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BMC Psychiatry

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Open Access 01-12-2021 | Suicide | Research article

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

Authors: Antoine Bérar, Guillaume Bouzillé, Patrick Jego, Jean-Sébastien Allain

Published in: BMC Psychiatry | Issue 1/2021

Abstract

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.

Available only for authorised users

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed; 2013.CrossRef

ICD-11 for Mortality and Morbidity Statistics (Version : 05/2021). [Cited 2021 Sep 4]. Available from: https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f790764418.

Chastaing M. Pathomimie et syndrome de Münchhausen. Revue Du Praticien. 2009;59(n°4):511–7.

Eastwood S, Bisson JI. Management of factitious disorders: a systematic review. Psychother Psychosom. 2008;77(4):209–18. https://doi.org/10.1159/000126072.CrossRefPubMed

Yates GP, Feldman MD. Factitious disorder: a systematic review of 455 cases in the professional literature. Gen Hosp Psychiatry. 2016;41:20–8. https://doi.org/10.1016/j.genhosppsych.2016.05.002.CrossRefPubMed

Bernard J, Najean Y, Alby N, Rain JD. Hypochromic anemias due to voluntarily induced hemorrhages. Lasthénie de Ferjol’s syndrome. Presse Med. 1967;75(42):2087–90.PubMed

Asher R. Munchausen’s syndrome. Lancet. 1951;1(6650):339–41. https://doi.org/10.1016/s0140-6736(51)92313-6.CrossRefPubMed

Caselli I, Poloni N, Ielmini M, Diurni M, Callegari C. Epidemiology and evolution of the diagnostic classification of factitious disorders in DSM-5. Psychol Res Behav Manag. 2017;10:387–94. https://doi.org/10.2147/PRBM.S153377.CrossRefPubMedPubMedCentral

Reich P, Gottfried LA. Factitious disorders in a teaching hospital. Ann Intern Med. 1983;99(2):240–7. https://doi.org/10.7326/0003-4819-99-2-240.CrossRefPubMed

10.

Sutherland AJ, Rodin GM. Factitious disorders in a general hospital setting: clinical features and a review of the literature. Psychosomatics. 1990;31(4):392–9. https://doi.org/10.1016/S0033-3182(90)72133-0.CrossRefPubMed

11.

Carney MW, Brown JP. Clinical features and motives among 42 artifactual illness patients. Br J Med Psychol. 1983;56(Pt 1):57–66. https://doi.org/10.1111/j.2044-8341.1983.tb01532.x.CrossRefPubMed

12.

O’Reilly RA, Aggeler PM. Covert anticoagulant ingestion: study of 25 patients and review of world literature. Medicine (Baltimore). 1976;55(5):389–99. https://doi.org/10.1097/00005792-197609000-00003.CrossRef

13.

Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore). 1961;40:1–30.CrossRef

14.

Maurice-Williams RS, Marsh H. Simulated paraplegia: an occasional problem for the neurosurgeon. J Neurol Neurosurg Psychiatry. 1985;48(8):826–31. https://doi.org/10.1136/jnnp.48.8.826.CrossRefPubMedPubMedCentral

15.

Grunberger G, Weiner JL, Silverman R, Taylor S, Gorden P. Factitious hypoglycemia due to surreptitious administration of insulin. Diagnosis, treatment, and long-term follow-up. Ann Intern Med. 1988;108(2):252–7. https://doi.org/10.7326/0003-4819-108-2-252.CrossRefPubMed

16.

Plassmann R. Inpatient and outpatient long-term psychotherapy of patients suffering from factitious disorders. Psychother Psychosom. 1994;62(1–2):96–107. https://doi.org/10.1159/000288910.CrossRefPubMed

17.

Freyberger H, Nordmeyer JP, Freyberger HJ, Nordmeyer J. Patients suffering from factitious disorders in the clinico-psychosomatic consultation liaison service: psychodynamic processes, psychotherapeutic initial care and clinicointerdisciplinary cooperation. Psychother Psychosom. 1994;62(1–2):108–22. https://doi.org/10.1159/000288911.CrossRefPubMed

18.

Shapiro AP, Teasell RW. Strategic-behavioural intervention in the inpatient rehabilitation of non-organic (factitious/conversion) motor disorders. NeuroRehabilitation. 1997;8(3):183–92. https://doi.org/10.3233/NRE-1997-8305.CrossRefPubMed

19.

Al-Qattan MM. Factitious disorders of the upper limb in Saudi Arabia. J Hand Surg Br. 2001;26(5):414–21. https://doi.org/10.1054/jhsb.2000.0503.CrossRefPubMed

20.

