Factitious injury and related conditions

Some patients consciously or unconsciously generate their own symptoms or physical injuries. Excluding deliberate self-harm (acknowledged by the patient), the remaining presentations can be categorized as somatoform disorders, factitious disorders (including Munchausen’s syndrome and Munchausen’s syndrome by proxy), and malingering. The distinction between these disorders is important for the plastic surgeon who may have the first opportunity to diagnose them.

How Can Someone Do This to Themselves?

It is not uncommon to encounter patients who appear to exaggerate their pain complaints for one reason or another. However, these are to be differentiated form those diagnosed with malingering or factitious disorders (FD). Both can be difficult to identify. Malingerers engage in a willfully and deliberately attempt to misrepresent their situation for some type of gain. FD represents a group of patients with significant psychiatric problems. Their behavior often includes self-inflicted wounds, which need to be differentiated from actions that may reflect a suicide attempt, depression, or the self-injurious behavior related to dissociative disorder. The FD patient may well have an altered sensitivity to pain. Their treatment is complex and requires an experienced professional.

Feigned Narratives Do Not Always Satisfy Needs

When Bradley Lewis announced in 2014 that psychiatry needed to make a "narrative turn", he backed up his appeal as follows: (1) the different explanatory models of mental disorders that are currently competing in psychiatry tell us different stories about mental health; (2) none of these stories has the privilege of being the only true one, and its alternatives the wrong ones; (3) the choice of a model in each case should be made in dialogue with the patient in order to ensure that the model will be chosen that best meets the patient’s goals and desires and, accordingly, would best support the process of recovery. The latter suggestion, however, is not easy to follow when the patients’ subjective goals and desires diverge from the clinical goal of returning the patients to a normal way of life, as is the case with the so-called factitious disorders. The problem is worsened by the theory-ladenness of the interpretations of patients’ first-person narratives. This paper argues against a common assumption that biases our understanding of abnormal behavior, in particular the behavior of those who feign illness. The assumption in question is the following: that such behavior satisfies certain – possibly unknown – psychological needs.

Recurrent ear bleed with profound bilateral sensorineural hearing loss: A case of Munchausen syndrome

Factitious disorders and Munchausen syndromes present with history and physical symptoms to all specialties, and they are often extensively evaluated. Diagnosis of Munchausen syndrome is a challenge and patients often do not receive the correct diagnosis and appropriate care especially in settings where access to mental health professionals is difficult. We present a case of recurrent bleed from the right ear, bilateral profound hearing loss and jerky movement of limbs that was extensively evaluated and followed up for 4 years until a diagnosis of Munchausen syndrome was reached. This case reports the risk of harm to the patient and wastage of healthcare resources unless physicians begin to actively evaluate for factitious disorders.

The COVID-19 and Munchausen Syndrome

A look at the social media, it can be seen that some people are pretending to have the COVID-19. The pretending to have the COVID-19 can manifest the symptoms of Munchausen syndrome. It can be speculated that people with factitious disorders may pretend to have the COVID-19 because of an inner need to get the sympathy and special attention from others; therefore, it is imperative that this issue should be studied with a multidisciplinary approach. In addition, people shouldn't share any message from those pretending to have COVID-19 that may result in increasing public stress.