Clinical, demographic, psychological, and behavioral features of factitious disorder: A retrospective analysis

Jiménez, Xavier F.; Nkanginieme, Ngozi; Dhand, Niyati; Karafa, Matt; Salerno, Karen E.

doi:10.1016/j.genhosppsych.2019.01.009

Cited by 15 publications

(12 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This picture is consistent with the hypothesis that patients with factitious disorder use the sick role as a means of maintaining one’s identity, maintaining relationships with others, and addressing unmet needs 4 . Furthermore, Mrs. L has diagnoses of MDD and BPD, as well as a history of sexual abuse and neglect, which are frequently comorbid with factitious disorder 3,5 . She was often open to tests and procedures, especially ones that carry risk.…”

Section: Case Historysupporting

confidence: 73%

“…4 Furthermore, Mrs. L has diagnoses of MDD and BPD, as well as a history of sexual abuse and neglect, which are frequently comorbid with factitious disorder. 3,5 She was often open to tests and procedures, especially ones that carry risk. There is also evidence for intentional exacerbation of symptoms or provocative gestures shortly before discharge from the hospital, as evidenced by Mrs. L telling the attending psychiatrist at the freestanding psychiatric hospital on the day of discharge that she had called a friend who owned a gun.…”

Section: Diagnosis and Impressionmentioning

confidence: 99%

See 1 more Smart Citation

“Non-healing Wounds”: Addressing Complex Physical and Emotional Trauma in a Case of Factitious Disorder

Peng

Koire

Eisendrath

et al. 2022

Harv Rev Psychiatry

View full text Add to dashboard Cite

CASE HISTORYMrs. L is a 38-year-old Caucasian female with a past psychiatric history of major depressive disorder (MDD), posttraumatic stress disorder (PTSD), borderline personality disorder (BPD), and opioid use disorder (OUD), three prior psychiatric hospitalizations, and a past medical history of migraine, hypothyroidism, psychogenic nonepileptic seizures, and chronic nonhealing abdominal wounds following a multiyear series of abdominal surgeries and complications, who self-presented to a hospital's emergency department (ED) with approximately one month of acute-on-chronic depression and suicidal ideation with a plan to commit suicide by self-inflicted gunshot wound or overdosing on pills. On initial evaluation in the ED, Mrs. L stated that she has felt chronically depressed for years; however, the depression had worsened within the past month. Mrs. L initially did not identify any specific stressors or life changes that led to the acute decompensation, but she later revealed that acute stressors include her son turning 18 and leaving home as well as physical pain. From the ED, she was admitted to a locked inpatient psychiatry unit for further evaluation and treatment, and was ultimately discharged home after several weeks. Past Psychiatric HistoryMrs. L has formal psychiatric diagnoses of MDD, PTSD, BPD, and OUD. She sees an outpatient psychiatrist, who is also her therapist, in her hometown on a weekly basis with a purported positive therapeutic relationship but poor compliance with appointments. She has had two suicide attempts. The first was at age 24 when she cut her wrists-but "not deep enough to kill me." The second was at age 26 when she swallowed pills but vomited them back up because she thought of her children. She denies any substance use.Her first psychiatric admission was following a disappointing surgery appointment, after which she expressed suicidal ideation and had a series of seizures. She presented to the ED accompanied by her mother, a teddy bear, and a fleece blanket. At that time, she was on olanzapine 5 mg twice a day, morphine sulfate 60 mg daily, clonazepam 2 mg three times a day as needed, and alprazolam 2 mg three times a day as needed. She appeared to have had a seizure and to have broken a rib, but an extensive work-up was unrevealing; the diagnosis was psychogenic nonepileptic seizures. She was prescribed levetiracetam and followed by a neurologist. Since then, she has had two hospitalizations at a free-standing psychiatric hospital, at which wound manipulations necessitated transfers to outside hospitals, as detailed below in past surgical history.Medications on her last admission were as follows: clonazepam 1 mg four times daily, levothyroxine 88 mcg daily, lisdexamfetamine 70 mg daily, mirtazapine 60 mg nightly, oxycodone 10 mg twice a day, pregabalin 150 mg twice a day, quetiapine 300 mg nightly, topiramate 75 mg twice a day, and trazodone 75 mg nightly. She was prescribed venlafaxine 75 mg daily but selfdiscontinued without consulting with her psychiatrist.Past medication tr...

show abstract

Section: Case Historysupporting

confidence: 73%

Section: Diagnosis and Impressionmentioning

confidence: 99%

“Non-healing Wounds”: Addressing Complex Physical and Emotional Trauma in a Case of Factitious Disorder

Peng

Koire

Eisendrath

et al. 2022

Harv Rev Psychiatry

View full text Add to dashboard Cite

show abstract

“…This European single-centre sample and the one studied by Jimenez are the two largest systematic samples of FDIS in recent years. The study by Jimenez, based in the USA, favoured a psychiatric approach and did not describe markers associated with the severity of the disorder (hospitalizations in intensive care, death) or the method of diagnosis [ 22 ]. Krahn’s robust study in 2003 enrolled 93 patients who were included according to the DSM-IV criteria on the basis of medical records and was also based in the USA [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Its authors called for further research, particularly to confirm the female predominance in FDIS, which could not be reliably concluded from case reports. FDIS was subsequently studied in a recent systematic sample [ 22 ]. Nevertheless, more than half of the subjects included in this research had an external motivation, in this case the prospect of financial gain, which could be an exclusion criterion according to the DSM-5 definition if it were the primary motivating factor.…”

