Factitious disorder (FD) imposed on self is a psychiatric disorder characterized by the intentional feigning of symptoms or the self-inflicted production of symptoms in the absence of an obvious external reward. Previously known as Munchausen syndrome, this term is now reserved for severe, chronic, or dramatic cases. Multiple theories for the pathogenesis of FD have been proposed, but most studies point to the behaviors exhibited as a coping mechanism to address emotional stress and resolve unmet psychosocial needs. This case report describes a 31-year-old male who frequently presented to several Emergency Departments at hospitals within the Appalachian region with intentional ingestion of foreign objects. These scenarios ultimately required the patient to undergo approximately 32 esophagogastroduodenoscopy (EGD) and 28 gastroscopy procedures over the course of two years. The patient also had a significant history of suicide attempts by prescription medication overdose, although clinical workup and laboratory confirmation of such ingestion was varied. After two years of these frequent ED presentations, the patient was evaluated for FD upon voluntary admission to an inpatient psychiatric facility. Due to the need for anesthetic agents in the frequent EGD's performed on this patient, the possibility of drug-seeking as the motivating factor for this patient’s behavior and the possibility of a co-occurring substance use disorder were considered. Suicidality in FD and the lack of case reports and reliable research on the topic makes a challenging diagnosis and clinical course even more complex. Additionally, the clinical management of FD is unique, and no reliable studies have detailed an effective treatment plan. Thus, to add to the literature, the treatment and outcome to date for the patient presented here and the suicidal ideation and intentional overdoses complicating this case are discussed. Continued research and reporting of FD cases will help guide clinicians in the treatment and management of this challenging diagnosis.
| Identifer | oai:union.ndltd.org:ETSU/oai:dc.etsu.edu:asrf-1903 |
| Date | 07 April 2022 |
| Creators | Gersch, Hannah G, Robinson, Fulton A, Cartwright, Jake K, DeFelice, Bryan A, Kadam, Rajesh S |
| Publisher | Digital Commons @ East Tennessee State University |
| Source Sets | East Tennessee State University |
| Detected Language | English |
| Type | text |
| Source | Appalachian Student Research Forum & Jay S. Boland Undergraduate Research Symposium |
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