Factitious Disorder Masquerading as Bipolar Disorder: A Case Series and Review of Approach toward Management

Abstract Factitious disorder (FD) is characterized by the patient fabricating injury or illness, with the primary goal of gratifying their psychological needs. Feigning of physical symptoms has been reported in different medical specialties fairly commonly; however, feigning of psychological disorders has been rare, with a study reporting its prevalence as 0.14%. Although there are published reports of FD presenting as schizophrenia, depression, post-traumatic stress disorder, and obsessive–compulsive disorder, the presentation with bipolar disorder has not been reported. We describe two such patients who presented to us claiming to have bipolar disorder. One of them is well educated, with a good knowledge of psychiatric disorders and curiosity to know further, and the other one has limited knowledge of mental illnesses. Both demonstrated the sick role in their own ways in the background of their personality traits. In both the cases, immediate confrontation was avoided. Although one of them relocated to a different city, gradual awareness through psychoeducation helped retain the other patient. Although literature is ambiguous about the outcome of immediate confrontation, a gradual process of reframing the presentation and validating the emotional distress plays an important role. Reducing the iatrogenic harm also forms an important component of treatment. Although various medications and therapies have been tried, FD still lacks a proper treatment guideline.