The author reviews several factitious disorders of the upper extremity (Secretan’s Syndrome, tourniquet-induced swelling, body integrity identity disorder, SHAFT syndrome). The theory of feigned disability for gain is discussed and different forms of gain are illustrated (e.g., monetary, emotional manipulation, avoidance of distress).
The diagnosis of a factitious disorder is often a difficult one to make. A detached, almost smiling indifference by a patient with an unusual clinical presentation can assist with the diagnosis. Early recognition of a factitious disorder, avoidance of unnecessary procedures, sensitive feedback, and referral to a mental health specialist may offer the best prospects for treatment.