A Man with Nails and Needles Inside: A Case Report of Factitious Disorder

In factitious disorder (Munchausen syndrome), patients induce or aggravate symptoms of physical or psychological illness to receive attention and medical treatment. The motivation of these patients is merely getting a sick role and medical care, and entering the medical system; most of these patients have simultaneous mood disorders (especially depression), or personality disorders. Patients with factitious disorder have no secondary gain.

Herein, we present a middle-aged Azerbaijani man from Sarab city, East Azerbaijan who referred to hospital with complaints of abdominal and leg pain. Based on examinations, he had undergone repeated surgical procedures (laparotomy and surgical removal of the external object from the leg) due to the presence of a foreign body (needle and nail) in the intestines and leg’s calf. The interview was done based on DSM-5 by a psychiatrist and after a two-month follow-up, the diagnosis was affirmed by a second opinion through a ground round session at the department of psychiatry, Tabriz university of medical sciences, Tabriz, Iran. He is under treatment with an SSRI along with cognitive psychotherapy.

Patients with atypical and unusual manifestations of an illness associated with frequent hospital admissions and receiving multiple therapies can lead us to the diagnosis of a factitious disorder. Although patients often deny their disease and evade treatment, he was ultimately diagnosed with factitious disorder and received psychiatric treatment. The treatment goal is to reduce mortality and morbidity and to treat the underlying psychiatric disorder.