Grunert B K, Sanger J R, Matloub H S, Yousif N J
Department of Psychology, Medical College of Wisconsin, Milwaukee, Wis.
J Hand Surg Am. 1991 Nov;16(6):1027-30. doi: 10.1016/s0363-5023(10)80062-0.
We evaluated 29 patients with factitious disorders in the hand who received Worker's Compensation benefits. Three types of factitious hand disorders based on physical presentation were self-mutilation and wound manipulation, edema, and finger and hand deformities. Two distinct psychological diagnoses present were factitious disorder with physical symptoms and conversion disorder. The Minnesota Multiphasic Personality Inventory revealed two personality profiles: emotionally dependent and angry and hostile. Behavioral treatment was implemented. The emotionally dependent group responded well, with 80% returning to work. The angry and hostile group had a much poorer response, with 21% returning to work. None of the self-multilating patients returned to work. We recommend a combined evaluation by a physician, a psychologist, and a hand therapist to achieve a definitive diagnosis for these disorders. The identification of psychological profiles assists in ascertaining which patients will be responsive to behavioral treatment.
我们评估了29名手部患有做作性障碍并领取工伤赔偿的患者。根据临床表现，三种类型的做作性手部障碍分别为自残与伤口处理、水肿以及手指和手部畸形。存在两种不同的心理诊断：伴有躯体症状的做作性障碍和转换障碍。明尼苏达多相人格调查表显示出两种人格特征：情感依赖型以及愤怒敌对型。实施了行为治疗。情感依赖型组反应良好，80%的患者重返工作岗位。愤怒敌对型组的反应则差得多，只有21%的患者重返工作岗位。没有一名自残患者重返工作岗位。我们建议由医生、心理学家和手部治疗师进行综合评估，以对这些障碍做出明确诊断。识别心理特征有助于确定哪些患者会对行为治疗有反应。
