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Case Reports
. 2023 May 18;15(5):e39197.
doi: 10.7759/cureus.39197. eCollection 2023 May.

A Diagnostic Dilemma: Is It Factitious Disorder With Nonepileptic Seizure or Malingering With Nonepileptic Seizure?

Badar Sabeen  1 , Temilola Majekodunmi  2 , Abdulhusein Kapasi  2 , Sherrie Bieniek  3 , David Leszkowitz  4
Affiliations
Case Reports

A Diagnostic Dilemma: Is It Factitious Disorder With Nonepileptic Seizure or Malingering With Nonepileptic Seizure?

Badar Sabeen et al. Cureus. .

Abstract

In reality, the lines between factitious disorder, functional disorder, and malingering are quite blurred. In factitious disorder and malingering, patients consciously and deliberately create false medical and/or psychiatric symptoms for self-gain, often approaching multiple healthcare facilities to evade detection. Although the factitious disorder is pervasive, and the literature lacks accurate and consistent information, comorbidity with nonepileptic seizure (NES, a component of functional disorder) is quite commonly documented. In our case, the patient feigned multiple symptoms including two seizures and a shoulder dislocation to gain access to opioids. The clinical picture was only significant for alcohol withdrawal, aspiration pneumonia (possibly intubation vs. NES-related), and self-induced shoulder dislocation. Generally, management of these disorders should involve multiple specialties, multiple approaches, and identifying the triggering and comorbid psychological disorders, such as abandonment issues, personality disorders, physical or emotional abuse, anxiety, depression, stress, and substance use. Blindly approaching patients with a factitious disorder or malingering will not lead to any productive outcomes. Perhaps, creating a patient database could help reduce futile efforts while providing patients with the required help. This case report describes the presentation, diagnosis, management, and outcomes related to a patient with NES, engaging the reader to decipher the most appropriate diagnosis.

Keywords: disorder; factitious; functional; malingering; nonepileptic; seizure.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CT brain without contrast
1a: coronal view without contrast showing normal integrity of bony, soft tissue, and vascular structures. 1b: horizontal view without contrast showing normal integrity of bony, soft tissue, and vascular structures CT: computed tomography
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