Vroege herkenning van dermatitis artefacta: Hoeveel bedrog en machteloosheid kan de dermatoloog aan?

Dermatitis artefacta is the dermatological variant of a disorder that is classified in psychiatry as a factitious disorder. Patients with a factitious disorder intentionally feign or self-induce medical symptoms with the aim of being recognized and treated as a patient. There is a substantial risk for severe iatrogenic complications. A good prognosis depends on early recognition of the disorder. In practice this is difficult because the patients present without any objective signs. Awareness of the signals of a pathological interaction between doctor and patient, such as feelings of frustration, distrust or abnormal positive feelings, can therefore be very useful. Also recognition of other alarm symptoms can be helpful. Doctors are advised to consider a factitious disorder in the differential diagnosis as early as possible and to discuss this openly with their patients. Furthermore consulting a psychiatrist is important. Goal of an intervention is primarily the ending of the pathological patient doctor interaction and the resulting iatrogenic complications. The prognosis can be positively influenced when the treating physician together with a psychiatrist confront the patient in a professional manner.