Factitious Anemia

Abstract

Two instances of factitious anemia, a disorder not previously described, are presented. The condition resulted from self-blood-letting in one case, the patient also attempting to produce a factitious hemolytic state on one occasion. Considerable diagnostic confusion was experienced, with some evidence for both chronic blood loss and hemolysis being present. In another patient, bloody diarrhea was thought to be owing entirely to ulcerative colitis and resection was performed. The distal colon was severely lacerated from, as was later proved, repeated introduction of a long knitting needle by the patient. Two other examples of self-blood-letting, occurring in Oslo, are briefly reviewed. Discussion includes emphasis on the confusing admixture of signs of both blood loss and hemolysis in such cases, the tendency for the subjects to be women in paramedical positions, and the common psychodynamic picture of atonement, obsessive-compulsive tendencies, and strong elements of hostility, guilt and depression. Some of the problems of confrontation are also discussed.