Factitious post traumatic stress disorder: a case report

‘Military Munchausen's’: assessment of factitious claims of military service in psychiatric patients

Thirteen per cent of referrals of ex-servicemen to a military psychiatric centre for the treatment of combat-related post-traumatic stress disorder (PTSD) in a 12-month period have proved to be factitious. A simple classification of factitious combat-related PTSD into those with no military service and those with military service but with false claims of combat is described. The possible causes of this behaviour are discussed and a guide to the detection of factitious claims for psychiatrists without military experience is given.

Pseudo-PTSD

Pseudo-posttraumatic stress disorder (pseudo-PTSD) refers to cases in which a patient's presentation is but a simulation of the actual clinical syndrome. The problem of pseudo-PTSD has been neglected by many clinicians and researchers, who often rely on the assumption that a patient's reported symptoms can be accepted as valid. The purpose of this article is to (a) consider the diverse causes of pseudo-PTSD, (b) emphasize the importance of the DSM-IV's guideline to rule out malingering, and (c) discuss the implications that pseudo-PTSD has for research and clinical practice.

Factitious Disorders: Reformulating the DSM–IV Criteria

The author criticizes and reformulates the DSM-IV criteria in a clinically and nosologically sensitive way. Criterion A, the intentional production of physical or psychological signs or symptoms, emphasizes symptoms and cannot accommodate pseudologia fantastica, voluntary false confessions, and impersonations. Criterion B, the motivation is to assume the "sick role," has no empirical content and fulfills no diagnostic function. The two criteria need reformulating in terms of lies and self-harm, respectively. Criterion C causes misdiagnosis by pushing factitious disorders into the somatoform and malingering categories and should be abandoned. The author discusses the implications for the etiology of conversion disorders and the classification of factitious disorders.