A pediatric case of factitious disorder with unexplained bleeding symptoms

Factitious disorder is characterized by deliberate production or imitation of physical or psychological symptoms in order to adopt the sick role. The disorder can be seen as factitious bleeding. Factitious bleeding is a rare disorder in pediatric population. The concomitant appearance of hemoptysis and hematuria in the same patient has not been previously reported. In this case report, we present a pediatric case of factitious disorder with both hemoptysis and hematuria.     

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.     

Anorexia nervosa with chronic episodes for more than 30 years in a patient with a comorbid schizotypal personality disorder

Schizotypal personality disorder (SPD) has rarely been reported as an eating disorder-related personality trait. A 23-year-old woman was diagnosed as having anorexia nervosa binge eating/purging type. At the age of 53 years, she was admitted to Jikei University Hospital because of excessive bodyweight loss. She was diagnosed as having SPD based on bizarre behavior, ideation and a tendency to seek isolation. She was treated with low-dose antipsychotics, and her impulsive behavior improved. The patient's SPD was considered to have had a psychopathological contribution to her chronic episodes of anorexia nervosa.     

大一女生非典型摄食障碍的初步调查

目的 了解非典型摄食障碍(EDNOS)的特征表现.方法 采用进食情况调查表(EDI)进行自评问卷调查、摄食障碍检查问卷( EDE)和SCID —I的H部分进行访谈的方法,对8 600名大一女生筛选和确诊摄食障碍,并获取各类摄食障碍的心理行为特征.结果 EDNOS的发病率最高,为7.277‰.EDNOS的代偿行为基本少于神经性厌食症和神经性贪食症;EDNOS群体中,选择剧烈运动和采取一种代偿行为所占的比例相对较高,分别为38.7％和43.5％.三类摄食障碍的EDI与EDE所有因子分的差异均无统计学意义;EDE的条目中,EDNOS的空腹和体重重要性分值低于神经性厌食症,而秘密进食分值低于神经性贪食症.结论 EDNOS总体上具有摄食障碍的所有临床特征,在某些症状上表现较轻,需要鉴别和引起重视.     

Munchausen's syndrome: a reconceptualization of the disorder

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) delineates three categories of factitious disorders: chronic with physical symptoms (Munchausen's syndrome); factitious disorder with psychological symptoms; and other factitious disorders with physical symptoms. Munchausen's syndrome served as the prototype for all factitious disorders at the time DSM-III was drafted, partly due to the disproportionate attention given to this variant of the disorder. Clinical experience suggests that existing categories do not adequately provide for commonly seen forms of factitious illness. It is now recognized that factitious disorder is the result of a complex interaction of personality factors and psychosocial stressors that often present with both medical and psychiatric symptomatology. Proposed changes in the revised edition of the diagnostic manual DSM-III-R include separate categories of factitious disorder with psychological, physical, and both psychological and physical symptoms. A case report of a patient for whom extensive records and thorough psychological assessment were available is exemplary of a more common course of the disorder (both psychological and physical symptoms) that by current classification would be considered "atypical." A reconceptualization of the disorder that gives emphasis to course and clinical features is suggested.     

The concept of mental disorder in Greek cinema

Mental patients in Greek society have never been considered as ‘sacred’, but on the contrary as handicapped, and cinema largely reflects these concepts. A total of 30 films that appeared to deal with mental disorder in a direct or indirect way have been reviewed. The identification of each mental disorder was made according to DSM-IV criteria. Five of these cases were presented as having a factitious disorder, seven were psychotic and two had dissociative (hysterical) disorders. The remaining eight cases related to personality disorder or character deviance. In two cases diagnosis was impossible. The image of mental disorder is consistent with psychiatric nosology, and disorders with‘dramatic’ or‘impressive’ manifestation of symptomatology are chosen. No real solutions, proposals or ideology on mental illness emerge.     

Therapeutic approach to a case of simulated disorder with psychiatric symptoms]

The case of a 38-year-old female inpatient with the diagnosis of factitious disorder with psychological symptoms--a presentation rarely reported in the psychiatric literature--is presented with special respect to her personality traits. On the basis of her biographical history a therapeutic approach was possible which tried to understand the symbolic value of the histrionic patient's symptoms. We regarded the manifestation of psychological symptoms as an attempt to express conflicts verbally and as an offer of a more mature form of communication in comparison to the former, autodestructive physical syndromes.     

Binge eating disorder and depression: A systematic review

The purpose of this systematic literature review is to examine previous studies that investigated the relation between depression and binge eating disorder (BED). Medline/PubMed published data from 1980 through 2006 was tracked using the following keywords: “binge eating disorder and depression”, “periodic binge eating and depression”, “binge eating disorder” and “periodic binge eating”. The findings of 14 studies were successfully highlighted: one cohort, four cross-sectional and nine case–control studies. Most studies (7/14) were conducted in the United States, with missing data varying between 2.3 and 44.32%, and seven studies emphasizing the most important variables. The majority of the studies (10/14) showed an association between depression and binge eating disorder, but carefully designed studies are required to minimize the limitations found in these studies.     

