Dealing with artefactual skin disorders

Dermatitis artefacta (DA) is a factitious skin disorder, which often occurs as a response to traumatic life events (such as physical/sexual abuse as a child or adult, or bereavement), or as a behaviour that may result in secondary gain (for example, financial reward or attention from others). Less often, it is the result of a dissociated state. Patients will create skin lesions themselves and then deny having done so. It is notoriously difficult to engage these patients with health services. DA is recognised in the Diagnostic and Statistical Manual of Mental Disorders (4th edn) as a mental health disorder, under the label of ‘factitious disorder’.