Le trouble factice est la production ou feinte ou intentionnelle de signes ou de symptômes physiques ou psychologiques dans le but de jouer le rôle de malade, sans avantages apparents. Quelques données montrent souvent une comorbidité du trouble factice avec d’autres troubles psychiatriques, comme la toxicomanie, les troubles somatoformes, la dysthymie, le trouble de la personnalité borderline et les troubles sexuels. La dermatillomanie est une maladie invalidante caractérisée par la cueillette répétitive de la peau qui provoque des lésions tissulaires. Ce trouble a une incidence de 2 %, il est actuellement considéré comme un trouble du contrôle des impulsions non spécifié. Cependant, il est associé à un taux élevé de comorbidités psychiatriques comme le trouble de la personnalité limite. À travers le cas d’une patiente présentant une comorbidité pathomimie et dermatillomanie, nous aborderons les caractéristiques cliniques et psychopathologiques du trouble factice et les difficultés thérapeutiques rencontrées devant cette comorbidité.

The number of patients requiring primary and secondary care for factitious disorder unexplained by any known medical condition is high. We report a case illustrating the clinical and psychopathological features of factitious disorder. The treatment difficulties encountered in the association of this disorder with dermatillomania are discussed.

The patient was a 22-year old girl with abrasions on the face and forearms with ingested epidermal layer of the skin. She also had multiple somatic complaints, the authenticity of which was difficult to confirm. The diagnosis of comorbid factitious disorder with dermatillomania was retained. In view of reducing self-harm acts, we prescribed a mood stabilizer associated with an anxiolytic for 6months. The self-harming acts have regressed, while the hypochondriacal complaints remain with a tendency of overstatement.

Factitious disorder (FD) is a mental disorder occurring in patients acting intentionally similar to a physically or mentally sick person with no apparent benefits. The reported cases often show FD comorbidity with other psychiatric disorders such as substance abuse, somatoform disorders, dysthymia, borderline personality disorder and sexual disorders. Comorbidity of factitious disorder with neurotic excoriation is exceptional, and rarely described in the literature. Pathological skin picking (PSP) is a disabling disorder characterized by repetitive skin picking, which causes tissue damage. It was estimated to affect 2% of the population. PSP is currently listed as an impulse control disorder not otherwise specified, it is associated with a high rate of psychiatric comorbidity like borderline personality disorder.

The comorbidity of factitious disorder and dermatillomania makes diagnosis very difficult. The limit between the two disorders is sometimes unclear.