Factitious Disorder in a Patient Claiming to be a Sexually Sadistic Serial Killer

Area of Science:

• Psychiatry
• Psychology
• Behavioral Science

Background:

• Factitious disorder is characterized by the conscious simulation of illness symptoms to fulfill an unconscious need for care or the sick role.
• Patients typically feign conditions eliciting empathy, aiming to engage caregivers.
• However, simulation of conditions provoking revulsion is also possible within diagnostic criteria.

Observation:

• This case report presents a patient who consciously fabricated a history of being a sexually sadistic serial killer with homicidal ideation.
• The patient's intention was to elicit personal attention, nurturance, and empathy from their psychotherapist.
• The fabricated condition, however, frightened the therapist, hindering the intended engagement.

Findings:

• The patient's simulation of a disturbing and revulsive persona, rather than an empathetic one, is a key observation.
• This presentation highlights a less common but viable manifestation of factitious disorder.
• The patient's actions demonstrate a complex interplay between the desire for care and the choice of simulated pathology.

Implications:

• This case expands the understanding of presentations within factitious disorder, particularly those involving revulsive rather than empathetic feigning.
• It underscores the importance of considering factitious disorder even when the simulated condition is designed to provoke negative reactions.
• The findings suggest that the unconscious need for attention and care can manifest through diverse and potentially counterproductive simulated illnesses.