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Program

Psychiatry

Training Level

Resident PGY1

Institution

Henry Ford Hospital

Abstract

Although the hospitalization of a patient with factitious disorder (FD) can incur healthcare costs that exceed $200,000, it also incurs a tremendous psychological impact on healthcare staff. We present the case of Ms. L, a 38 year old Caucasian female with severe FD. We examine psychosocial factors associated with FD and offer strategies for inpatient physicians to collaboratively manage this condition. Ms. L presented to the ED after ingesting multiple batteries. Although this acute medical issue resolved within 1 week, Ms. L was hospitalized for months. Her symptomatology was encapsulated by two themes: suicidal ideation by starvation, and ‘seizures’. Shortly after Ms. L was cleared medically, she began to be interviewed for placement. During this period, Ms. L declared that she would attempt to kill herself by starvation and developed a curious ‘seizure’ disorder. The escalation of Ms. L’s medical acuity led to a preponderance of rejections for placement. When Ms. L understood this, she happily resumed eating and drinking. Furthermore, her ‘seizures’ were initially treated with standard anti-epileptic drug regimens, which paradoxically exacerbated her symptoms. It became clear that Ms. L feigned symptoms because it provided attention through positive and/or negative reinforcement. Eventually the primary team only began to monitor Ms. L from afar without alerting her to the team’s presence, and the lack of any reinforcement terminated all ‘seizure’ symptoms.

Publication Date

5-2019

Factitious disorder: a case report with clinical guidance for management

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