Factitious disorders of the upper limb in Saudi Arabia.

This prospective study investigated 28 patients with factitious disorders of the upper limb. Several cases did not fit any of the well-known factitious syndromes such as SHAFT or Münchhausen syndrome. Patients were divided into five groups, three of which comprised active mutilators who either induced wounds, introduced foreign bodies or induced arm swelling and oedema. Passive mutilators were considered in a separate group and were defined as those who complained of factitious pain or numbness of the limb, for which there was no secondary gain regarding employment or compensation: these patients underwent surgery and hence persuaded the surgeon to do the mutilation. The fifth group of patients exhibited hand posturing and were divided into two subgroups: patients with psychological hand posturing and those seeking secondary gain (malingerers). The clinical presentation, diagnosis and outcome are described for each group.