Factitious disorders in a teaching hospital.

To obtain an overview of factitious disorders in hospitalized patients we surveyed the cases found in our hospital during a 10-year period. Forty-one disorders were identified including one that was fatal and others that were chronic, severe, and life-threatening. The disorders fell into four subgroups: self-induced infections, simulated illnesses, chronic wounds, and surreptitious self-medication. These subgroups had implications for prognosis and management. The patients included 39 women and 2 men, average age 33 years, 28 working in medical jobs. With three possible exceptions, none of the patients had Munchausen's syndrome and were not malingerers or sociopaths. Most of these patients were immature, passive, and hypochondriacal; none had major mental disorders. Thirty-three patients were confronted with evidence that their disorders were self-induced; none signed out of the hospital or became suicidal. Although only 13 patients acknowledged causing their disorders, most improved after confrontation and 4 of the most chronic became asymptomatic. The cases differed from commonly held assumptions about factitious disorders.