Classification system for factitious syndromes in the hand with implications for treatment

Area of Science:

• Hand Surgery
• Psychiatry
• Occupational Medicine

Background:

• Factitious disorders in the hand are challenging to diagnose and treat, particularly in patients receiving workers' compensation.
• Understanding the psychological underpinnings is crucial for effective management.

Purpose of the Study:

• To evaluate the presentation, psychological profiles, and treatment outcomes of patients with factitious hand disorders.
• To identify factors predicting response to behavioral interventions.

Main Methods:

• Retrospective evaluation of 29 patients with factitious hand disorders receiving workers' compensation.
• Classification of disorders by physical presentation (self-mutilation, edema, deformities) and psychological diagnosis (factitious disorder with physical symptoms, conversion disorder).
• Assessment using the Minnesota Multiphasic Personality Inventory (MMPI) to identify personality profiles (emotionally dependent, angry/hostile).

Main Results:

• Three presentations identified: self-mutilation/wound manipulation, edema, and deformities.
• Two primary psychological diagnoses: factitious disorder with physical symptoms and conversion disorder.
• Emotionally dependent patients had an 80% return-to-work rate following behavioral treatment.
• Angry/hostile patients had a 21% return-to-work rate.
• No self-mutilating patients returned to work.

Conclusions:

• Factitious hand disorders present diversely and are linked to specific psychological profiles.
• MMPI-identified personality profiles predict treatment response to behavioral therapy.
• A multidisciplinary evaluation (physician, psychologist, hand therapist) is recommended for accurate diagnosis and tailored treatment planning.