Factitious Disorder Research Articles

Somatization Disorders: Diagnosis, Treatment, and Prognosis

Somatization Disorders: Diagnosis, Treatment, and Prognosis

Clinical Manual of Emergency Psychiatry

Clinical Manual of Emergency Psychiatry

Clinical Manual of Emergency PsychiatryClinical Manual of Emergency Psychiatry RibaMichelle B.M.D., M.S. RavindranathDivyM.D., M.S. ; Washington, D.C., American Psychiatric Publishing, Inc., 2010, 434 pages, $62

Clinical Manual of Emergency PsychiatryClinical Manual of Emergency Psychiatry RibaMichelle B.M.D., M.S. RavindranathDivyM.D., M.S. ; Washington, D.C., American Psychiatric Publishing, Inc., 2010, 434 pages, $62

Psychosomatic disorders: the canalization of mind into matter

Psychosomatic disorders represent a therapeutic conundrum. Despite compelling evidence to suggest the integrity of mind and body, humans are famously prone to experiencing them as separate. This paper explores the scientific challenges posed by psychosomatic disorders and how changing cultural notions contribute to their perplexing presentations. Excerpts of cases from patients with chronic pelvic pain, chronic fatigue, and a factitious disorder are presented as examples of the challenges that these patients pose in analysis. An explanatory model of mind/body interaction based on early maternal-infant interactions and the placebo response complex is proposed as the basis for how psychosomatic pathologies may develop. Finally, therapeutic approaches to the psychological treatment of patients with psychosomatic issues are considered.

Recurrent Deep Ulcers Resembling Rare Cancers as a Form of Factitious Disorder

Factitious disorders are defined as acts of self-harm that directly or indirectly result in clinically-relevant injury. They are typically performed in secret and without direct intention of suicide (1, 2). The patient’s initial goal is hospital admission and receiving medical treatment to confirm the severity of their state (3). Current prevalence ranges of factitious disorders is between 0.05 and 2.0%, with women being 4–20-fold more likely to be affected than men (1, 4–8). Contemporary psychodermatology classifies these disorders as: 1) dermatoses of primary psychiatric genesis (emotional/psychiatric disorders); 2) dermatoses with a multifactiorial basis, of which the course is subject to psychiatric influences (psychosomatic disease); or 3) secondary psychiatric disorders due to serious or disfiguring dermatoses (somatopsychic disease) (9). Mood swings, anxiety, impulsive behavior and somatization disorders are common among patients with dermatitis artefacta (5, 10–12).

Factitious disorder as a differential diagnosis for recurrent skin graft failure

This case report presents the history of a 43-year-old man who sustained a relatively minor burn to his face but who subsequently suffered significant morbidity. Although the wound was grafted on a number of occasions, it failed to heal. Multiple investigations were carried out to determine the cause of recurrent wound breakdown. It had been suspected that the patient was interfering with the wound but this could not be proven initially. He was eventually diagnosed with factitious disorder and it was only when this was managed in the multi-disciplinary setting that his wound finally healed.

Pediatric condition falsification (Munchausen syndrome by Proxy) as a continuum of maternal factitious disorder (Munchausen syndrome)

Pediatric condition falsification (PCF), also known as Munchausen syndrome by Proxy or Medical Child Abuse, is a somewhat rare form of child abuse and neglect. Its association with a history of adult factitious disorder (AFD) or Munchausen syndrome in the perpetrator is also well known. Exogenous insulin injection to cause hypoglycemia both in the context of PCF and AFD has been reported in the literature. However, the coexistence of both conditions via insulin injection in the same family has not been reported in the literature. This paper presents a family, in which the mother was diagnosed with AFD and her three children with PCF perpetrated by their mother via exogenous insulin injection.

021 Factitious presentations in neurology

AimsFactitious Disorder is a psychiatric condition where patients deliberately simulate illness in order to adopt the sick role. Though it has been closely associated with neurology since its origins, recent...

Poster 253: Rehabilitation of Factitious Disorder

Poster 253: Rehabilitation of Factitious Disorder

Levodopa Addiction and Factitious Disorder in a Patient With Idiopathic Parkinson's Disease

Levodopa Addiction and Factitious Disorder in a Patient With Idiopathic Parkinson's Disease

