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Epidemiology and evolution of the diagnostic classification of factitious disorders in DSM-5

Authors Caselli I, Poloni N, Ielmini M, Diurni M, Callegari C

Received 6 October 2017

Accepted for publication 2 November 2017

Published 11 December 2017 Volume 2017:10 Pages 387—394

DOI https://doi.org/10.2147/PRBM.S153377

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor Igor Elman

Ivano Caselli, Nicola Poloni, Marta Ielmini, Marcello Diurni, Camilla Callegari

Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy

Abstract:
A systematic search for all case reports and case series of adult patients with factitious disorders (FD) in the databases MEDLINE, Scopus, and PsycINFO was conducted. FD is a psychiatric disorder in which sufferers intentionally fabricate physical or psychological symptoms in order to assume the role of a patient, without any obvious gain. The clinical and demographic profile of patients with FD has not been sufficiently clear. Thus, the aims of this study were to outline a demographic and clinical profile of a large sample of patients with FD and to study the evolution of the position of FD in the Diagnostic and Statistical Manual of Mental Disorders. One thousand six hundred thirty-six records were obtained based on key search terms, after exclusion of duplicate records. Five hundred seventy-seven articles were identified as potentially eligible for the study, of which 314 studies were retrieved for full-text review. These studies included 514 cases. Variables extracted included age, gender, reported occupation, comorbid psychopathology, clinical presentation, and factors leading to the diagnosis of FD. In the sample, 65.4% of patients were females. Mean age at presentation was 33.5 years. A health care profession was reported most frequently (n=113). Patients were most likely to present in psychiatry, neurology, emergency, and internal medicine departments. The broad survey of sociodemographic profile of the sample has highlighted some important points for early diagnosis and early psychiatric treatment. The study showed that the patients did not meet Diagnostic and Statistical Manual of Mental Disorders-5 diagnostic criteria in 11.3% of cases.

Keywords:
fabricated illness, factitious disorder, medically unexplained symptoms, Munchausen syndrome

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