CPCP: Factitious Disorder by Dr. Garrett Wilcox MD

Dr. Garrett Wilcox MD
Dr. Garrett Wilcox MD

Here’s a great review of Factitious Disorder presented today by Family Medicine resident Dr. Garrett Wilcox, MD. It’s a poorly understood form of simulated illness which is distinct from somatic symptom disorders and malingering (an accusation, not a diagnosis) in which the patient deliberately feigns illness and lies to health care professionals about the origin of physical or psychiatric symptoms and signs.

Every month I’m on service as the general hospital psychiatric consultant I get called in which I and other doctors at least suspect that a patient is engaging in deliberate self-injury and deception about it.

Over the years I’ve used both confrontation and nonconfrontation, to which the Eastwood and Bisson reference in Dr. Wilcox’s presentation refers.

I’m always surprised by the results. There doesn’t seem to be much consistency in how patients react. Confrontation is necessary if the patient is doing something to himself which could result in loss of life or limb. If a consulting psychiatrist is going to do this, you have to be implacable about it and have the resources to back it up by having a secure psychiatric unit to which the patient can be admitted–usually by emergency court order. You also need to have medical resources available to manage the many medical problems patients self-induce. A medical-psychiatry unit is ideal.

Generally, non-confrontational approaches are employed if the medical problem the patient is perpetrating on himself is not immediately dangerous.

A University of Iowa physician published a case report about a patient with Factitious Disorder, the colorful Indiana Cyclone.

Always, the goal is to provide safe, compassionate care. Because patients with Factitious Disorder are motivated to deceive doctors, they will usually not admit what they’re doing.

Recovery, not confession, is the goal.

In order to see the picture galleries of photos or powerpoint slides, click on one of the slides, which will open up the presentation to fill the screen. Use the arrow buttons to scroll left and right through the slides or up and down to view any annotations.



Author: Jim Amos

Dr. James J. Amos is Clinical Professor of Psychiatry in the UI Carver College of Medicine at The University of Iowa in Iowa City, Iowa. Dr. Amos received a B. S. degree in Distributed Studies (Zoology, Chemistry, and Microbiology) in 1985 from Iowa State University and an M.D. from The University of Iowa in Iowa City, Iowa in 1992. He completed his psychiatry residency, including a year as Chief Resident, in 1996 at the Department of Psychiatry at The University of Iowa. He has co-edited a practical book about consultation psychiatry with Dr. Robert G. Robinson entitled Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry. As a clinician educator, among Dr. Amos’s most treasured achievements is the Leonard Tow Humanism in Medicine Award.