The Wandering Woman: A Case Study of Catatonia vs Factitious Disorder

A 61-year-old woman with an unknown psychiatric history presented with mutism, stupor, negativism, and withdrawn behavior. She was admitted to the psychiatric unit for what appeared to be catatonia. Medical records were not readily available. A comprehensive evaluation did not uncover any medical etiology. Lorazepam was ineffective at consistently reversing her catatonic symptoms. During week three of hospitalization, she was given olanzapine with subsequent improvement in her negativism. Several physicians believed her catatonic symptoms were feigned given multiple episodes of spontaneous purposeful movement when she was not under the direct supervision of staff. There is minimal literature on distinguishing catatonia and factitious disorder. This distinction is crucial because these diagnoses require very different treatments, and the iatrogenic complications related to the treatment of catatonia with high-dose benzodiazepines and electroconvulsive therapy are significant. Rapid access to electronic health records can facilitate treatment for patients who cannot provide a medical history, especially when factitious disorder is included in the differential diagnosis.