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Peter Reich, MD; J. Michael Lazarus, MD; Martin J. Kelly, MD; Malcolm P. Rogers, MD

JAMA. 1977;238(5):420-421.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

PATIENTS who pretend to be sick and willingly undergo intrusive procedures, including surgery, have been seen at every medical center. The motives for this bizarre behavior often remain obscure, even when the patient is studied thoroughly.

Reviews of chronic factitious illness or Munchausen's syndrome emphasize the heterogeneity of the underlying psychiatric conditions, but also indicate a marked preponderance of patients with personality disorders, and with histories of early childhood trauma and deprivation.^1,2 In a study of factitious illness, Spiro identified three clinical types: sociopathic, hysterical, and schizophrenic.² Major factitious illness is rare in childhood and adolescence, although malingering with factitious fever³ and other simulated symtoms can occur.

We report the case of an adolescent boy who for nearly a year succeeded in simulating an enterovesicular fistula by contaminating his urine with feces and foodstuff, at times by retrograde injection of foreign substances into his bladder. The case . . . [Full Text PDF of this Article]

Author Affiliations
From the Psychiatry and Renal Divisions, Department of Medicine, Peter Bent Brigham Hospital, and the Departments of Psychiatry and Medicine, Harvard Medical School, Boston.

Footnotes
Reprint requests to 721 Huntington Ave, Boston, MA 02115 (Dr Reich).

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