Why do Iranian patients with factitious disorder choose skin symptoms instead of pain? a literature review of factitious disorder in Iranian patients

Background: Factitious disorder (FD) is a psychiatric condition in which the affected person deliberately makes up diseases, injuries, or symptoms. Diagnosing this condition is a serious medical challenge. No studies have been conducted in Iran to show these patients’ clinical and demographic profiles in an adequate sample size. The present article attempts to extract demographic and clinical details of Iranian FD patients by reviewing the related published articles. Methods: A search was conducted on this disorder in English and Persian articles published by Iranian researchers between 1960 and 2020 in the MEDLINE, Web of Science, EMBASE, PsychInfo, Google Scholar, and SID databases using factit*, artefacta*, artefactua*, and Munchausen* as keywords in combination with “by proxy” and “imposed upon another”. Ultimately, 33 case report articles and 35 cases in total were included in the study, and demographic and clinical details of patients were extracted from the articles. Results: Of the 35 FD patients, 27 were women. The patients’ mean age was 32.5 years. Factors leading physicians to the diagnosis of FD were atypical presentation (n = 18) followed by an unsubstantiated presentation. FD symptoms were mainly physical (n = 31), and reporting unusual and atypical wounds were the most common cause of patients’ visits, with a frequency of 25%. Most patients had not undergone a thorough psychiatric examination, and in those who had been evaluated, the most common diagnoses reported were mood disorder and anxiety disorder. Conclusion: It appears that greater attention is required to teach the diagnosis and assessment of FD.