Goldstein A B
Case Western Reserve University, USA.
Int J Psychiatry Med. 1998;28(2):221-41. doi: 10.2190/8LRP-5YTD-3VP2-3HC6.
The current article offers a new conceptualization of factitious disorders based on cases reported in the literature.
The current analysis examines twenty-nine cases of factitious disorder patients over the course of ten years (1986-1996). Cases were found through PSYCHLIT and MEDLINE searches. Patient variables examined include: demographics, occupational status, marital status, childhood history, extent of medical history, the presence of a borderline personality disorder, and presence of a psychosocial stressor prior to the onset of the factitious disorder.
An examination of the cases found demographic patterns of illness presentation consistent with previous reviews of the disorder. From the examination emerged two distinct types of factitious presentations-one acute, one chronic. A two-dimensional approach is introduced in an attempt to understand various disease presentations. Cases were classified based on proposed Current Life Stress and Chronic Life Pattern dimensions. These dimensions are measures of the extent to which the patient's factitious presentation is in response to an immediate psychosocial stressor, or an action consistent with a long-term maladaptive behavior pattern resulting from an underlying character pathology. Three patient groups were identified based on estimated patient levels of each dimension. The three groups are: Stress Response, Life Response, and Mixed Response.
Recommendations are made to increase the role of physicians in the detection of factitious patients, as well as to move toward a more uniform reporting of cases of factitious disorders in the literature.
本文基于文献报道的病例，对做作性障碍提出一种新的概念化认识。
本分析研究了1986年至1996年这十年间29例做作性障碍患者的病例。通过检索PSYCHLIT和MEDLINE数据库找到这些病例。所研究的患者变量包括：人口统计学特征、职业状况、婚姻状况、童年经历、病史范围、边缘型人格障碍的存在情况以及做作性障碍发病前是否存在心理社会应激源。
对这些病例的研究发现，疾病表现的人口统计学模式与之前对该障碍的综述一致。通过研究出现了两种不同类型的做作性表现——一种是急性的，一种是慢性的。引入了一种二维方法来试图理解各种疾病表现。根据提议的当前生活应激和慢性生活模式维度对病例进行分类。这些维度衡量的是患者的做作性表现是对即时心理社会应激源的反应，还是与由潜在性格病理导致的长期适应不良行为模式一致的行为。根据每个维度的估计患者水平确定了三个患者组。这三个组分别是：应激反应组、生活反应组和混合反应组。
提出了一些建议，以增强医生在识别做作性障碍患者方面的作用，并使文献中做作性障碍病例的报告更加统一。
