Anticoagulant abuse: a psychotic syndrome?

A case of surreptitious ingestion of oral anticoagulants is presented. The patient, a 31-year-old nurse, was followed for more than 3 years and underwent thorough psychological and psychiatric evaluation. Anticoagulant malingerers are by no means rare; however, little is known about the psychiatric disturbances in these patients. The tendency has been to regard these patients as having neurotic or personality disturbances. The data in the present case suggest that factitious hemorrhagic disease is caused by a psychotic disturbance. The results of psychiatric therapy are discussed.