While undergoing treatment in the psychiatric depart-
ment,4.C., a 40-year-old white male, who had arrived in
the casualty department complaining of an uncontrol-
lable anxiety attack and in a state of fluctuating con-
sciousness, was found to be suffering from a psy-
chopathological condition characterized by pathologi-
cal lying, gambling, compulsive restlessness, a long
clinical history of chronic back pain, with multiple inva-
sive diagnostic investigations and repeated surgery for
disc hernia with relative complications, culminating in
the fitment of a fixed neurostimulator, a slowdischarge
morphine pump and the patient being granted a full dis-
ability pension. The continual increases in the doses of
morphine suggested a tendency towards drug addic-
tion.
After providing a brief overview of lhe historical back-
ground and current concepts relating to the relation-
ship between factitious disorders, malingering and
hysteria, the authors discuss the differential diagnosis
of the case, suggesting a diagnosis of M\uf9nchausen
syndrome (the hypothesis best supported by the clini-
cal evidence). This diagnosis, although the subject of
much academic debate, is, unfortunately, still not fre-
quently encountered in the medical literature, with the
result that even today it has a strong clinical, relational
and social impact
