Child and Adolescent Illness Falsification

ArticleinPEDIATRICS 105(2):336-42 · March 2000with 34 Reads
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Abstract
To review the current state of knowledge on factitious illness in children and adolescents to help clarify the relationship of this phenomenon to a range of somatizing disorders in children and factitious disorder by proxy. The literature of the past 30 years was reviewed for cases describing children <18 years old who have intentionally falsified symptoms of illness, without known parental involvement. Cases in which a parent was involved, the child acknowledged a credible motive, the deception was identified after age 18, or which appeared in foreign languages were excluded. Data on age, gender, factitious symptoms, method, duration of deception, and outcome of confrontation, where available, were gathered from case studies. Forty-two cases of illness falsification by children were identified, with a mean age of 13.9, and a range from 8 to 18 years. The majority of patients were female (71%), and the gender imbalance was greater for the older children. The most commonly reported falsified or induced conditions were fevers, ketoacidosis, purpura, and infections, and the fabrications ranged from false symptom-reporting to active injections, bruising, and ingestions. The mean duration of the falsifications was almost 16 months before detection. Many of the children admitted to their deceptions when confronted, and some had positive outcomes at follow-up. The descriptions of some of these children as bland, depressed, and fascinated with health care were remarkably similar to adults with factitious disorders. Medical conditions fabricated by children may go undetected for a variety of reasons, or diagnosed as somatization. Further study of children who falsify symptoms may in some cases help identify earlier experiences of Munchausen by proxy abuse or covert parental coaching of illness falsification, and provide more effective interventions. Better understanding and identification of these children is likely to help prevent the development of more chronic adult factitious disorders.

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    IntroductionPhysiological habitsSelf-mutilationFactitious disordersReferences
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  • Article
    Full-text available
    Munchhausen by Proxy syndrome (MPS) is a disorder that disease symptoms created by a parent is type of abuse. Because of disease is resistant, and clinic is not clear, clinicians can often overlooked. It should not be forgotten that although MPS is a rare disease, it can cause serious health problems. One year 1 month old male patient was admitted to our emergency department with complaints of diarrhea and vomiting. The tests were normal and the patient had no complaints during hospitalization and he have had hospitalization story many times before, due to the presence of different symptoms, patient have been followed with MPS in mind. Then, the patient admitted to hospital with complaints of blood in stool. The determination of the mother to create of the child anus bleeding with thermometer, have been diagnosed with MPS, reported to social services and parents was referred for psychiatric assessment. Repeated hospitalizations, especially in the presence of symptoms the absence of an etiologic cause, this syndrome should be considered in the differential diagnosis. Because children that are abused by an MPS perpetrator are likely to be hospitalized multiple times, it is important for the health staff to pay attention diagnose of this abuse. © The Journal of Current Pediatrics, published by Galenos Publishing.
  • Article
    Background: Youth have been assumed historically to be less capable of deception than adults, even though acts of deception in childhood are not uncommon. Relatively little attention has focused on how frequently they feign or exaggerate during healthcare evaluations. Purpose: The current article reviews the literature relevant to using validity tests in children and adolescents, as well as provides a case example of a young adolescent providing noncredible effort and exaggerated symptomatology during neuropsychological evaluation after a mild traumatic brain injury. Conclusion: Numerous case reports and case series have documented clearly that medical and neuropsychological noncredible presentations occur in children, likely more often than many practitioners believe. Thus far, research has found that the base rates of pediatric noncredible presentations are highest in children seen frequently by rehabilitation providers (i.e., children with persistent problems after mild traumatic brain injury and children from families seeking disability benefits on their behalf). Subjective clinical judgment is apt to be ineffective in consistently detecting noncredible presentations. Fortunately, recent research supports the use of several stand-alone validity tests in identifying noncredible pediatric data including the Test of Memory Malingering, Word Memory Test, and Medical Symptom Validity Test. If feigning and exaggeration are not considered in work-ups by rehabilitation practitioners, mismanagement and iatrogenic harm to the child can result.
