Factitious disorders and pathological self-harm in a hospital population: an interdisciplinary challenge.
Factitious disorder, Munchausen's Syndrome, and deliberate self-harm have recently been conceptualized as different facets of self-destructive behavior. A descriptive typological classification has been presented by Willenberg et al., but has not yet been tested with a clinical sample. The instrument distinguishes between direct self-harm (e.g., self-inflicted wounds), self-induced disease (e.g., factitious fever), and indirect self-harm delegated to medical staff (e.g., repeated operations occasioned by feigned symptoms). All patients referred to the psychosomatic-psychotherapeutic liaison-consultation service or to the outpatients' department within 14 months (n = 995) and all patients discharged from in-patient psychosomatic-psychotherapeutic treatment within 2 months (n = 62) were assessed. Expert instruction and supervision were provided for the diagnosticians. The assessment was continued for a subsequent year, without special supervision (n = 1,058). Self-destructive behaviors were diagnosed in 7.5% of the cases in the first sample, with certainty (59.5%) or on suspicion (40.5%). In the subsequent sample without supervision, the rate reduced to 3.6%. Referrals had come from almost all clinical departments, including the emergency unit (26%), surgery, internal intensive care, endocrinology (9.5% each), neurology, infectiology, nephrology (7.1% each), dermatology, gastro-enterology, cardiology (4.8% each) and surgical intensive care (2.4%). The occurrence of pathological self-destructive phenomena is underrated when using only the ICD-criteria. The rate is influenced by diagnostic attention.
Fliege
Herbert
H
Division of Internal Medicine, Psychosomatics, Charité, Humboldt-University, Berlin, Germany. herbert.fliege@charite.de
Scholler
Gudrun
G
Rose
Matthias
M
Willenberg
Hans
H
Klapp
Burghard F
BF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005162:Factitious Disorders / Q000453:epidemiology* / Q000534:rehabilitation*; D005260:Female; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000534:rehabilitation*