A systematic review of factitious decompression sickness

We present a case of factitious decompression sickness (DCS) involving a patient emergently treated at a hyperbaric medicine facility in New Zealand. Patients with factitious disorder feign illnesses such as DCS in order to receive care and attention despite the lack of an underlying illness. Other studies have suggested that 0.6% to as many as 9.3% of hospital admissions are factitious in nature. Therefore we believe that factitious DCS is occurring more often than hyperbaric clinicians suspect. DCS can be life-threatening, and hyperbaric medicine clinicians will almost always "err on the side of caution" when patients are referred with symptoms of DCS. Because DCS can be diagnosed based on subjective symptoms and self-reported history, there are opportunities for factitious patients to receive hyperbaric therapy. The costs associated with factitious DCS include transport, staff resources and preventing patients with treatable conditions from accessing the hyperbaric chamber. We performed a systematic review of the literature and found eight additional reported cases of confirmed or suspected factitious DCS. We report our findings and recommendations for hyperbaric medicine specialists regarding the recognition and management of factitious DCS.