Factitious skin lesions as an expression of a familiar crisis

The factitious disorder is a deliberately induced, hidden self-mutilation b ased on a psychic conflict. We present a previously healthy nine-year old girl with initially obscure s ymmetric skin lesions. Family history, psychological exploration, special tests like pictural expr ession and scenial exhibition revealed the child's fear of a divorce of her parents and her own identity problem, These examinations aroused the suspi cion that the girl could only express her conflict of ambivalence by self-i njury behavior in the meaning of artificial disease. Guided by this impression, an intensive conversation with both parents was undertaken, focussing the familiar crisis. Afterwards, the skin lesions disappeared The girl admitted the self-mutilat ion. A family therapy was initiated.