  • Chapter
    Somatic disorders and malingering are often frustrating for patients, their families, and physicians. The presentation is widely variable but often includes exaggeration of physical symptoms, self-inflicted wounds, and tampering with lab results. Somatic disorder is a mental illness that is not associated with conscious secondary gain. In contrast, malingering is a feigned illness or disability in which there is an identifiable motive. Children and adolescents can falsify subjective and objective symptoms. Many physicians do not consider that their pediatric patients could be deceiving them, and thus a high percentage of these patients undergo extensive diagnostic testing before a diagnosis of somatic disorder is reached. The etiology of factitious disorder is unclear. It is more common in females and is hypothesized to be a coping mechanism to early exposure to traumatic events. No objective testing exists to confirm the diagnosis, and many patients refuse psychiatric therapy. A thorough physical and mental status exam is essential when evaluating these patients; however, no finding has been shown to be pathognomonic. Patients that present with a history of multiple diagnostic testing and evaluation from numerous physicians and hospital systems without a clearly defined diagnosis should raise a concern. The DSM-IV defines criteria for a diagnosis of factitious disorder and should be used as a reference. Once a diagnosis is reached, treatment is difficult. Psychiatric consultation is crucial and mental health intervention is imperative. Once confronted with a diagnosis, many adolescents, in contrast to adults, will be responsive to psychiatric therapy. Although many physicians are reluctant to suspect deception by their pediatric patients, early detection is critical to prevent treatment of a nonexistent disease and to break the cycle of behavior at an early age.
  • Article
    Psychocutaneous conditions are difficult to diagnose and a challenge to treat. Clinical manifestations can be caused by diverse and creative methods from garlic to deodorant. This review discusses the literature on dermatitis artefacta (DA). Although the overall incidence of DA is not known, the importance is emphasized by a strong association with borderline personality disorder (BPD) and dissociation disorders as well as a prevalence of 33% in patients diagnosed with anorexia and bulimia. Furthermore, DA is frustrating for physicians and family members, with a differential diagnosis that includes severely morbid medical conditions. Thus, recognizing and correctly diagnosing DA is critical to avert unnecessary tests, treatments, and frustrations, ultimately allowing for more efficient management and better healing.
  • Article
    : "The question of whether a patient actually has fever is seldom seriously raised. Obviously, before embarking upon a prolonged, tedious and expensive search for the cause of fever, one should be sure that the elevation in temperature is not a spurious phenomenon." Petersdorf and Bennett, 19571
  • Article
    A 10-year-old girl showed macroscopic hematuria, purpuric rash, bloody stool and complained of abdominal pain and joint pain for three years. The extensive investigations including intravenous urography, cystoscopy, barium enema, upper gastrointestinal X-rays, sigmoidoscopy and renal biopsy failed to reveal the sources of bleeding for urinary and gastrointestinal tracts and to explain abdominal and joint pains. The major blood group of the patient was B, while that in the urine obtained by the patient without supervised conditions was A or AB. This finding indicated that macroscopic hematuria was factitious in origin and the patient stated that symptoms were fabricated by herself. The various psychological tests failed to disclose the motives for this bizarre behavior and to obtain the evidence of psychosis. This case presents the youngest and fourth case of Munchausen's syndrome in children and suggests that when bizarre clinical and laboratory findings are observed. Munchausen's syndrome should be suspected and its consideration may obviate harmful and unnecessary investigations as well as medications.
  • Article
    This paper proposes the idea that the story of factitious or exaggerated illness is coauthored or that symptoms may be coached through the dynamics of the family. The physician is unwittingly engaged as a coauthor by performing diagnostic tests and treatments. Children and family members may be invited to coauthor or collude in the presentation of false symptoms as well. The importance of assessing the participation of family members in illness presentation was discussed as well as the difficulty in determining intentionality of symptom production. Four cases are presented including test data which indicate that the more “active” the family may be in presentation of symptoms, the more likely they are to present a cohesive family picture and to seek outside support and the less likely they are to report Stressors. Treatment ideas include acknowledging the possibility of both conscious and unconscious production of symptoms by family members in the creation of a story of illness. Treatment suggestions included the promotion of an alternative story to illness.
