Factitious Disorder

Dr. Eric Lu shared a fascinating case of factitious disorder presenting as pseudomonal bacteremia with fevers. Some takeaways:

  • Munchausen's disease is a severe form of factitious disorder, and tends to present in men more often than women, while factitious disorder in general is much more likely to affect women and have an association with an occupation in health care.

The diagnosis should enter one's differential if any of the following:

  1. implausible patient-reported disease course
  2. discrepancy between reported symptoms and signs
  3. laboratory test results inexplicable or inconsistent with patient complaints
  4. treatment response inconsistent with known patterns (such as, wounds that do not heal, blood sugars that continue to be abnormal despite treatment)
  5. no known or obvious secondary gain from feigned illness
  • Non-punative confrontation does not result in increased psychiatric escalation or increased risk of leaving AMA
  • Management should center around establishing the diagnosis in the medical chart, focusing all care through one physician, and treating concomitant mental health disease