Testing a cognitive model of generalized anxiety disorder in the eating disorders

Generalized anxiety disorder (GAD) is one of the most common comorbid disorders found in individuals with eating disorders. Despite this, little is known of shared vulnerability factors between the two disorders. The aim of the present study was to examine the four main components of a cognitive model for GAD in the eating disorders. One hundred and sixty-two females took part. Three groups were formed comprising of 19 participants with an eating disorder and GAD, 70 with an eating disorder without GAD and 73 healthy controls. All completed self-report questionnaires that measured eating attitudes, levels of GAD, intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance. Participants with an eating disorder and GAD scored the highest on all four components when compared to healthy individuals and on most components when compared to those with an eating disorder. Participants with an eating disorder without GAD scored higher on all components compared to healthy controls. Findings extend our understanding of shared vulnerability factors between the eating disorders and GAD.     

Factitious disorder on an inpatient psychiatry ward

The authors present 6 cases of factitious disorder seen on a general adult inpatient psychiatry unit of a university hospital. They review the clinical features of this disorder and suggest that factitious disorder is much more prevalent among psychiatric inpatients than is commonly recognized. Strategies to assist in the diagnosis and management this disorder are detailed.     

Disgust sensitivity and eating disorder symptoms in a non-clinical population

In order to further explore the relationship between disgust sensitivity and eating disorder symptoms, 2 studies were carried out. In the first study, 352 higher education students (166 women, 186 men) completed a set of questionnaires measuring various aspects of disgust sensitivity and eating disorder symptoms. A correlational analysis revealed that there were few significant correlations between disgust scales and eating pathology scores. One exception was the relation between disgust sensitivity and external eating behavior, although this link only emerged in women. To investigate this relationship in more detail, Study 2 confronted women high (n = 29) and low (n = 30) on external eating behavior with a series of disgusting and neutral pictures. It was hypothesized that women who scored high on external eating would display shorter viewing times of disgusting pictures (i.e., show more avoidance behavior) than women scoring low on external eating. However, this hypothesis was not confirmed by the data. Altogether, the results of these studies suggest that there seems to be no convincing relationship between disgust sensitivity and eating disorder symptomatology, thereby casting doubts on the role of this individual difference factor in the development of eating pathology.     

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.     

Comorbidity of eating disorders with bipolar disorder and treatment implications

OBJECTIVES: To review the scientific evidence examining the comorbidity among eating disorders and bipolar disorder (BD). METHODS: We reviewed all published English-language studies addressing the comorbidity of anorexia nervosa, bulimia, bulimia nervosa, and binge eating disorder in patients with BD and studies of comorbidity of BD in patients with eating disorders. In addition, we discuss the pharmacologic treatment implications from reviewed studies of agents used in BD and eating disorders. RESULTS: Community and clinical population studies of the lifetime prevalence rates of eating disorders in patients with BD, and of BD in patients with eating disorders, particularly when subthreshold and spectrum manifestations of these disorders are included, indicate high rates of comorbidity among these illnesses. CONCLUSIONS: Pharmacologic treatment approaches to patients with BD and a co-occurring eating disorder require examination of the possible adverse effects of the treatment of each syndrome on the other and attempts to manage both syndromes with agents that might be beneficial to both.     

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.     

Pharmacological treatment of psychiatric comorbidity in bipolar disorder: a review of controlled trials

OBJECTIVE: Little is known about the treatment of psychiatric comorbidities in bipolar disorder. The aim of this review was to summarize the literature on controlled pharmacological trials that have been conducted in psychiatric conditions that commonly co-occur in bipolar disorder. METHODS: A Medline search (1980-October 2005) using the terms bipolar disorder and randomized controlled trials, comorbidity, anxiety disorders, alcohol abuse or dependence, substance abuse or dependence, eating disorder, impulse control disorders, attention-deficit disorder, lithium, anticonvulsants, atypical antipsychotic drugs, antidepressants, stimulants was used. RESULTS: The literature establishes a strong association between bipolar disorder and substance abuse/dependence, anxiety disorders, impulse control disorders, eating disorders and attention-deficit hyperactivity disorder. Comorbidity often complicates the diagnosis and the treatment of bipolar disorder and worsens its course of illness and prognosis. Few controlled pharmacological studies have examined the treatment of comorbid conditions in patients with bipolar disorder. CONCLUSIONS: Treatment of psychiatric comorbidities in bipolar disorder is not based on controlled data but is largely empirically based. Controlled trials in patients with bipolar disorder and comorbidity are urgently needed.     