  • Article
    The authors report the case of an adolescent boy who for nearly a year succeeded in simulating an enterovesicular fistula by contaminating his urine with feces and foodstuff, at times by retrograde injection of foreign substances into his bladder. The case is unusual because of the patient's youth, his personality and family background, and the availability of information about the motive for his behavior.
  • Article
    Factitious hypoglycemia (FH) in a diabetic patient represents a difficult diagnostic and costly management problem. An adolescent diabetic with FH is reported. A literature search revealed 10 adolescent and 45 adult diabetic patients with FH. Tests currently available for diagnosis are evaluated. The role of psychiatric therapy in relation to overall management and prognosis is stressed.
  • Article
    The purpose of the study was to describe the physical complaints and symptoms of persistent somatization patients. Individuals in the general population (age 17-49 yr) with at least 10 general admissions during an 8-yr period were studied. Persistent somatizers (i.e. patients with more than six medically unexplained general admissions) were compared with patients whose admissions could be ascribed to well-defined somatic disorders. Somatizers were characterized by multiple symptoms from many organ systems, and their physical complaints simulated most types of somatic disorder. Although some symptoms were more common than others, none were infrequent, so neither 'classic' conversion symptoms nor pain symptoms were found to be especially characteristic of the persistent somatizer. Gender had no influence on number of registered symptoms, whereas the number increases with age. The finding question the use of a predefined symptom checklist in the diagnostic criteria for somatizing disorder. The major part of the somatizers present a different illness picture when admitted with medically unexplained disorders compared with admission for which no adequate medical explanation could be found. However, one fifth had, when admitted with a medically explained diagnosis, also been admitted with the diagnosis medically unexplained at another admission. One fifth of the persistent somatizers had been admitted at least once for factitious illness, but apart from the fact that they had more symptoms and admissions, they did not differ from the other persistent somatizers.
  • Article
    Factitious purpura may present as a perplexing problem for the dermatologist and can mimic serious disease. This form of mechanical purpura, often caused by suction may be deliberately or unknowingly induced by the patient. Some cases may go unrecognized for a considerable length of time and undergo unnecessary investigation before the diagnosis is realized. Three cases of purpura are reported in which the causative agents were very different.
  • Article
    A most unusual case of Munchausen's syndrome in an 18-year-old Yemeni female is described. The patient presented with bleeding from various sites; repeated subcutaneous emphysema of the face, orbit and upper chest; ulcers on the tongue, and dermatitis autogenica. The illness was confirmed to be factitious and self-induced when she was caught red-handed trying to inject air. We believe this to be the first report of a case where all these features occurred concurrently and only the second report where a patient developed self-induced orbital emphysema.
  • Article
    Full-text available
    A 15 year old girl who had pain, oedema of her left hand, and fever of four months' duration is described. Marked demineralisation of her hand was shown by radiography, and increased articular uptake by technetium-99m bone scan. All these changes were indistinguishable from reflex sympathetic dystrophy. After two admissions to hospital and multiple explorations we discovered that she had induced her symptoms herself and a diagnosis of Munchausen's syndrome was made. As far as we know this presentation has not been previously reported and might help to explain the physiopathology of some signs of reflex sympathetic dystrophy.
  • Article
    A 16-year-old girl showed waxing and waning proteinuria and fat globules in urine for three years. There were no other abnormal findings except for the urinalysis. The renal biopsy findings did not indicate glomerular disease. Electrophoresis of the urinary protein showed two abnormal fractions at the alpha and beta globulins. Immunoelectrophoresis demonstrated that these abnormal proteins were not derived from human serum proteins, but were egg proteins. It appears that the proteinuria was factitious and that egg proteins were injected into the bladder, as they were also present in the bladder urine.
