Univ Rennes 1, CHU Rennes, Service de Médecine Interne et Immunologie Clinique, 2 rue Henri Le Guilloux, 35 033, Rennes, France.
Univ Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France.
BMC Psychiatry. 2021 Nov 23;21(1):588. doi: 10.1186/s12888-021-03582-8.
Despite cases of factitious disorder imposed on self being documented in the literature for decades, it appears to remain an under-identified and under-diagnosed problem. The present study aimed to explore factitious disorder imposed on self in a series of French patients.
Patients 18 years old and over with factitious disorder imposed on self were retrospectively included by two independent reviewers according to DSM-5 criteria in Rennes University Hospital for the period 1995 to 2019. Patients were identified from a clinical data warehouse.
49 patients with factitious disorder imposed on self were included. Among them, 36 (73.5%) were female. The average age at diagnosis was 38.4 years. The 16 patients with a health-related profession were all female. Direct evidence of falsification was found in 20.4% of cases. Falsification was mainly diagnosed on the basis of indirect arguments: history of factitious disorder diagnosed in another hospital (12.2%), extensive use of healthcare services (22.4%), investigations that were normal or inconclusive (69.4%), inconsistent or incomplete anamnesis and/or patient refusal to allow access to outside information sources (20.4%), atypical presentation (59.2%), evocative patient behaviour or comments (32.7%), and/or treatment failure (28.6%). Dermatology and neurology were the most frequently involved specialities (24.5%). Nine patients were hospitalized in intensive care. Some of them received invasive treatments, such as intubations, because of problems that were only reported or feigned. The diagnosis of factitious disorder imposed on self was discussed with the patient in 28 cases (57.1%). None of them admitted to making up the disorder intentionally. Two suicide attempts occurred within 3 months after the discussion of the diagnosis. No deaths were recorded. 44.9% of the patients returned to the same hospital at least once in relation to factitious disorder imposed on self.
The present study reinforces data in favour of a predominance of females among patients with factitious disorder imposed on self. This diagnosis is difficult and is based on a range of arguments. While induced cases can be of low severity, cases that are only feigned can lead to extreme medical interventions, such as intubation.
尽管数十年来文献中已有关于人为自我伤害障碍的病例报道，但该障碍似乎仍然未被充分识别和诊断。本研究旨在探索一系列法国患者中的人为自我伤害障碍。
根据 DSM-5 标准，两名独立评审员回顾性纳入了 1995 年至 2019 年期间在雷恩大学医院就诊的年龄在 18 岁及以上的人为自我伤害障碍患者。患者是从临床数据仓库中识别出来的。
共纳入 49 名人为自我伤害障碍患者。其中，36 名（73.5%）为女性。诊断时的平均年龄为 38.4 岁。16 名有医疗保健相关职业的患者均为女性。20.4%的病例发现有伪造直接证据。伪造主要基于间接论据诊断：在另一家医院诊断的人为障碍病史（12.2%）、广泛使用医疗保健服务（22.4%）、检查正常或无定论（69.4%）、不完整或不完整的病史和/或患者拒绝允许访问外部信息源（20.4%）、非典型表现（59.2%）、有暗示性的患者行为或评论（32.7%）和/或治疗失败（28.6%）。皮肤科和神经科是最常涉及的专科（24.5%）。9 名患者住进了重症监护病房。由于仅报告或佯装的问题，其中一些患者接受了有创治疗，如插管。在 28 例病例（57.1%）中与患者讨论了人为自我伤害障碍的诊断。他们都没有承认故意制造这种障碍。在诊断讨论后 3 个月内发生了 2 例自杀未遂。没有死亡记录。44.9%的患者至少因人为自我伤害障碍再次回到同一家医院就诊。
本研究强化了人为自我伤害障碍患者中女性占多数的证据。该诊断具有一定难度，基于多种论据。虽然诱导性病例可能程度较轻，但仅佯装的病例可能会导致极端的医疗干预，如插管。
