Sham pathologies and subjective truth

The homogeneity of "sham disorders accompanied by physical symptoms" as def ined in the DSM-IV does not exist, as various syndromes that have been inde pendently described are included in these disorders Should they then be con sidered as related forms of the same entity or, on the contrary, as indicat ions of distinct problems? The history of symptom recognition is particular ly helpful in answering the question. Each of the first cases that were rep orted had indeed specific features that generally vanished only to reemerge . It may then be shown that the "subjective position" of sham pathologies s hould not be confused with that of patients presenting Munchhausen's syndro me, which in turn is not identical to that of Lasthenie de Ferjol's syndrom e occurring in women. Three original cases are reported;they allow the auth ors to question the clinical relevance and boundaries of this distribution. It also leads us to understand that features differentiating classificatio n of all three syndromes, including those features generating the syndrome distribution along a continuum ranging from self-inflicted injury to mythom ania, relies on both the subject's relationships with the Other (particular ly with the Other represented by the physician's face) and the status that will have his/her own body. Taking into account these two factors will allo w us finally to discuss the type of psychic structure in which these disord ers should be included and further to underline factors that guarantee thei r unity. It also emphasizes their basic significance, i.e., that the body c onsidered as the other definitely allows each individual to build up his id entity as otherness, i.e., the hard core loss. (C) 1999 Elsevier, Paris.