  • Article
    Full-text available
    From the age of 4 a boy repeatedly feigned epileptic fits. He later admitted that his mother had taught him that he was epileptic and had trained him to behave like that.
  • Article
    One hundred and sixteen (3.5%) of 3,300 specimens submitted by 72 patients as urinary stones were artifacts, i.e. not formed of accepted constituents of urinary calculi. The laboratory diagnostic methods included infrared and wet chemical analysis, and X-ray diffraction. Twenty-eight were of organic origin and some of these were undoubtedly submitted by accident as calculi. Eighty-eight were of mineral origin, mainly quartz and feldspar, and it is believed that the great majority were submitted for secondary gain or for psychiatric reasons. Ten patients each submitted from 2 to 10 artifacts. Five cases studies are presented which illustrate some confounding clinical and laboratory findings. Spurious stones can lead to difficult clinical and laboratory problems.
  • Article
    Six adolescents, 12 to 15 years old, with insulin-dependent diabetes mellitus were discovered to be secretively taking extra insulin, not with the intent of improving metabolic control. Large discrepancies between reported and observed insulin requirements were noted. Psychosocial problems antedated the discovery of surreptitious insulin administration in all. Psychological testing and psychiatric evaluation revealed a variety of psychiatric conditions; depression was common. In two patients surreptitious insulin administration was believed to represent suicidal behavior. In others, it appeared to represent symptom substitution when use of other health-threatening behaviors such as recurrent ketoacidosis was made increasingly difficult through appropriate intervention. Surreptitious insulin administration may be one symptom of serious underlying psychiatric dysfunction in adolescents with insulin-dependent diabetes.
  • Article
    Consider the following reports: Patient 1.—An 11-year-old boy with a three-year history of insulin-dependent diabetes mellitus was referred to the Children's Diabetes Management Center, Galveston, Tex, for a decreasing insulin dose and marked hypoglycemia with a recent onset of seizures. His metabolic control had always been good, with no episodes of Ketoacidosis; his mother rigidly controlled his insulin administration and food intake. The patient had a two-year history of mild hypoglycemia for which he received carbonated sugar-containing drinks and cake. Because of the increasing frequency of these hypoglycemic episodes, his insulin dosage was decreased from a total of 30 U/d to 8 U/d over the six-month period before admission. During a five-day evaluation, his blood glucose levels increased, as did his insulin requirements (0.8 U/kg/d). His mother continued to be reluctant to allow her son any freedom to manage his disease. Although the child admitted that he had occasionally given
  • Article
    Munchausen syndrome by proxy (MSBP) is a form of child abuse wherein the mother falsifies illness in her child through simulation and/or production of illness, and presents the child for medical care, disclaiming knowledge as to etiology of the problem. From the literature, 117 cases of MSBP were reviewed. The most common presentations of MSBP were bleeding, seizures, central nervous system depression, apnea, diarrhea, vomiting, fever, and rash. Short-term morbidity rate was 100%; long-term morbidity rate was 8%. Mortality rate was 9%. Failure to thrive was associated with MSBP in 14% of cases. All perpetrators of MSBP were the mothers. The origins of this type of aberrant maternal behavior remain abstruse, as do the long-term psychological effects on the child victims. Guidelines for medical, social service, and legal management are provided.
  • Article
    The case of an adolescent girl with a factitious lip crusting is presented. The usefulness of treating this disorder in a way similar to the treatment given adolescents with psychosomatic disorders is illustrated.
