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Wires in the body: a case of factitious disorder.

Sinha-Deb K, Sarkar S, Sood M, Khandelwal SK - Indian J Psychol Med (2013)

Bottom Line: These metallic wires were present in both her upper and lower limbs in the muscle bulk and were visible on X-ray.The patient could not be engaged in a therapeutic relationship and the family took premature discharge against medical advice, as they believed in supernatural causation for the phenomenon and were afraid that medical intervention might bring further ill fortune.The case highlights the importance of belief systems of family members as a barrier in managing such cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Factitious disorder can present with a wide variety of symptomatology. We present a case of a young girl presenting with spontaneous extrusion of wires from her limbs. These metallic wires were present in both her upper and lower limbs in the muscle bulk and were visible on X-ray. She sought repeated surgical removal of these wires, but the wires would invariably reappear. The patient could not be engaged in a therapeutic relationship and the family took premature discharge against medical advice, as they believed in supernatural causation for the phenomenon and were afraid that medical intervention might bring further ill fortune. The case highlights the importance of belief systems of family members as a barrier in managing such cases.

No MeSH data available.


Related in: MedlinePlus

X-ray of thigh
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Figure 2: X-ray of thigh

Mentions: Ms. S, a female aged 16 years, hailing from rural background in northern India, with lower socio-economic status, presented with recurrent spontaneous extrusion of copper wires from all of her limbs for the past 1½ years. The patient initially reported pain and development of pustules in the posterior aspect of the left hand which took a long time to heal when an X-ray revealed thin metallic wires in the muscle bulk. These wires were removed by a surgeon, but the problems recurred after a couple of days. Subsequently these wires would be removed every week or two at a clinic in a nearby town, but they would soon recur. The copper wires extracted from the patient surgically would be entrusted to the family members, who would dispose them off near home. The patient and the family members sought treatment at many places in nearby towns but there would be recurrence in a few days. The family members had also taken her to many faith healers for cessation of extrusion of these wires, who told them that she was afflicted by a powerful jinn causing the presence of the wires. Faith healers had suggested rituals which the patient did not follow meticulously. She had also received brief media attention for her symptoms, which she liked and the family members would often talk about it with pride during the interview. The patient presented to our center after she was refused surgery for extraction of wires by local surgeons, who referred her to a tertiary care center. She was admitted in the psychiatry ward for management. In past history, the family members reported that the patient had difficulty with affect regulation since childhood. She would be stubborn and inconsiderate toward younger siblings, would get angry easily, and refuse food. She would refuse to do the delegated household chores, sought attention of others and would go out of the house without informing the family members. Physical examination of the patient revealed multiple scars and wounds bilaterally, in the forearms, arm, thighs and knees. However, no scars or wounds were present in any inaccessible areas like back. On interview the patient was guarded. She appeared tidy and kempt with normal speech, had euthymic affect and no perceptual and thought abnormalities. Higher mental functions were within normal limits. She expressed displeasure on being asked about any psychological stressors and focused primarily on her physical complaints. When asked nonjudgmentally about the possible source of such wires in the body she became verbally aggressive and assumed a challenging stance toward the ward team. Engaging her into a therapeutic relationship was very difficult. She refused psychometric and personality testing and did not cooperate for the same on repeated attempts. X-rays of multiple body areas were obtained [Figures 1 and 2] and a surgery consultation was sought. The surgical team decided against operation as it was considered unnecessary with risk of further tissue scarring, and advised regular dressing of the wounds.


Wires in the body: a case of factitious disorder.

Sinha-Deb K, Sarkar S, Sood M, Khandelwal SK - Indian J Psychol Med (2013)

X-ray of thigh
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3775056&req=5

Figure 2: X-ray of thigh
Mentions: Ms. S, a female aged 16 years, hailing from rural background in northern India, with lower socio-economic status, presented with recurrent spontaneous extrusion of copper wires from all of her limbs for the past 1½ years. The patient initially reported pain and development of pustules in the posterior aspect of the left hand which took a long time to heal when an X-ray revealed thin metallic wires in the muscle bulk. These wires were removed by a surgeon, but the problems recurred after a couple of days. Subsequently these wires would be removed every week or two at a clinic in a nearby town, but they would soon recur. The copper wires extracted from the patient surgically would be entrusted to the family members, who would dispose them off near home. The patient and the family members sought treatment at many places in nearby towns but there would be recurrence in a few days. The family members had also taken her to many faith healers for cessation of extrusion of these wires, who told them that she was afflicted by a powerful jinn causing the presence of the wires. Faith healers had suggested rituals which the patient did not follow meticulously. She had also received brief media attention for her symptoms, which she liked and the family members would often talk about it with pride during the interview. The patient presented to our center after she was refused surgery for extraction of wires by local surgeons, who referred her to a tertiary care center. She was admitted in the psychiatry ward for management. In past history, the family members reported that the patient had difficulty with affect regulation since childhood. She would be stubborn and inconsiderate toward younger siblings, would get angry easily, and refuse food. She would refuse to do the delegated household chores, sought attention of others and would go out of the house without informing the family members. Physical examination of the patient revealed multiple scars and wounds bilaterally, in the forearms, arm, thighs and knees. However, no scars or wounds were present in any inaccessible areas like back. On interview the patient was guarded. She appeared tidy and kempt with normal speech, had euthymic affect and no perceptual and thought abnormalities. Higher mental functions were within normal limits. She expressed displeasure on being asked about any psychological stressors and focused primarily on her physical complaints. When asked nonjudgmentally about the possible source of such wires in the body she became verbally aggressive and assumed a challenging stance toward the ward team. Engaging her into a therapeutic relationship was very difficult. She refused psychometric and personality testing and did not cooperate for the same on repeated attempts. X-rays of multiple body areas were obtained [Figures 1 and 2] and a surgery consultation was sought. The surgical team decided against operation as it was considered unnecessary with risk of further tissue scarring, and advised regular dressing of the wounds.

Bottom Line: These metallic wires were present in both her upper and lower limbs in the muscle bulk and were visible on X-ray.The patient could not be engaged in a therapeutic relationship and the family took premature discharge against medical advice, as they believed in supernatural causation for the phenomenon and were afraid that medical intervention might bring further ill fortune.The case highlights the importance of belief systems of family members as a barrier in managing such cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Factitious disorder can present with a wide variety of symptomatology. We present a case of a young girl presenting with spontaneous extrusion of wires from her limbs. These metallic wires were present in both her upper and lower limbs in the muscle bulk and were visible on X-ray. She sought repeated surgical removal of these wires, but the wires would invariably reappear. The patient could not be engaged in a therapeutic relationship and the family took premature discharge against medical advice, as they believed in supernatural causation for the phenomenon and were afraid that medical intervention might bring further ill fortune. The case highlights the importance of belief systems of family members as a barrier in managing such cases.

No MeSH data available.


Related in: MedlinePlus