Section: Introductionmentioning

confidence: 99%

A descriptive, retrospective case series of patients with factitious disorder imposed on self

et al. 2021

View full text Add to dashboard Cite

Background Despite cases of factitious disorder imposed on self being documented in the literature for decades, it appears to remain an under-identified and under-diagnosed problem. The present study aimed to explore factitious disorder imposed on self in a series of French patients. Methods Patients 18 years old and over with factitious disorder imposed on self were retrospectively included by two independent reviewers according to DSM-5 criteria in Rennes University Hospital for the period 1995 to 2019. Patients were identified from a clinical data warehouse. Results 49 patients with factitious disorder imposed on self were included. Among them, 36 (73.5%) were female. The average age at diagnosis was 38.4 years. The 16 patients with a health-related profession were all female. Direct evidence of falsification was found in 20.4% of cases. Falsification was mainly diagnosed on the basis of indirect arguments: history of factitious disorder diagnosed in another hospital (12.2%), extensive use of healthcare services (22.4%), investigations that were normal or inconclusive (69.4%), inconsistent or incomplete anamnesis and/or patient refusal to allow access to outside information sources (20.4%), atypical presentation (59.2%), evocative patient behaviour or comments (32.7%), and/or treatment failure (28.6%). Dermatology and neurology were the most frequently involved specialities (24.5%). Nine patients were hospitalized in intensive care. Some of them received invasive treatments, such as intubations, because of problems that were only reported or feigned. The diagnosis of factitious disorder imposed on self was discussed with the patient in 28 cases (57.1%). None of them admitted to making up the disorder intentionally. Two suicide attempts occurred within 3 months after the discussion of the diagnosis. No deaths were recorded. 44.9% of the patients returned to the same hospital at least once in relation to factitious disorder imposed on self. Conclusions The present study reinforces data in favour of a predominance of females among patients with factitious disorder imposed on self. This diagnosis is difficult and is based on a range of arguments. While induced cases can be of low severity, cases that are only feigned can lead to extreme medical interventions, such as intubation.

show abstract

“…Emotional (67%) and spousal (23%) were common gains, similar to a study by Jimenez et al which showed both kinds of gains in about 100% and 13% of patients. 20 Krahn et al showed emotional gains in 69.9% (including 22.6% abuse history) and gains in immature relationship issues in 20.4% of patients. 21 Factitious disorder may be refractory to treatment as the patient usually exhibits persistence and compulsiveness in the voluntary behaviour.…”

Section: Totalmentioning

confidence: 99%

A Study on Traits and Gains in Factitious Disorder, and a New Self-Report Rating Scale

Kumar¹,

Raaj²

2019

jebmh

View full text Add to dashboard Cite

BACKGROUNDFactitious disorder is a psychiatric diagnosis presenting with feigning of illness, lying in the continuum of somatoform and dissociative disorders through to malingering. Symptoms overlap as traits and gains confound the diagnosis. We wanted to study the pattern of sociodemographic distribution and types of gains between groups of patients with factitious and dissociative disorders, the intensity of factitiousness, masochism and compulsiveness among the two groups, and correlation between the traits. METHODSA cross-sectional observational study with convenience sampling, with consenting patients with factitious disorder and dissociative disorders, attending the outpatient unit in July 2017 to April 2018 period in the Department of Psychiatry in this tertiary teaching hospital, following institutional ethical committee clearance was undertaken. After case to case matching of patients between the two groups for major types of presenting symptoms, 30 patients in each group were considered for the study. Sociodemographic profile, a self-structured 22 item self-report rating scale for factitious disorder, Yale-Brown Obsessive-Compulsive Scale, and Masochism personality disorder criteria (DSM-III-R) were the tools used. Appropriate descriptive statistics with chi squared and t-tests and correlation coefficients were used. RESULTSAbout 67% and 63% had motor symptoms and 20% and 26.7% had cardiorespiratory symptoms in the two groups. Emotional gains were predominant in two-thirds of patients in both groups. Factitious patients had high scores in a new factitious intensity (FAC22-SR) scale and YBOCS, and mild score in masochism traits. CONCLUSIONSGains have been proved as the driving force in conversion as well as factitious disorder. Early diagnosis of factitious disorder is important as misdiagnosis results in a chronic course with costly complications. Addressing obsessive compulsiveness, and masochist behavioural attributes may improve prognosis.

show abstract

Clinical, demographic, psychological, and behavioral features of factitious disorder: A retrospective analysis

Cited by 15 publications

References 9 publications

“Non-healing Wounds”: Addressing Complex Physical and Emotional Trauma in a Case of Factitious Disorder

“Non-healing Wounds”: Addressing Complex Physical and Emotional Trauma in a Case of Factitious Disorder

A descriptive, retrospective case series of patients with factitious disorder imposed on self

A Study on Traits and Gains in Factitious Disorder, and a New Self-Report Rating Scale

Contact Info

Product

Resources

About