Factitious Disorders and Trauma-Related Diagnoses

The recent plethora of lawsuits involving allegations of iatrogenically implanted memories of satanic ritual abuse and other traumas has highlighted the existence of a unique group of psychiatric patients. Although these patients are often successful at deceiving therapists (and sometimes juries), the case studies in this special issue reveal the chronic nature of their propensity to invent traumatic identities and past histories. The core clinical features of affect dysregulation, somatization, and impaired object relations, together with frequent histories of alcohol and substance abuse, parallel the psychiatric co-morbidity frequently found in genuine trauma victims. These case studies also point to early childhood problems in attachment, and sometimes to real childhood trauma, as possible etiologic factors. The current diagnostic system does not adequately capture the full range of these patients' psychopathology, which involves the creation of factitious identities and fictional traumatic personal histories. The particulars of these histories change over time as the patients incorporate, deliberately and/or “unconsciously,” details derived from outside sources. Although clearly susceptible to being influenced by authority figures of all kinds, it is evident from these case studies that the core psychopathology at work here is intrinsic to the patients and not the by-product of therapeutic misadventure.