  • Article
    FIRST DESCRIBED 36 years ago (Lancet 1951;1:339-341), Munchausen's syndrome has been considered a rare psychiatric aberration occurring predominantly in adult men in their late 30s. However, evidence presented at the Society for Adolescent Medicine meeting in Seattle suggests that, in fact, the syndrome may be much more common, occur at a much earlier age, and have its origin in childhood abuse or neglect. Ed Tyson, MD, and Dennis Fortenberry, MD, of the University of Oklahoma Health Sciences Center, Oklahoma City, were introduced to Munchausen's syndrome in the way that many other clinicians have been: by encountering a patient with a long history of hospital admissions for numerous unrelated disorders. In this case, the patient was a 19-year-old woman who, over a three-year period, had seen 31 physicians in 12 specialties, been hospitalized 15 times for 154 days, and undergone 38 radiological procedures and 182 laboratory tests for a variety of
  • • An adolescent girl with factitious Cushing's syndrome underwent several years of intricate (and expensive) laboratory investigations before she was discovered to have been taking large doses of prednisone. (Am J Dis Child 1981;135:852-853)
  • Article
    This paper reports a case of Munchausen syndrome in a pediatric patient. The patient, a 13-year-old boy, presented with a complaint of persistent otalgia. As a result of the patient's deception of his physicians, he underwent numerous unnecessary investigations and two unnecessary operative procedures. The patient's deception included the simulation of a cerebrospinal fluid leak. The literature with respect to Munchausen syndrome in the pediatric patient is reviewed. Emphasis is placed on the fact that physicians, by their investigations and treatments, inflict most of the morbidity on this group of patients. Specific warning signals as well as an approach for management of these patients are also reviewed.
  • Article
    Several psychiatric conditions—conversion disorder, somatization disorder, factitious disorder, and malingering—are characterized by medical or psychiatric symptoms that are not “real” in that they lack a demonstrable biologic basis. In addition, these disorders share many other features in common, particularly when one corrects for a possible gender bias in diagnosis. We therefore offer the hypothesis that these “dissimulating disorders” may be closely related, and might be fruitfully studied as a group.
  • Article
    Full-text available
    Incapacitated brittle diabetic subjects are a small subset of insulin-dependent diabetic individuals who are unable to maintain a normal lifestyle because of frequent disruptions secondary to severe hyperglycemic and/or hypoglycemic episodes. Thirty incapacitated patients were referred for evaluation because the cause of their diabetic instability could not be determined by their personal physicians despite extensive patient training in correct diabetes management, frequent hospitalizations for observation, and multiple diagnostic testing. From the 30 patients, a diagnostic algorithm was developed (described in the companion article) from which the etiology of brittle diabetes could be established in 29. This article provides the clinical characteristics of each of the 30 patients, a description of the etiologic categories of brittle diabetes, and the clinical follow-up from the time that the etiologic diagnosis was established and treatment recommended. Although extensive medical records were sent with each patient, without prospective objective testing under rigidly controlled conditions, the correct etiologic diagnosis would not have been evident from the clinical presentation of the patient. Of equal importance in identifying the etiology of brittle diabetes was the acceptance and cooperation of the referring physician in providing close follow-up and repeat insulin challenge testing when necessary. In this referred patient population, eight subjects had factitious disease, eight were malingering, seven had communication deficits, two had gastroparesis, two had systemic insulin resistance, two had miscellaneous causes of brittle diabetes, and one patient remained undiagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)
  • Article
    Though the incidence is not known, conversion symptoms appear to be relatively common in adolescents. The diagnosis depends upon eliciting a pattern of behavior and symptomatology characteristic of conversion reactions, and not merely by excluding an 'organic' etiology. Clinical experience suggests that the majority of cases may be appropriately managed by primary care physicians who possess an interest in the emotional problems of adolescents and a willingness to develop basic psychiatric skills.
  • Article
    A unique psychocutaneous syndrome characterized by relapsing febrile nodular nonsuppurative panniculitis was seen in a teenage girl. Her disease, thought to be Weber-Christian syndrome clinically and pathologically, was eventually discovered to be caused by self-injections of milk. The bizarre pattern of typical factitial dermatitis is easily recognized, but exceptional cases may closely resemble authentic disease. Although factitial dermatitis may be associated with many different psychiatric conditions, the highest suspicion should be reserved for the hysterical personality. The characteristic behavior of the hysterical personality can alert the clinician to the possibility of factitial dermatitis.
