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Factitious disease: clinical lessons from case studies at Baylor University Medical Center

Adria C Savino1, John S Fordtran

  • 1Baylor University Medical Center, Dallas, Texas, USA.

Proceedings (Baylor University. Medical Center)
|January 26, 2007
PubMed

Insights

Factitious disease involves intentionally faking illness for emotional relief, complicating diagnosis and potentially leading to iatrogenic harm. Recognizing subtle clues is crucial for accurate medical management and patient safety.

Area of Science:

  • Psychiatry
  • Internal Medicine
  • Medical Ethics

Background:

  • Factitious disease is the intentional production or feigning of illness to assume the sick role and relieve emotional distress.
  • Estimated to occur in 3-5% of physician-patient encounters, factitious disorder presents diagnostic challenges.
  • Patients with factitious disease are difficult to recognize due to subtle presentation and low clinician suspicion, often leading to unnecessary medical interventions.

Purpose of the Study:

  • To present case studies illustrating diverse clinical aspects of factitious disease.
  • To discuss diagnostic challenges, clinician and psychiatric roles, and ethical considerations in managing factitious disease.
  • To highlight the potential for iatrogenic harm and the importance of accurate diagnosis, contrasting with a case of misdiagnosed psychogenic pain.

Main Methods:

  • Presentation of 6 case studies from Baylor University Medical Center.
  • Discussion of clinical features, diagnostic clues, and management strategies for factitious disease.
  • Inclusion of a contrasting case study to emphasize diagnostic accuracy.

Main Results:

  • Factitious disease is challenging to diagnose, often leading to unnecessary procedures and iatrogenic complications.
  • Clinician suspicion is often low, and psychiatric abnormalities may be overlooked.
  • Accurate diagnosis is critical, as demonstrated by a case where misdiagnosis led to severe patient harm.

Conclusions:

  • Enhanced knowledge of factitious disease's clinical features can improve diagnostic accuracy.
  • Early recognition and appropriate management are essential to prevent iatrogenic harm.
  • Ethical considerations and collaborative diagnostic approaches involving clinicians and psychiatrists are vital.

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