Vaduganathan M, McCullough S, Fraser T, Stern T. Death due to Munchausen syndrome: a case of idiopathic recurrent right ventricular failure and a review of the literature. Psychosomatics. 2014;55(6):668–72. https://doi.org/10.1016/j.psym.2014.05.013.CrossRefPubMed

21.

Krahn LE, Li H, O’Connor MK. Patients who strive to be ill: factitious disorder with physical symptoms. Am J Psychiatry. 2003;160(6):1163–8. https://doi.org/10.1176/appi.ajp.160.6.1163.CrossRefPubMed

22.

Jimenez XF, Nkanginieme N, Dhand N, Karafa M, Salerno K. Clinical, demographic, psychological, and behavioral features of factitious disorder: a retrospective analysis. Gen Hosp Psychiatry. 2020;62:93–5. https://doi.org/10.1016/j.genhosppsych.2019.01.009.CrossRefPubMed

23.

Madec J, Bouzillé G, Riou C, Van Hille P, Merour C, Artigny M-L, et al. eHOP clinical data warehouse: from a prototype to the creation of an inter-regional clinical data centers network. Stud Health Technol Inform. 2019;264:1536–7. https://doi.org/10.3233/SHTI190522.CrossRefPubMed

24.

Inserm/Kantar Health/Roche. Obépi 2012. Enquête épidémiologique nationale sur le surpoids et l’obésité. 2012 [Cited 2020 Feb 8]. Available from: https://www.roche.fr/content/dam/rochexx/roche-fr/roche_france/fr_FR/doc/obepi_2012.pdf

25.

Niforatos JD, Chaitoff A. Factitious disorder commonly presents as dermatitis factitia: a U.S. population-based study. Gen Hosp Psychiatry. 2020;64:129–30. https://doi.org/10.1016/j.genhosppsych.2020.02.003.CrossRefPubMed

26.

Levenson JL, Chafe W, Flanagan P. Factitious ovarian Cancer: feigning via resources on the internet. Psychosomatics. 2007;48(1):71–3. https://doi.org/10.1176/appi.psy.48.1.71.CrossRefPubMed

27.

Feldman MD. Prophylactic bilateral radical mastectomy resulting from factitious disorder. Psychosomatics. 2001;42(6):519–21. https://doi.org/10.1176/appi.psy.42.6.519.CrossRefPubMed

28.

Feldman MD, Hamilton JC. Mastectomy resulting from factitious disorder. Psychosomatics. 2007;48(4):361. https://doi.org/10.1176/appi.psy.48.4.361.CrossRefPubMed

29.

Bass C, Halligan P. Factitious disorders and malingering: challenges for clinical assessment and management. Lancet. 2014;383(9926):1422–32. https://doi.org/10.1016/S0140-6736(13)62186-8.CrossRefPubMed

30.

Lempérière T. Troubles conversifs, troubles factices, simulations : approche clinique. Ann Méd Psychol Rev Psychiatr. 2010;168(4):286–90. https://doi.org/10.1016/j.amp.2010.03.003.CrossRef

31.

Snowdon J, Solomons R, Druce H. Feigned bereavement: twelve cases. Br J Psychiatry. 1978;133(1):15–9. https://doi.org/10.1192/bjp.133.1.15.CrossRefPubMed

32.

Sanders MJ, Bursch B. Psychological treatment of factitious disorder imposed on another/Munchausen by proxy abuse. J Clin Psychol Med Settings. 2020;27(1):139–49. https://doi.org/10.1007/s10880-019-09630-6.CrossRefPubMed

33.

Huffman JC, Stern TA. The diagnosis and treatment of Munchausen’s syndrome. Gen Hosp Psychiatry. 2003;25(5):358–63. https://doi.org/10.1016/S0163-8343(03)00061-6.CrossRefPubMed

34.

APSAC Taskforce. Munchausen by Proxy: Clinical and Case Management Guidance: The American Professional Society on the Abuse of Children (APSAC); 2017. https://www.apsac.org/single-post/2017/12/12/new-practice-guidelines-available-munchausen-by-proxy-mbp-clinical-case-management-guid.

35.

Galli S, Tatu L, Bogousslavsky J, Aybek S. Conversion, factitious disorder and malingering: a distinct pattern or a continuum? Front Neurol Neurosci. 2018;42:72–80. https://doi.org/10.1159/000475699.CrossRefPubMed

Title: A descriptive, retrospective case series of patients with factitious disorder imposed on self
Authors: Antoine Bérar
Guillaume Bouzillé
Patrick Jego
Jean-Sébastien Allain
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Suicide
Somatoform Disorder
Suicide
Somatoform Disorder
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03582-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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