ABSTRACT
Few within arm's length of factitious disorder patients are spared entanglement in the sticky web they spin. They deliver their tales so glibly that they often rival the most silken-tongued con artist and take in all parties. Factitious disorder patients then help the hoax assume a life of its own, growing and seeking out new participants until (actually, unless) someone who is caught up catches on and intervenes. Ironically, the very nature of medical care, focused as it is on caring and curing and consumed with worries about patients’ rights and malpractice claims, actually facilitates disease portrayals. The implicit obligation of the physician to his or her patient is the persistent pursuit of a definitive diagnosis and treatment, even when signs and symptoms defy logic. Vague or confusing descriptions of symptoms are not unusual in clinical practice; some patients are globally shy or inarticulate, or never developed the particular vocabulary to describe feeling-states, whether emotional or physical.