Laxative Abuse

Laxatives have been used for health purposes for over 2000 years, and for much of that time abuse or misuse of laxatives has occurred. Individuals who abuse laxatives can generally be categorized as falling into one of four groups. By far the largest group is made up of individuals suffering from an eating disorder such as anorexia or bulimia nervosa. The prevalence of laxative abuse has been reported to range from approximately 10% to 60% of individuals in this group. The second group consists of individuals who are generally middle aged or older who begin using laxatives when constipated but continue to overuse them. This pattern may be promulgated on certain beliefs that daily bowel movements are necessary for good health. The third group includes individuals engaged in certain types of athletic training, including sports with set weight limits. The fourth group contains surreptitious laxative abusers who use the drugs to cause factitious diarrhoea and may have a factitious disorder. Normal bowel function consists of the absorption of nutrients, electrolytes and water from the gut. Most nutrients are absorbed in the small intestine, while the large bowel absorbs primarily water. There are several types of laxatives available, including stimulant agents, saline and osmotic products, bulking agents and surfactants. The most frequently abused group of laxatives are of the stimulant class. This may be related to the quick action of stimulants, particularly in individuals with eating disorders as they may erroneously believe that they can avoid the absorption of calories via the resulting diarrhoea. Medical problems associated with laxative abuse include electrolyte and acid/base changes that can involve the renal and cardiovascular systems and may become life threatening. The renin-aldosterone system becomes activated due to the loss of fluid, which leads to oedema and acute weight gain when the laxative is discontinued. This can result in reinforcing further laxative abuse when a patient feels bloated and has gained weight. Treatment begins with a high level of suspicion, particularly when a patient presents with alternating diarrhoea and constipation as well as other gastrointestinal complaints. Checking serum electrolytes and the acid/base status can identify individuals who may need medical stabilization and confirm the severity of the abuse. The first step in treating laxative misuse once it is identified is to determine what may be promoting the behaviour, such as an eating disorder or use based on misinformation regarding what constitutes a healthy bowel habit. The first intervention would be to stop the stimulant laxatives and replace them with fibre/osmotic supplements utilized to establish normal bowel movements. Education and further treatment may be required to maintain a healthy bowel programme. In the case of an eating disorder, referral for psychiatric treatment is essential to lessen the reliance on laxatives as a method to alter weight and shape.

Differentiation Is Useful

Jacobi et al in their article on child abuse and neglect rightly mention Munchhausen syndrome by proxy (MSBP). However, in the article, symptoms of children with a factitious disorder are confused with symptoms of by proxy (3), and Munchhausen syndrome by proxy (MSBP) is an important subcategory among the factitious disorders (2). The differentiation makes for an important difference from the perspective of pediatricians and within the context of basic psychosomatic services and the work of Balint groups: In Munchhausen syndrome by proxy (1), the psychological or real parent (for example, the mother) presents the child under the pretext of manufactured symptoms of disease (Pseudologia phantastica); for example, a 2 year old child is reported to have had “seizures” at night. In factitious disorders by proxy, by contrast, manipulative measures are taken that are directly harmful for the child (for example, administration of medical drugs). It also makes sense to differentiate between the two syndromes from a clinical perspective because it is often possible to address the dynamic in Munchhausen syndrome at the level of psychosomatic basic care as the mother’s own suffering (for example, excessive fears related to her body, which are projected on to the child). By contrast, in the factitious disorders, the disruption to the relationship between child and psychological parent is usually much more severe and unraveling the entire dynamic is a protracted process—and, additionally, the child is at immediate risk.

Physician-based estimates of medically unexplained symptoms: a comparison of four case definitions

Medically unexplained symptoms (MUS) are considered a common occurrence in medical settings, although definitions, methodologies and resulting prevalence rates for MUS vary widely between studies. The objective of the present study was to characterize physicians' estimates of MUS, including clinically significant MUS, and to demonstrate in a single study how estimates vary based on the definition used. Two hundred and thirteen physicians completed an online questionnaire regarding the number of patients who present to their clinic with MUS. To reduce memory biases, participants reported on the number of patient seen in their most recent clinic day who met increasingly restrictive case definitions for MUS. Weekly estimates were also obtained. The least restrictive definition yielded an estimate of 11%. When certainty criteria were added to the definition of MUS, the estimate decreased considerably to 4%. Approximately 3% of patients were estimated to have chronic MUS that affected their daily functioning or caused significant distress (i.e. psychologically significant MUS), and only half of these, 1.5%, were assigned a diagnosis of somatoform disorder or factitious disorder. The proportion of MUS cases accounted for by malingering was 18%. The present study documents significantly lower estimates of MUS than chart review studies. However, our results suggest that a significant proportion of the total number of patients who present with MUS have abnormal illness behaviour associated with significant impairment or distress. Despite physicians' recognizing significant distress and dysfunction in these cases, formal diagnoses of somatoform or factitious disorder are rarely assigned.

Symptômes dépressifs et pathomimie : comorbidité ou trouble psychiatrique factice ?

