Jafferany Mohammad, Khalid Zaira, McDonald Katherine A, Shelley Amanda J
Department of Psychiatry, Central Michigan University College of Medicine, 1000 Houghton Ave, Saginaw, MI 48602.
Department of Psychiatry, Central Michigan University College of Medicine, Saginaw, Michigan, USA.
Prim Care Companion CNS Disord. 2018 Feb 22;20(1):17nr02229. doi: 10.4088/PCC.17nr02229.
Factitious disorder can present in multiple health care settings, with patients intentionally producing symptoms to assume the sick role. This assumption of the sick role can result in multiple hospitalizations with unnecessary diagnostic workup, as well as invasive diagnostic procedures that can lead to worrisome side effects. Differential diagnoses that should be ruled out include malingering, somatic symptom disorder, and anxiety disorders. For many providers, patients with factitious disorder can be a challenge to treat because the etiology of the disorder remains unclear. There are multiple psychological theories that attempt to explain the motivation and thought process behind the voluntary production of symptoms. Some of these theories have addressed disruptive attachments during childhood, possible intergenerational transfer of the disorder, personal identity conflicts, somatic illness as a form of masochistic activity toward oneself, and intrapsychic conflicts. Confrontation and psychotherapy with a multidisciplinary team has been proposed as a form of treatment. An understanding of the psychological factors associated with factitious disorder can help providers understand the rationale behind the patient's presentation and aid in the formulation of a treatment plan.
诈病可出现在多种医疗环境中，患者故意制造症状以扮演病人角色。这种对病人角色的扮演可能导致多次住院以及进行不必要的诊断检查，还会进行侵入性诊断程序，从而引发令人担忧的副作用。需要排除的鉴别诊断包括诈病、躯体症状障碍和焦虑症。对于许多医疗服务提供者而言，诈病患者可能是治疗上的挑战，因为该疾病的病因仍不清楚。有多种心理学理论试图解释自愿制造症状背后的动机和思维过程。其中一些理论探讨了童年时期的破坏性行为、该疾病可能的代际传递、个人身份冲突、将躯体疾病作为一种对自己的受虐活动形式以及心理内部冲突。有人提议由多学科团队进行对峙和心理治疗作为一种治疗形式。了解与诈病相关的心理因素有助于医疗服务提供者理解患者表现背后的原理，并有助于制定治疗计划。
