponding ICD-10 diagnosis F68.1 remains severely under assigned and often misdiagnosed. Based on a previously conducted nationwide survey in Germany, we extended the analyzed variables to further understand FD characteristics.The assignments regarding the following variables in the German diagnosis-related group statistics were analyzed: residence of the patient and location of the diagnosing institution, primary referral to the diagnosing institution, reason for admission and discharge, specialty department, total length of stay, length of stay in the longest treating department, surgery performed, case mix revenue, regional type of the treating institution, and patients’ region of origin.A very distinct difference was observed in the assignment rates based on the homeland of the diagnosed patient and diagnosing institution. The assignment rate showed no significant difference across German regions. Based on our findings, a patient with FD in Germany might exhibit the following “typical” traits: A woman in her late thirties from a rural area is referred by a physician or another hospital wherein she was previously treated for more than a day to an institution for fully inpatient hospital treatment wherein she completes her treatment regularly. Dermatology, neurology, emergency, and internal medicine departments tend to be confronted with patients with FDs more often than other departments; however, surgery is performed in every fifth case. Patients are primarily treated in only one department for ~ 25 days. The case mix revenue will most probably not exceed €5000.
Highlights
Munchausen syndrome [1] and other factitious disorders (FDs) are well known to a majority of physicians, the ICD-10 diagnosis F68.1 is severely under assigned and misdiagnosed
Due to adaptions in the diagnosisrelated group (DRG) statistics during this period, we examined the case mix revenue between 2010 and 2016 as well as the regional type of the treating institution and patients’ region of origin between 2011 and 2016
There is a relative scarcity of systematic studies on the incidence of FDs, with the major obstacle of obtaining a reliable and valid incidence being the nature of this disorder itself
Summary
Munchausen syndrome [1] and other factitious disorders (FDs) are well known to a majority of physicians, the ICD-10 diagnosis F68.1 is severely under assigned and misdiagnosed. The current Norwegian version of ICD-10, like the English and German versions, defines F68.1 as the “intentional production or feigning of symptoms or disabilities, either physical or psychological”. It provides the following description: “The patient feigns symptoms. Forensic Science, Medicine and Pathology (2021) 17:431–436 of irreversible harm to these patients because of unnecessary invasive examinations and repeated interventions. The implementation of unnecessary diagnostic tests and intervention procedures generates significant expenses. In the United States of America, the annual cost was estimated to be $40 million [7]
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