  • Article
    Conflicts about the onset of sexual intercourse have been reported to cause a variety of symptoms. A 16-year-old black female claimed to have passed a stone in her urine. Investigation of her complaints caused some doubt that an organic cause was involved. Social history showed that she had recently begun to have sexual intercourse despite a religious belief that intercourse before marriage was wrong. After an extensive medical work-up, she was discharged with instructions to bring in another stone if passed. A stone subsequently presented by the patient proved to be a piece of lead shot. Those caring for adolescents need to be aware that conflicts about sexual intercourse may present in a number of ways, including urinary-tract complaints.
  • Article
    A case of Münchausen Syndrome diagnosed in an antenatal ward is reported. This patient, while pregnant, presented a variety of factitious obstetric complications to her medical attendants. Examination of the patient's hospital records threw light on the natural history of Münchausen Syndrome, and suggested the possibility that the nature of her interactions with hospitals were of aetiological significance. The implications of this hypothesis are considered.
  • Article
    A 14-year-old white female is treated for a common ingrown toenail with a permanent ablative procedure. The patient feigns factitious illness in the form of a postoperative infection to prolong medical care. No past history of neurotic disorder is related. Finally, after five hospitalizations, factitious illness is identified.
  • Article
    To review the empirical literature on somatization in the pediatric age group, emphasizing prevalence, influence on health care utilization, issues in the development of somatization, comorbidity with other psychiatric disorders, assessment, and treatment. One hundred nineteen studies and reports addressing medically unexplained somatic symptoms in children and adolescents were compiled via MEDLINE search and extensive cross-referencing. All available controlled studies were included, as were selected case reports and collections of cases. Selected citations from the adult literature were chosen for relevance to pediatric somatization. Recurrent, medically unexplained physical symptoms are common in the pediatric age group, are often associated with other psychiatric symptoms, and may represent a common presentation of psychiatric disorder in the primary care setting. DSM-III-R-defined somatization disorder is rare, and pseudoneurological symptoms are unusual. Patients may be at risk for potentially dangerous, costly, and unnecessary medical investigations and treatments, and they may excessively utilize health care services. Our current understanding of pediatric somatization and its consequences is limited. Collaboration between mental health professionals and primary health care providers is essential. Consistent terminology, developmentally appropriate classification, and systematic future research will be necessary for the development of successful prevention and treatment strategies.
  • Article
    Self-induced factitious disorders are defined and distinguished from conditions they may resemble. Review of the literature since 1965 indicates much more frequent reporting in recent years, but most health care providers are still not sufficiently aware of the common factitious disorder. Up to 5% of physician-patient encounters may be because of factitious disorders, but these are only suspected when the workup leads to contradictory findings. Laboratory tests are often the only definitive diagnostic method, and clinicians may not be familiar with current technologies. Some clinical clues are listed; heightened awareness and the need for early diagnosis are emphasized. Discordant laboratory results should raise the possibility of a factitious disorder. Sophisticated laboratory tests that can accurately assay very small amounts of specific hormones or foreign substances in body fluids facilitate the diagnosis. The primary physician can now confirm an initial clinical diagnosis of factitious disorder promptly and directly rather than only by exclusion.
  • Article
    We report the case of a 15-year-old girl who simulated a complex clinical picture including cutaneous lesions, fever, arthralgia, asthenia and oliguria. A diagnosis of probable systemic lupus erythematosus (SLE) was assumed by numerous specialists and steroid therapy instituted. Factitious SLE should be considered for differential diagnosis of SLE, especially when laboratory evidence for autoimmunity is not demonstrated.
  • Article
    Since factitious disorders entered the official psychiatric nomenclature in DSM-III and DSM-III-R, there has been a proliferation of reports and commentary about this unusual disorder. We present an update of the recent literature. The psychiatric and medical literature was searched. Clinical reports and critical/theoretical papers were reviewed; eighty-five are summarized here. Available data is descriptive and anecdotal. Reports focus on the following four topics, which are discussed here: 1) diagnostic issues, 2) the newly proposed DSM-IV category of factitious disorder by proxy, 3) epidemiology and course, 4) new developments in treatment and management. Factitious disorders are uncommon but serious illnesses that present diagnostic and management dilemmas. Deriving systematic information about these illnesses is a major challenge.
