title: Exaggerating, mislabeling or simulating obsessive-compulsive symptoms: case reports of patients claiming to have obsessive-compulsive disorder.
abstract: BACKGROUND
  There are no reported cases of factitious or simulated obsessive-compulsive disorder (OCD). However, over the last years, our clinic has come across a number of individuals that seem to exaggerate, mislabel or even intentionally "produce" obsessive and/or compulsive symptoms in order to be diagnosed with OCD.
  
  
  METHODS
  In this study, experienced clinicians working on a university-based OCD clinic were requested to provide clinical vignettes of patients who, despite having a formal diagnosis of OCD, were felt to display non-genuine forms of this condition.
  
  
  RESULTS
  Ten non-consecutive patients with a self-proclaimed diagnosis of OCD were identified and described. Although patients were diagnosed with OCD according to various structured interviews, they exhibited diverse combinations of the following features: (i) overly technical and/or doctrinaire description of their symptoms, (ii) mounting irritability, as the interviewer attempts to unveil the underlying nature of these descriptions; (iii) marked shifts in symptom patterns and disease course; (iv) an affirmative "yes" pattern of response to interview questions; (v) multiple Axis I psychiatric disorders; (vi) cluster B features; (vii) an erratic pattern of treatment response; and (viii) excessive or contradictory drug-related side effects.
  
  
  CONCLUSIONS
  In sum, reliance on overly structured assessments conducted by insufficiently trained or naïve personnel may result in invalid OCD diagnoses, particularly those that leave no room for clinical judgment.
authors.affiliation: Anxiety and Obsessive-Compulsive Disorders Research Program, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil; Departamento de Psiquiatria e Saúde Mental, Instituto de Saúde da Comunidade, Universidade Federal Fluminense (UFF), Niterói, Brazil. Electronic address: lfontenelle@gmail.com.
authors.forename: Leonardo F
authors.initials: LF
authors.lastname: Fontenelle
authors.affiliation: Anxiety and Obsessive-Compulsive Disorders Research Program, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
authors.forename: Natália M
authors.initials: NM
authors.lastname: Lins-Martins
authors.affiliation: Anxiety and Obsessive-Compulsive Disorders Research Program, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
authors.forename: Isabela A
authors.initials: IA
authors.lastname: Melca
authors.affiliation: Anxiety and Obsessive-Compulsive Disorders Research Program, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
authors.forename: André Luís C
authors.initials: AL
authors.lastname: Lima
authors.affiliation: Anxiety and Obsessive-Compulsive Disorders Research Program, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
authors.forename: Gabriela B
authors.initials: GB
authors.lastname: de Menezes
authors.affiliation: Departmento de Neurologia, Psicologia e Psiquiatria, Universidade Estadual Paulista (UNESP), Botucatu, Brazil.
authors.forename: Albina R
authors.initials: AR
authors.lastname: Torres
authors.affiliation: School of Psychological Sciences, Monash University, Melbourne, Australia.
authors.forename: Murat
authors.initials: M
authors.lastname: Yücel
authors.affiliation: Departmento de Psiquiatria, Universidade de São Paulo (USP), São Paulo, Brazil.
authors.forename: Euripedes C
authors.initials: EC
authors.lastname: Miguel
authors.affiliation: Departamento de Psiquiatria e Saúde Mental, Instituto de Saúde da Comunidade, Universidade Federal Fluminense (UFF), Niterói, Brazil.
authors.forename: Mauro V
authors.initials: MV
authors.lastname: Mendlowicz
mesh_terms: D000293:Adolescent; D000328:Adult; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis*; D055815:Young Adult