Factitious Skin Disorders with External Incentives

In most cases, self-inflicted skin artefacts are dictated by psychiatric disorders. However, there are also subjects whose simulations are motivated by illicit intent (malingering): in these cases, the simulators are well aware of their actions and hidden motivations. Malingering, that can involve any medical speciality, is normally a diagnosis of exclusion afterwards all psychical and psychological factors contributing to the patient’s presentation have carefully considered and excluded. Malingering can also rarely be observed in adolescents, whereas it is closely linked with military service. In the occupational field, there are many reasons that can prompt a subject to simulate a disease: to obtain prolongation of a prior disease or its recognition of occupational affliction and to obtain a higher class of disability pension. A particular aspect to the problem of the occupational dermatitis artefacta is constituted by attempts to produce results to patch tests which would otherwise give negative results. Dermatitis artefacta can be voluntary provoked on the skin of unaware subjects by proxy (witchcraft syndrome). Secrétan syndrome is characterized by a hard oedema of the back of one or both hands and forearms, induced by applying a haemostatic ligature or tight bandaging around the forearms. In the field of malingering, it must be considered the possibility that also religious stigmata, as example of intricate relationship between medicine, psychology, psychiatry, and spirituality, could be self-inflicted for illegal and/or profit purpose.