  • Article
    Very little is known about the long-term impact of Munchausen by Proxy abuse on children, as many victims probably are never identified and most have been lost to follow-up soon after termination of protective services supervision. This exploratory study examined the childhood experiences and long-term psychological outcomes for 10 adults, ranging from 33 to 71 years of age, who were self-identified victims of illness fabrication by a parent. Subjects completed a 33-item questionnaire including demographic and open-ended questions and a checklist of PTSD symptoms, supplemented by telephone interviews. Subjects described a range of experiences from poisonings and induced bone fractures to symptom exaggeration. Subjects generally felt unloved and unsafe in childhood; a few were directly aware of their parent's deceptions. They made limited attempts to alert others, with little success. Subjects reported significant emotional and physical problems in childhood, and problems in adulthood including insecurity, reality-testing issues, avoidance of medical treatment and posttraumatic stress symptoms. Most of their siblings were also abused, physically or medically. Some subjects express considerable residual anger towards the abusing mothers, but a surprising degree of sympathy for the fathers who passively colluded or failed to protect. Some of the MBPS parents have continued fabricating their own medical illnesses or harassing their adult children with fabricated dramas even decades later.
  • Article
    Three female patients aged 9, 13 and 14 years, respectively, seen by the authors over a 1-year period presented with the complaint of recurrent hematemesis (2 patients) or melena (1 patient). The (presumed) bleeding episodes had only been seen by the respective patient and one parent (the mother in two cases and the father in one). In two cases, the other parent was antagonistic with the reported situation. A clear symbiosis had been forged between the index case and the allied parent. Two patients had previously been seen in several hospitals and had undergone various diagnostic tests, including esophagogastroduodenoscopies, all of which had proved normal. Two girls had attempted suicide. Two of the mothers had a depressive disorder. Re-evaluation of the patients by the authors again ruled out any cause for the presumed bleeding or any sequelae originating from it. The patients and their parents were referred to a psychiatric service but this was only complied by one family; the other two repeatedly avoided attending the psychiatric clinic. Awareness of this pattern of presentation and of the psychiatric profiles of the patients and their families is critical for practitioners in order to recognize factitious illness whenever a patient with a history of gastrointestinal bleeding presents with incongruous or illogical medical history and clinical findings.
  • Article
    To describe two cases of factitious HIV disease and their implications for clinical practice and research. Review of medical records and literature search. A 19-year-old female and 17-year-old male were referred to an adolescent HIV clinic for evaluation and treatment of HIV disease. The former reported having been tested at a primary care clinic because of her history of transfusions, although the likely route of infection was intravenous drug use. The 17-year-old claimed to have contracted HIV through unprotected vaginal intercourse. Both patients reported HIV-related symptoms and prior seropositive HIV antibody test results which could not be corroborated. Other important features were histories of mental health problems, lack of apparent distress regarding HIV infection, and extensive knowledge of HIV disease. In both cases, the most likely diagnosis was Factitious Disorder with combined psychological and physical signs and symptoms, based on the feigning of seropositive HIV test results, report of physical symptoms undocumented by physical examination, the need to assume the sick role, and the absence of obvious secondary gain. This report serves to underscore the need to confirm the presence of HIV infection in young people who seek treatment for HIV disease, especially when clinical presentations resemble these cases.
  • Article
    The case is discussed of a 22 yr old woman whose left leg had been amputated following the spreading infection of subcutaneous abscesses. When similar abscesses developed later on her right leg, the possibility that her recurrent abscesses might be self induced was considered and eventually verified. Her subsequent medical and psychiatric course is discussed, and the perplexing problem of how to treat the patient with factitious disease is considered.