[Reflex sympathetic dystrophy vs. a factitious disorder]

Three women aged 18, 30 and 21, were admitted with complaints of reflex sympathetic dystrophy. These patients were caught at inducing their symptoms. Factitious disorders may be more common and serious than expected. It is suggested to include this diagnosis routinely in the differential diagnosis when dealing with inexplicable complaints, symptoms or therapy resistance. If factitious disorders are diagnosed it is advised to confront the patients. This is important in order to limit further iatrogenic damage to the patient. It also allows the physician to inform other doctors. After confrontation quite a few patients will stop inducing their symptoms. Most of them become angry, deny self-induction and refuse psychiatric help. Sometimes patients will withdraw from treatment. Despite these negative reactions patient confrontation is mandatory.