In 1951, Asher([double dagger]) created the name Munchausen's syndrome to describe one form of factitious disease (10).
According to current usage, Munchausen's syndrome is considered to be the most extreme form of factitious disease.
There is a much larger group of patients with factitious disease who are repeatedly hospitalized for diagnostic tests and treatment but who are not dramatic or aggressive in their demeanor.
The benefits and risks of confrontation have been analyzed by Reich and Gottfried (18), who reviewed 41 cases of various types of factitious disease from a single institution.
Parenthetically, it is interesting to note that factitious disease often begins shortly after a stressful event (32, 33).
First, patients with subtle forms of factitious disease don't appear different from other patients with similar symptoms caused by authentic disease (20, 26, 34, 35), and the psychiatric abnormalities they have are not recognized by their doctors (36).
False-negative tests, particularly for senna, may delay the diagnosis of factitious disease for years and contribute to complications from unnecessary or inappropriate medical or surgical therapy and overutilization of healthcare resources.
Therefore, as with many other factitious diseases, physicians must use clinical evidence from multiple sources to establish a diagnosis of surreptitious laxative ingestion, rather than rely primarily on laboratory tests.
Moreover, the ability to detect factitious disease may become harder with increasing sophistication of patients mimicking cardiac symptoms.
In most instances, these are not truly factitious disease because the patient has no intention of inducing disease.