Factitious disorder with abdominal pain and multiple surgical operations: A case report.

ABSTRACT

Factitious disorder is characterized by physical or psychological symptoms that a person intentionally produces or feigns to pretend to be sick although not for external benefits such as financial compensation. As a result of the difficulty in diagnosing the disorder, its prevalence is relatively rare. The definite diagnosis and its proper management is important, particularly in preventing unneeded medical procedures as well as reducing stress in these patients’ families and reducing cost of management. We report a 17-year-old woman who presented to the Department of Surgery with severe abdominal pain and underwent her 5th abdominal operation due to provisional diagnosis of gut obstruction. The surgeon found only some fibrosis which could not explain her severe abdominal pain. After the operation, she still had abdominal pain, distension and intermittent fever although no source of infection nor physical illness could be found to explain this. Psychiatric consultation was came out because of her disturbed behavior and because she was uncooperative. We found that she had been admitted to several hospitals more than 50 times and had undergone 4 major operations in the past 4 years because of her abdominal pain. Surprisingly she was not distressed at all despite these chronic physical illnesses. After close observation by ward nurses, her persistent fever finally disappeared. We transferred her to our psychiatric ward and gave one of serotonin-specific reuptake inhibitors (SSRIs) which is effective in treating compulsion as well as depression, together with family counseling and individual psychotherapy. Finally she confessed that she feigned the symptoms, so we could make the definite diagnosis of factitious disorder with predominantly physical signs and symptoms.