ARTIFICIAL DISORDERS - BETWEEN DECEPTION AND SELF-HARM - PSYCHIATRIC-CONSULTATION IN A UNIVERSITY CLINIC

During a 18-year-period 93 patients (f=76, m=17) with a factitious dis order were identified in the psychiatric consultation service of a uni versity hospital (incidence: 0.62%). 50% of women were working in medi cal professions whereas only 6% of men. Chronic courses of illness wer e prevailing, but at least one quarter of female patients showed an in termittent type. There was a classical Munchhausen syndrome in 11% of patients. Depressive and anxiety disorders (10%, 4%) were to be respec ted as psychiatric comorbidity. Ca 25% of the patients suffered from a somatic illness in addition to the factitious disorder, and one third of the women had symptoms of psychosomatic, especially of eating diso rders. Previous somatoform disorders, deliberate self harm and attempt s of suicide were to be noted in the psychiatric history of ma ny pati ents. There were frequent traumatizing events (foster home, disturbing family disharmony, physical and sexual abuse, early losses, serious i llnesses) in the early biography. Various psychosocial stressors could be identified in the actual eliciting situation. The results are disc ussed in respect of epidemiology, development and clinical phenomenolo gy of factitious disorders, psychodynamics and psychopathology of dece ption and self harm, and therapeutic options in the psychiatric consul tation service.