Dermatitis Artifacta in a case of Factitious and Dissociative disorder-Help seeking in a myriad of ways

Abstract

Factitious disorder is defined by the intentional production or feigning of physical or psychological symptoms with the objective of assuming the sick role. Dermatitis artifacta (DA) is a psychocutaneous condition in which skin lesions are produced or inflicted by the patient's own actions. Patients present with lesions of various forms and bizarre shapes, which are difficult to recognize. Patients often deny responsibility, so the direct confrontation will mostly lead to withdrawal and seeking help somewhere else. The self-mutilative behavior  often serves as an extreme form of nonverbal communication, an appeal for help and usually occurs in patients with poor coping skills and often represents a maladaptive response to psychological stressor. DA is frustrating for physicians and family members, with a differential diagnosis that includes severely morbid medical conditions. As with all factitious disorders, patients with DA  waste  precious  time  and  resources  with unnecessary  tests  and  produce  high  costs  to  the healthcare  system. Increased awareness of DA can save physicians, patients, and family members many medical visits and allow for better management. In this case report, we describe a female patient with dermatitis artefacta,  associated with dissociative disorder presenting with recurrent multiple genital ulcers. This case leads us to suggest that extreme help seeking need can present with a varied psychiatric manifestations, starting from dissociative episodes to dermatitis artefacta.