Volume 22, Lesson 18

Enigmatic Patients: Factitious Disorder with Physical Symptoms

Lois E. Krahn, MD

Dr. Krahn is a Consultant, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.

Editor's Note

I have only seen one case of factitious disorder in my career, during my residency when I was serving as a liaison. A middle-aged woman with mysterious cardiovascular symptoms, nervousness, and weight loss was discovered hiding thyroid hormone in her hospital room and using it to induce physical symptoms that had puzzled her doctors. Her motives were never fully understood, and, although she was referred for psychiatric care following discharge, I do not know whether she complied or may have found herself at some other hospital repeating her deception.

I suspect this more extreme form of the disorder is uncommon, although epidemiological studies are hard to come by. Lesser degrees of factitious behavior--such as exaggerating physical symptoms, providing a false medical history, simulating physical symptoms, or modifying physiologies to create symptoms in times of physical illness--represent gradually intensifying phases, and are undoubtedly more common.

Why do patients do this? There are a variety of motives that Dr. Krahn cites, i.e., dependency needs, interpersonal problems with physicians, a desire for excitement, underlying hostility, and self-destructiveness. It's a difficult diagnosis to ascertain, and often comorbid with other psychopathologic conditions. In this lesson, the author highlights some of the management strategies useful in such patients.