Differential Diagnosis for a Patient Manifesting Symptoms to Get Investigations Done

• Single most likely diagnosis:
  • Factitious Disorder: This condition is characterized by the intentional production or feigning of physical or psychological symptoms, primarily motivated by the desire to assume the sick role. The patient's behavior of manifesting symptoms to get investigations done aligns closely with the criteria for factitious disorder, making it the most likely diagnosis.
• Other Likely diagnoses:
  • Munchausen Syndrome by Proxy (if the patient is inducing illness in another person, typically a child, to gain attention and sympathy for themselves): While this involves a third party, the underlying motivation and behavior of seeking medical attention through fabricated or induced illness are similar.
  • Somatic Symptom Disorder: This disorder involves one or more chronic physical symptoms (e.g., pain, fatigue) that are distressing and result in significant disruption of daily life. Although the primary motivation isn't to undergo investigations, the focus on symptoms could lead to extensive medical evaluations.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Hypochondriasis (Illness Anxiety Disorder): Although the primary concern here is the fear of having a serious disease rather than seeking investigations, it's crucial to differentiate as the anxiety and distress can be significant and require appropriate management.
  • Malingering: This involves the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding work, obtaining financial compensation, or avoiding prosecution. While the motivation differs from factitious disorder, the presentation can be similar, and missing this diagnosis could lead to inappropriate management and potential legal issues.
• Rare diagnoses:
  • Munchausen Syndrome (a more extreme form of factitious disorder where the fabrication of illness is more elaborate and may involve multiple hospitalizations and unnecessary medical procedures): This is a rare condition but should be considered in patients with a history of recurrent, factitious illnesses.
  • Factitious Disorder Imposed on Another (when an individual fabricates or induces illnesses in someone else, often to gain attention and sympathy for themselves): Similar to Munchausen Syndrome by Proxy but can involve any dependent, not just children.