Factitious disorder with physical manifestations: pitfalls of diagnosis and management.

Münchausen's syndrome is a chronic form of factitious disorder in which fabricated physical manifestations are used to attain multiple hospital admissions. Patients with this disorder are exposed to unnecessary invasive studies, and their entire life may come to revolve around attainment of hospitalization. In addition, medical personnel are subjected to confusion and frustration, scarce resources are wasted, and institutions are left with enormous unpaid bills. Using an illustrative case, we demonstrate pitfalls in the diagnosis and management of these patients, with emphasis on breaking the cycle of repeated hospitalizations, and discuss the enormous human and economic costs of their insatiable quest for medical attention.