The factitious disorders, more commonly known as pathomimia, are mainly expressed as organic symptoms voluntarily induced by the patient. Patients suffering from these disorders do not seek to obtain immediate secondary benefits, contrary to simulation. They send the physician a challenge, sometimes by means of self-mutilation, or exposure to a vital risk. Their objective is to raise the interest and the mobilization of the medical community. The patient will develop intense relationships with the medical staff, technically mobilized as well as emotionally, as far as the factitious character of the disorder is uncovered. In some cases, factious disorders are conditions in which a person acts as if he or she has a psychiatric disorder, by deliberately exhibiting psychiatric symptoms. Most often described are factitious acute psychotic disorders, mourning, affective disorders and post-traumatic stress disorders. Psychiatric factitious disorders are difficult to diagnose, but they share common diagnosis criteria with other pathomimias. These subjects may suffer from pathomimia because of the occurrence of other psychiatric symptoms, such as pathological personalities, adaptation disorders, abuse and/or dependence on alcohol or other substances, or depressive disorders. This paper describes three clinical cases of pathomimia, diagnosed after hospitalization in a psychiatric unit for depressive symptoms, as a correlate to their factitious or authentic character. Three case reports, describing patients with pathomimia hospitalized in a department of psychiatry for depressive disorders. The first case was a 57 year-old man considered as suffering from a bipolar disorder hospitalized for a depressive syndrome. The symptoms described and reported are those of a factitious disorder. The patient interrupted the medical care by asking to be discharged from the hospital. The second case was a young woman hospitalized following a suicide attempt. She has a history of multiple somatic and psychiatric factitious disorders. On admission she had depressive symptoms, more likely linked with a pathological personality, rather than with a major depressive episode. The third case presented a Munchausen syndrome. He was hospitalized for depressive symptoms. He had a comorbid major depressive episode. The prescription of antidepressants led to a significant clinical improvement. These three cases indicate that a real depressive syndrome may be observed with a patient suffering from pathomimia. Therefore, a neutral and complete psychiatric evaluation is necessary so as to not deprive these patients from the opportunity for an adapted treatment.

Levodopa Addiction and Factitious Disorder in a Patient With Idiopathic Parkinson’s Disease

Levodopa Addiction and Factitious Disorder in a Patient With Idiopathic Parkinson’s Disease

Troubles conversifs, troubles factices, simulations : approche clinique

Some kinds of problems are encountered in clinical practice: (1) frequent association between conversion disorder and organic pathology (epilepsy and hysterical fits); (2) factitious disorders overloading an organic pathology (diabetes, asthma); (3) malingering overloading conversion disorder.

The origins of factitious disorder

Factitious disorder is the deliberate simulation of illness for the purpose of seeking the sick role. It is a 20th-century diagnosis, though the grounds for its introduction are uncertain. While previous authors have considered the social changes contributing to growth in the disorder, this article looks at some of the pressures on doctors that may have created the diagnostic need for a disorder between hysteria and malingering. The recent history of those disorders suggests that malingering would no longer be acceptable when applied to the potentially larger numbers involved in workers' compensation or in mass conscription. Equally, the absolution given to hysteria on the basis of the Freudian subconscious would survive only as long as that model retained credibility. Growing egalitarianism and changing doctor-patient relationships in the 20th century would no longer tolerate a sharp division between culpable malingering and exculpated hysteria, which may previously have been made on grounds of class or gender. They would contribute to the need for a mediating diagnosis, such as factitious disorder.

Artifizielle Störungen und selbstverletzendes Verhalten in der Hand- und Plastischen Chirurgie

Self-mutilation in the context of factitious disorder can lead to prolonged and complicated treatment in every medical field. Because of a prevalence of 1-5% in hospitalised patients, it is important to be aware of this disorder to protect patients from self- and foreign-induced harm. Often the patient history gives important hints. The different manifestations of this disorder, the specific doctor-patient relationship, several techniques of confrontation and current treatment are presented. Clinical cases from the fields of hand and plastic surgery are presented.

À propos d’un cas de syndrome de Münchhausen par procuration à expression psychiatrique

The factitious disorder by proxy or syndrome of Münchhausen by proxy is the production of symptoms to a child by a mistreating adult who wishes to play the sick role through this child. This syndrome is a child abuse where the care system is instrumented. The medical profession becomes itself maltreating by scheduling more and more invasive additional examinations: the mortality would be 5 %. The symptoms most frequently presented to the paediatricians are sleep apneas and convulsions. The disease by proxy questions the clinicians in front of its unusual form and its absence of anatomoclinical parallelism. If all somatic symptoms were described, forms of artificial disorder by proxy with psychiatric expression are probably underestimated. After a review of the literature on the syndrome of Münchhausen by proxy on one hand and its psychiatric expression on the other hand, we shall explain a clinical case illustrating this atypical presentation. The psychotic symptoms adduced by the mother were able to be thwarted during an observation in protected environment which is ended the medical nomadism. The diagnostic of factitious disorder by proxy is very complex. The child can present an authentic psychiatric disorder establishing a differential or tangled diagnosis. On the other hand, the complications are numerous. The victim can develop psychological aftereffects of this child abuse like behavioural problems. The child can even secondly participate to the presentation of the symptoms in a morbid alliance with the simulated parent. We shall return on diagnostic and therapeutic measures of care to offer to the maltreated child but also to the parent too, whose psychopathological determiners will be useful to clarify.

Factitious Disorders in Neurology: An Analysis of Reported Cases

Factitious disorder (FD) is the deliberate production or simulation of symptoms in order to adopt the sick role. The authors look at FD in the neurology setting. The authors examined documented, published cases. FD cases in neurology are strikingly different from those in other specialties in terms of their demographics. Whereas the paradigm of FD in medicine as a whole is of the socially stable female healthcare worker, neurology continues to report largely the classic itinerant “Munchausen's” type. The authors explore two possible explanations for this: either that female healthcare workers with FD do not present neurologically, or that, if they do, they are diagnosed with conversion disorder.