Fritzsche K, Venhoff N, Larisch A
Abteilung für Psychosomatische Medizin und Psychotherapie am Universitätsklinikum Freiburg, Hauptstr. 8, 79104 Freiburg.
Dtsch Med Wochenschr. 2008 May;133(19):1004-6. doi: 10.1055/s-2008-1075684.
A 23-year-old woman was admitted to the department of rheumatology for detailed diagnostic tests for a suspected immune deficiency. Over the past 3 years, she has had repeated unexplained febrile episodes and impaired wound healing, which required permanent antibiotic treatment.
Extensive tests initially showed no definitively diagnostic findings. Based on various clinical and inconsistencies in biochemic tests, the suspicion of a self-inflicted cause increased. In several interviews with a psychologist of the psychosomatic consultation service, the patient finally admitted manipulation by means of i. v. application of bacterially contaminated water.
The self-inflicted injuries were interpreted as the consequence of a serious psychological trauma, as well as a self-healing attempt to prevent an emotional breakdown. The trust which the patient developed in her specialist carers after admitting the deception, made it possible to motivate her to continue psychotherapy.
If a factitious disorder is suspected, the doctor should not be too precipitous in confronting the patient without expression of empathy, but rather respect the self-inflicted injury as a measure of self-preservation. Such non-confrontational behavior on the part of the carer enables the patient to accept the offer of psychotherapy without losing face.
一名23岁女性因疑似免疫缺陷被收入风湿病科进行详细诊断检查。在过去3年里，她反复出现不明原因的发热发作，伤口愈合受损，需要长期使用抗生素治疗。
广泛的检查最初未显示明确的诊断结果。基于各种临床情况和生化检查中的不一致之处，对自伤原因的怀疑增加。在与身心咨询服务的心理学家进行的几次面谈中，患者最终承认通过静脉注射受细菌污染的水进行自我伤害。
自我伤害被解释为严重心理创伤的后果，以及防止情绪崩溃的自我修复尝试。患者在承认欺骗行为后对其专科护理人员产生的信任，使她有可能被激励继续接受心理治疗。
如果怀疑是做作性障碍，医生在没有表达同理心的情况下与患者对质时不应过于仓促，而应将自我伤害视为一种自我保护措施予以尊重。护理人员的这种非对抗性行为能使患者在不丢面子的情况下接受心理治疗。
