Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland.
Neuro-Ophtalmology Unit, Hospital of Jules-Gonin, Lausanne, Switzerland.
J Med Case Rep. 2023 Aug 11;17(1):340. doi: 10.1186/s13256-023-04063-0.
There is a high prevalence of somatoform disorders and medically unexplained symptoms. When it comes to deciding whether a patient is able to work, it is essential to differentiate a somatoform disorder from a factitious disorder. The case presented demonstrates the impact on disability benefits and the subsequent psychosocial repercussions of misdiagnosing between a factitious disorder and a somatoform disorder.
A 42-year-old Caucasian woman worked as a 100% fiduciary accountant until the age of 32 when she was placed on medical leave due to persistent trigeminal neuralgia. Afterward, she developed total blindness, not explained by a physiological process, accompanied by distress in a crucial emotional context. We evaluated the patient for a revision of a disability income after a diagnosis of factitious disorder with severe consequences such as disability income suspension and family conflict. Our psychiatric examination concluded the diagnoses of pain disorders related to psychological factors and a dissociative neurological symptom disorder with visual disturbance.
Blindness not explained by a physiological process may accompany trauma and psychological distress. Differentiating this pathology from factitious disorder or simulation is essential from an insurance medicine point of view, but also for its treatment.
躯体形式障碍和无法用医学解释的症状较为常见。在决定患者是否能够工作时，区分躯体形式障碍和诈病至关重要。本病例介绍说明了误诊为诈病和躯体形式障碍对残疾福利的影响，以及随后的心理社会后果。
一名 42 岁的白人女性曾担任 100%信托会计师，直到 32 岁时因持续性三叉神经痛而请病假。此后，她出现了无法用生理过程解释的完全失明，并伴有在关键的情感背景下的痛苦。我们对患者进行了残疾收入的修订评估，此前她被诊断为诈病，后果严重，如残疾收入暂停和家庭冲突。我们的精神病学检查得出的诊断为与心理因素相关的疼痛障碍和伴有视觉障碍的分离性神经症状障碍。
无法用生理过程解释的失明可能伴随着创伤和心理痛苦。从保险医学的角度来看，区分这种病理与诈病或模拟至关重要，这也是治疗的关键。
