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“’Tis but thy name that is my enemy”
Published in Michael R. Bütz, Parental Alienation and Factitious Disorder by Proxy Beyond DSM-5: Interrelated Multidimensional Diagnoses, 2020
For now, what is important to understand is that these individual/dynamic symptoms have been described as not only rare1 and complex but controversial. The authors’ efforts to refine this list of characteristics and dynamic properties may still provoke disagreement among some professionals. In addition, since that time growing concerns have been expressed in the literature that these phenomena are far more prevalent than once imagined (Ferrara et al., 2012): Factitious disorders were diagnosed in 14/751 patients, resulting in a prevalence of 1.8%. Three of 14 (21.4%) patients fulfill the criteria for Munchausen syndrome. Munchausen syndrome by proxy was identified in four of 751 patients, resulting in a prevalence of 0.53%.(p. 366)
Illness and Illusion
Published in Marc D. Feldman, Gregory P. Yates, Dying to be Ill, 2018
Marc D. Feldman, Gregory P. Yates
The pamphlet was met with resounding approval. So, too, was Asher’s article. Reports of Munchausen’s syndrome13 came flooding in from across the world, with doctors sharing cases of fabricated kidney stones, urinary tract infections, high and low blood sugar, tuberculosis, heart disease, leukemia, etc. The authors often expressed begrudging admiration for the medical sophistication of their patients. In 1975, after nearly 200 articles were published on Munchausen’s syndrome, the disorder received formal recognition in the ICD–9. The American Psychiatric Association followed suit in 1980 with the publication of the DSM–III. The word “factitious” was revived to incorporate Munchausen’s syndrome into an entirely new diagnostic category. “Factitious disorder” was now an umbrella diagnosis for a cluster of psychiatric disorders, all characterized by: “Physical or psychological symptoms that are produced by the individual and are under voluntary control [for] no apparent goal other than to assume the patient role.”
Self-Deception in Somatoform Conditions
Published in Kyle Brauer Boone, Neuropsychological Evaluation of Somatoform and Other Functional Somatic Conditions, 2017
In the DSM-5 (2013), the somatoform category is now labeled “Somatic Symptom and Related Disorders,” and whereas in the DSM-IV there was an emphasis on absence of medical explanation for the symptoms, in the DSM-5 Somatic Symptom Disorder the focus is on atypical reactions and behaviors related to the symptoms, with less concern as to whether symptoms have an actual underlying physiological underpinning. In Somatic Symptom Disorder, the physical symptoms cause distress and/or disrupt daily life, and excessive thoughts, feelings, and behaviors related to the symptoms are present. In Illness Anxiety Disorder, the individual exhibits a preoccupation with having or acquiring a serious illness, however, symptoms are not present or are mild in intensity; the person experiences a high level of anxiety about health, and engages in excessive health-related behaviors. In Conversion Disorder (Functional Neurologic Symptom Disorder), symptoms involve voluntary motor or sensory function, and there is an incompatibility between symptoms and recognized neurologic or medical conditions. In Psychological Factors Affecting Other Medical Condition, psychological issues adversely impact the documented medical condition. Factitious Disorder (Imposed on Self or Imposed on Other) is also included in the Somatic Symptom and Related Disorders category.
Assessing Risk and Supportive Care for a Hospital Discharge Refusal
Published in The American Journal of Bioethics, 2021
It is also important to understand more about the IV medication side effects Brian experienced (he noted they were “too strong” despite such treatment being the most effective for his cellulitis). Acquiring more information about his side effects can lead to additional or alternative medical interventions for alleviating his discomfort and treating his cellulitis. Furthermore, if efforts are made to alleviate both the side effects and his eczema, Brian might be more willing to adhere to antibiotic treatment in the hospital (if permitted), at the extended care facility, or with a home care provider. Such efforts can also help rule out malingering (e.g., leave of absence from work is a secondary gain) or factitious disorder (e.g., illness is fabricated or exaggerated for attention).
Identification of chloramphenicol in human hair leading to a diagnosis of factitious disorder
Published in Clinical Toxicology, 2020
Alice Ameline, Marie Caroline Taquet, Jean-Edouard Terrade, Bernard Goichot, Jean-Sébastien Raul, Pascal Kintz
A 41-year-old female physician was hospitalized for massive esophageal bleeding and hypoxemic pneumopathy. She had a history of lumbar disc herniation, beginning in 2012, which had been evaluated and managed by multiple surgical teams from at least six different countries. Several local infections had ensued, with multiple types of antibiotics being prescribed over the preceding months, but not known to include chloramphenicol. Indeed, one cannot totally exclude that chloramphenicol had never been given, the subject was in France since at least 2 years, a country where the drugs is not therapeutically available. The scar reopened and evolved toward a wide and deep chronically open lumbar wound with no local nor systemic signs of infection. The antibiotics had thus been stopped and the situation remained unchanged after their termination. The patient complained of lower limb weakness and fecal incontinence over several months and she presented with lower limb amyotrophy and had become bedridden. She was examined by several neurosurgeons and neurologists who could not identify an organic cause to account for her symptoms. Neuroimaging was non-explanatory. No blood abnormalities were noticed, including the absence of aplastic anemia or reduced hemoglobin production. During her last hospital stay, she was caught several times modifying the intravenous heparin flow rate, and manipulating her central venous catheter and her lumbar wound dressings. Feces were found, on one occasion, in her lumbar wound dressing. She frequently impeded nurses from taking care of her lumbar wound adequately. She repeatedly requested inappropriate, wide-spectrum antibiotics and repeatedly asked for invasive device insertion, such as central venous catheters and urinary catheters, without adequate medical need. In addition, beige capsules of unclear origin were found in her hospital bed on several occasions. As a result, her providers considered a diagnosis of factitious disorder.
An interesting case of functional visual loss presenting as a left homonymous hemianopia
Published in Clinical and Experimental Optometry, 2021
Factitious disorders are characterised by intentionally produced symptoms for the purpose of assuming the sick role.1,2,9,10 Differentiating among these various diagnostic categories remains difficult and within the psychiatrist’s realm. In the absence of positive findings on investigation, confirmation of the diagnosis rests on demonstrating vision is better than would otherwise appear to be.