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.     

躯体症状障碍共病做作性障碍的访谈与诊治

33岁女咨客在无重大疾病的情况下突发头昏、心慌、气短、呕吐等,多次就诊疗效欠佳。咨客及家属均否认睡眠差、反复清洁、易焦虑担心,访谈中反复诉多种躯体不适。经多次澄清得到真实病史后,总结出她因轻微狐臭而形成的关注本体感觉的固有模式,并在无意识中以卧病在床获取丈夫陪伴,遂诊断为躯体症状障碍共病做作性障碍,给予生物-心理-社会的综合干预。     

A case report of comorbid eating disorder and factitious disorder

A review of the literature on comorbid eating disorder and factitious disorder reveals that they are very rare. In this report the authors present the case of a 26-year-old Japanese female, who, in the midst of treatment for eating disorder, was found to be fabricating her physical symptoms, by injecting unclean water into her intravenous bottle. As a result she was diagnosed with factitious disorder.     

“做作性障碍”的访谈与诊疗

一位40岁的男性退伍军人主诉反复发作偏头痛和胃痛。在过去20年里,他辗转多家医院,生活的大部分时间都花在了住院或看门诊上。虽然医学检查的结果为阴性并且医生告知他没有病,但他仍然很享受充当"病人"的角色,已到不惑之年尚未成家立业也不以为然。他的症状表面上类似疾病焦虑障碍,即先前的疑病症,但实际上他并不坚持或真正认为自己患了重病。患者的伪装行为与诈病者相似,但他不是为了任何外部利益才来寻求医疗关注,实际情况是他多年来自费支付医疗费用,这正与诈病者寻求经济的犒赏相反。对于这个案例,最可能的诊断是"对自身的做作性障碍",患此障碍的个体的行为具有欺骗性并在他人面前表现出自己是有病的,但不受任何外部犒赏的驱动。反而,患者所追求的犒赏全部来自内部,即当获得医生诊疗时情感上的满足。     

A bewitching case of factitious disorder in Zimbabwe

A rural Zimbabwean man attributed the appearance of needles in his leg to witchcraft, but medical practitioners suspected that the needles were self-introduced. Psychiatric evaluation revealed no major mental illness. The patient met criteria for the Euro-American diagnosis of factitious disorder, persisting in his claim that he had been the victim of witchcraft. The patient's claim cannot be considered delusional because belief in witchcraft is culturally sanctioned within Shona culture. The case appears to be one of factitious disorder with both physical and psychological symptoms. Differential diagnoses must be broadened to consider culturally specific phenomena such as witchcraft.     

Diagnostic legitimacy of factitious disorder with psychological symptoms

The authors question the clinical status of factitious disorder with psychological symptoms as a mental disorder. In particular, they argue that unresolved issues regarding the motivational basis of this disorder and the lack of clearly delineated inclusion, exclusion, and outcome criteria seriously compromise its diagnostic legitimacy. Two case reports are presented to illustrate these difficulties. Future studies should consider these empirical and conceptual difficulties in refining the diagnosis of factitious disorder with psychological symptoms for DSM-IV.     

Postpartum depression and factitious disorder: a new presentation

This article discusses a presentation of Munchausen Syndrome by Proxy. It is believed this factitious disorder was precipitated and grew out of the context of a postpartum depression. To our knowledge, no such case has been reported in the past and implications for new exclusion criteria defining a fictitious disorder are raised. Furthermore, reintegration of the perpetrator back to family is discussed and suggestions are made for follow-up.     

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.     

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.     

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.     

Patients who strive to be ill: factitious disorder with physical symptoms

OBJECTIVE: Factitious disorder with physical symptoms characterizes patients who strive to appear medically ill and assume the sick role. Clinical suspicion is highest for female health care workers in the fourth decade of life. This study was designed to analyze the diagnosis of factitious disorder, the demographics of affected patients, and intervention and treatment. METHOD: Retrospective examination was of 93 patients diagnosed during 21 years. Two raters agreed on subject eligibility on the basis of DSM-IV criteria and absence of a somatoform disorder and a plausible medical explanation. RESULTS: The group included 67 women (72.0%); mean age was 30.7 years (SD=8.0) for women and 40.0 years (SD=13.3) for men. Mean age at onset was 25.0 years (SD=7.4). Health care training or jobs were more common for women (65.7%) than men (11.5%). Most often, inexplicable laboratory results established the diagnosis. Eighty had psychiatric consultations; 71 were confronted about their role in the illness. Only 16 acknowledged factitious behavior. Follow-up data were available for only 28 patients (30.1%); maximum duration of follow-up was 156 months. Two patients were known to have died. Few patients pursued psychiatric treatment. Eighteen left the hospital against medical advice. CONCLUSIONS: Factitious disorder affects men and women with different demographic profiles. Diagnosis must be based on careful examination of behavior, motivation, and medical history and not on a stereotype. Laboratory data and outside medical records help identify suspicious circumstances and inconsistencies. Confrontation does not appear to lead to patient acknowledgment and should not be considered necessary for management.     

Pseudologia fantastica and factitious disorder: review of the literature and a case report

Pseudologia fantastica is sparsely defined in the psychiatric literature, and has not been reviewed in the English-language psychiatric literature since 1988. To redefine the role of pseudologia fantastica in factitious disorder, the case of a 56-year-old man with factitious disorder is discussed.     

Evidence-based medicine and medicine-based evidence: the expert witness in cases of factitious disorder by proxy

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.     

Insulin-induced factitious hypoglycemic coma

Hypoglycemia due to the ingestion of oral hypoglycemic agents or injection of insulin is a common way for chronic factitious disorder to present to physicians. Despite this fact, factitious hypoglycemic coma is rare. Because hypoglycemia is potentially fatal, with numerous sequelae, physicians need to be aware of its occurrence and method of detection. A case of chronic factitious disorder presenting as hypoglycemic coma is presented and its implications discussed.     

Ingestion of metals and factitious disorders. Impulse control disorder presenting on a background of situational conflicts

We describe the case of a 27-year-old woman who in addition to the symptoms of factitious disorder showed deliberate ingestion of foreign objects. The relationship between secret and open self-destructive behavior is discussed. Analysis of situational factors highlights the importance of interactional background for the manifestation of impulsive self-harm. Parallels are pointed out to foreign body ingestion in institutionalized persons. Therapeutic issues are discussed.