In a consecutive series of admissions to the Johns Hopkins Sexual Disorders Unit, 4 out of 20 patients appeared to have simulated paraphilic symptoms that further assessment indicated were either exaggerated or not present. The paper presents case histories of these 4 patients. A descriptive comparison is made between these patients and control groups of patients who admitted having paraphilic symptoms and a group of patients accused to having paraphilic symptoms but who denied them. Patients who simulated paraphilias tended to be self-referred (75%) and without current legal charges (100%). None of these patients was referred or sought treatment for pedophilia, in contrast to the other two patient groups, in which pedophilia accounted for 75% of the referrals. Several possible explanations for why patients might simulate paraphilias and implications for therapists who evaluate or treat sex offenders are discussed.

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Three psychiatrist authors illustrate the impact of social media on their professional lives by reflecting on personal stories about their experiences with social media. They reflect on their experiences with listservs, chat rooms, online forums, blogs, podcasts, and other interactive media, while recounting actual stories involving those media. The impact of social media on professional advocacy across broad populations is addressed. In addition, the use of social media in educating psychiatric trainees and informing forensic evaluations is discussed. Finally, social media as a tool for enhancing consumer advocacy and addressing controversial patient safety procedures in emergency settings is discussed.

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