Differential Diagnosis
- Single most likely diagnosis
- D) Factitious disorder: This is the most likely diagnosis because the patient has a history of multiple hospital admissions for various symptoms with no clear underlying cause, and she was caught intentionally contaminating her laparoscopy site, which is a classic behavior associated with factitious disorder. Factitious disorder is characterized by the intentional production or feigning of physical or psychological symptoms, primarily motivated by the desire to assume the sick role.
- Other Likely diagnoses
- H) Somatization disorder: Although less likely than factitious disorder given the direct evidence of the patient inducing illness, somatization disorder is a possibility. It involves multiple, recurrent physical complaints without a clear medical cause, which could fit the patient's history of numerous hospital admissions for unexplained symptoms. However, the intentional act of contaminating the wound site leans more towards factitious disorder.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- None specifically fit this category perfectly in the context of the provided options and the scenario described, as the critical aspect here is the psychological diagnosis rather than a potentially life-threatening condition that was missed. However, it's essential to consider that patients with factitious disorder can sometimes induce serious medical conditions, so careful medical evaluation is always necessary.
- Rare diagnoses
- A) Adjustment disorder with disturbance of conduct, B) Conduct disorder, C) Conversion disorder, F) Major depressive disorder, G) Oppositional defiant disorder: These are less likely given the specific scenario. Adjustment disorder and conduct disorder might be considered if there were more context about the patient's behavior and emotional response to stressors, but they don't directly explain the fabrication of illness. Conversion disorder involves neurological symptoms without a medical cause, which doesn't fit the patient's presentation. Major depressive disorder and oppositional defiant disorder could be comorbid conditions but don't directly explain the patient's behavior of inducing illness. Hypochondriasis (now more commonly referred to as Illness Anxiety Disorder) involves excessive worry about having a serious illness, which is different from the intentional production of symptoms seen in this patient.