Conversion syndromes in neurology. A psychopathological and psychodynamic differentiation of conversion disorder, somatization disorder and factitious disorder

Conversion syndromes are frequent among medically unexplained somatic symptoms in neurology. A careful differential diagnosis must be carried out in a psychiatric consultation service. In a prospective study lasting for over four years 169 patients with pseudoneurological signs of conversion were included. From a clinical point of view the following conversion syndromes were presented: astasia/abasia: 27.2%, paresis/plegia: 24.3%, aphonia: 1.8%, hyp-/anaesthesia: 21.9%, blindness: 5.3%, non-epileptic seizures: 19.5%. According to the diagnostic criteria of DSM-III-R three subgroups were differentiated: conversion disorder (n = 132), somatisation disorder (n = 28), factitious disorder (n = 9). Intermittent courses of illness were prevailing in conversion disorder, whereas chronic courses predominated in the other two subgroups. High rates of psychiatric comorbidity were typical signs of somatisation disorder. Frequent autodestructive motives (suicidality, deliberate and covert self-harm, chronic pain, high rate of operations) in illness behaviour had to be registered in somatisation and factitious disorder. Both subgroups were characterised by frequent traumatic events during early development. Important socio-economic aspects of illness behaviour above all in somatisation and factitious disorder were underlined. The results are discussed in terms of psychiatric differential diagnosis and psychiatric comorbidity, psychodynamic evaluation, illness behaviour and therapeutic options in a C/L-service.     

进食障碍疗效的影响因素分析

目的:了解进食障碍住院患者疗效的影响因素. 方法:收集36例进食障碍患者住院治疗的临床资料并进行分析. 结果:根据疗效分组显示,疗效好的患者闭经时间短、住院时间长、体质量(体重)增加明显、鼻饲治疗者多(P均<0.05),而在病程、起病年龄、入院前体质量减轻情况,有否导泻,引吐,入院时汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评分、住院意向、住院病房模式等方面差异均无显著性(P均>0.05). 结论:进食障碍的患者需要及早、长程的综合治疗,对于治疗依从性差的患者,鼻饲治疗颇为有效.有自行导泻引吐症状可能是促使患者住院治疗的重要因素.     

Treatment experiences of Latinas with current or past binge eating disorder and/or bulimia nervosa

ABSTRACT

This study utilized a female sample of 43 Latinas with a history of binge eating disorder and/or bulimia nervosa to investigate disparities in health care that may act as barriers to or correlates of treatment for these women. Results indicated that 65% of our sample sought treatment for their eating disorder. The most commonly utilized treatment providers were psychologist/therapist for individual therapy and nutritionist/dietician, while therapist-led group therapy was rated as the most helpful treatment and treatment by a physician was rated as least helpful. Participants endorsed eating disorder stigma, eating disorder shame, mental health shame, and cost of treatment as the most influential barriers to seeking or receiving treatment. Acculturation to White dominant society was associated with greater perceived treatment helpfulness. Findings from this study can be used to inform treatments for Latinas in order to potentially increase effectiveness, treatment-seeking, and recovery rates.     

Factitious disorder and factitious disorder by proxy

Similar to the adult patient, a child or adolescent may actively feign or produce artificial symptoms (synonymous: Munchausen syndrome). The more frequent case is that the child suffers from being an object of symptom fabrication induced by a close person caring for the child, regularly the mother (Munchausen syndrome by proxy). This review focuses on psychopathological aspects of the clinically more relevant factitious disorder by proxy. Typical behaviour and personality characteristics are presented that can be taken as clinical warning signs. Doctor-mother-interaction is affectively challenging due to conflicting tasks imposed on the physician. Complementary to pediatric exclusion of genuine disease, psychopathological assessment is required to exclude other sources of deviant illness behaviour. Factious disorder shares particular features (active violation of the child, false report of history, aggravated symptom presentation and increased doctor-hopping, difficulties in conforming maternal report in biomedical data) with other psychopathological entities (child abuse, simulation, dissociative disorders, somatoform disorders including hypochondria, variants of maternal overprotection and infantilization, psychosis or delusion in the mother). Criteria for differentiation are presented. Three concepts on the psychopathological etiology of factitious disorder by proxy are relevant: In some cases, it may be conceived as secondary manifestation of a primary psychopathological entity or personality disorder. Learning theory emphasises operant rewards received from vicarious sick role. Attachment theory provides possible explanations concerning the traumatic impact on the child, early sources of psychopathology in the fabricating mother and risks for intergenerational transmission of factitious disorders.     

预防性干预对女大学生摄食障碍危险因素的影响

目的在华中地区的两所高校做一个小样本的摄食障碍预防性干预,并检验干预的效果。方法将19例有摄食障碍倾向的女大学生根据所在学校分为对照组（11例）和干预组（8例）。干预组接受6次为期3周的干预课程,同期间对照组不做任何处理。两组分别干预前评估和干预后评估,并进行结果比较。结果两组在内化瘦身理想、饮食关注、体重和体型关注4个方面的改变差异有统计学意义（P〈0．05）。比较于对照组,干预组的这四个指标显著降低了。结论研究结果表明此次干预在内化瘦身理想,饮食关注,体重和体型关注4个方面发挥了预期的效益,干预使得这4项指标都有所降低。