[Pathomimesis and Münchhausen syndrome]

Factitious disorders, as pathomimesis and Münchhausen syndrome, have to be diagnosed early to avoid numerous exams and inadequate treatments, which intensify symptoms. Lesions are self-inflicted in a fully conscious manner. The patient does not search for direct benefits, hides his/her responsibility in the induction of lesions. Factitious disorders have to be differentiated from simulation and it is necessary to understand that they are the expression of an intense mental suffering, which is often unknown by the patient. Diagnosis is difficult, with various clinical manifestations, but it is not a diagnosis by a process of elimination: it is supported by the presence of personality disorders, usually borderline disorders. Management is complex and often disappointing. To keep a therapeutic relationship with the patient requires collaboration between all healthcare personals; psychotherapeutic treatment is possible only with the installation of a trusting relationship and with associated cares of physical symptoms.