Factitious disorder and coexisting depression: a report of successful psychiatric consultation and case management

The authors present a case illustrating factitious illness with a coexisting depressive disorder. The factitial presentation involved self-mutilation that served to procure and prolong patient status, while obscuring the recognition of a major depressive episode. The importance of accurate assessment and prompt recognition of factitious illness is discussed, with emphasis upon the identification of contributing psychodynamics, underlying psychopathology and ongoing psychosocial stressors. Psychiatric consultation efforts were successful, but in the context of considerable morbidity. Psychotherapeutic gains occurred only after vigorous antidepressant drug therapy and substantial psychotherapeutic efforts that empathically addressed the patient's masochism and dependency.