Factitious mourning: painless patienthood.

Of 20 patients who falsely reported the deaths of loved ones in order to assume the patient role, most presented with depression and suicidal ideation secondary to reported multiple dramatic deaths for which there was no available verification, and many had histories of factitious physical symptoms, manipulative suicide attempts, substance abuse, and sociopathy. Diagnostic categories were of limited usefulness for these patients. Factitious symptoms can better be understood as one form of dysfunctional care-eliciting behavior. The authors recommend early and repeated confrontations in a firm but nonjudgmental manner combined with referral to outpatient psychotherapy focused on the underlying characterological problems.