边缘型人格障碍患者合并事实性障碍的诊断与管理:病例报告

Filipa Gomes Tavares, Sara Nascimento, Sílvia Batista
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摘要

本病例展示了边缘型人格障碍和事实型人格障碍并发的情况,这种情况并不常见,文献中也鲜有描述。我们分享该病例的目的是为了增加科学数据,并在可能的情况下帮助处理类似情况。本病例是一名患有边缘型人格障碍的门诊患者,因怀疑自己患有混合状态而住院治疗。随后,她出现了意识和行为上的变化。首先,这类似于谵妄,尽管没有明显的解释,而且除了她体内的苯二氮卓之外,所有实验室检查结果均无异常。当她的意识恢复后,她面对我们收集到的家庭信息,承认了自我伤害(过度用药)作为假装中风的手段,以及癌症和化疗症状(她剪掉了自己所有的头发),以便得到孩子们的关注。后来,她出院并被送往精神康复机构。虚构症是一种诊断不足、容易混淆的疾病,可能与边缘型人格障碍有关。尽管有一些文献证明边缘型人格障碍与因素性障碍之间存在共病关系,但作者之间仍存在争议,数据也很稀少。这名患者明显合并了这两种疾病,这证实了它们之间的联系。
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Diagnosing and Managing Comorbid Factitious Disorder in a Borderline Personality Disorder: A Case Report
This case demonstrates a comorbid Borderline Personality Disorder and Factitious Disorder situation, uncommon and sparsely described in the literature. Our purpose in sharing it resides as means to augment scientific data and possibly help manage similar situations. This case represents a patient with Borderline Personality Disorder, from an outpatient setting, who was hospitalized due to a mixed state suspicion. She then developed consciousness and behavior changes. Firstly, it resembled a delirium, although there was no obvious explanation for it and besides benzodiazepines in her system, all lab exams were clear. When her consciousness was recovered she was confronted with family information we gathered, and admitted self-injuring (excessive medication) as a means to pretend a stroke, as well forged cancer and chemotherapy symptoms (she cut off all her hair), in order to receive her children’s attention. She was later discharged and oriented to a mental rehabilitation institution. Factitious Disorder is an underdiagnosed and confounding condition and possibly correlated to Borderline Personality Disorder. Despite some literature demonstrating a comorbidity relation between Borderline Personality Disorder and Factitious Disorder, there is still controversy among authors, as well as sparse data. This patient showed a clear comorbidity between these two disorders, which corroborates their connection.
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