Version June 2024
| Presentation | Means of simulation that have been reported | Possible methods of detection |
| Autoimmune | ||
| Goodpasture's syndrome | False history, adding blood to urine | Bronchoalveolar lavage negative for hemosiderin-laden cells |
| Systemic lupus erythematosus | Malar rash simulated through cosmetics, feigning joint pain | Negative antinuclear antibody test, removability of rash |
| Dermatological | ||
| Burns | Chemical agents such as oven cleaner | Unnatural shape of lesions, streaks left by chemicals, minor injury to fingers |
| Excoriations | Self-infliction | Found on accessible parts of the body, or, eg, a preponderance of left-sided lesions in a right-handed person |
| Lesions | Injection of exogenous material such as talc, milk, or gasoline | Puncture marks left by needles, discovery of syringes |
| Endocrine | ||
| Cushing's syndrome | Steroid ingestion | Evidence of exogenous steroid use |
| Hyperthyroidism | Thyroxine or L-iodothyronine ingestion | The 24-hr I-131 uptake is suppressed in factitious disease and increased in Graves' disease |
| Hypoglycemia or insulinoma |
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| Pheochromocytomy | Epinephrine or metaraminol injection | Analysis of urinary catecholamines may reveal epinephrine only or other suspicious findings |
| Gastrointestinal | ||
| Diarrhea | Phenolphthalein or castor oil ingestion | Testing of stool for laxatives, increased stool weight |
| Hemoptysis | Contamination of sputum sample, self-induced trauma such as cuts to tongue | Collect specimen under observation, examine mouth |
| Ulcerative colitis | Laceration of colon with knitting needle | |
| Hematological | ||
| Aplastic anemia | Self-administration of chemotherapeutic agents to suppress bone marrow | Hematology/oncology consultation |
| Anemia | Self-induced phlebotomy | Blood studies |
| Coagulopathy | Ingestion of warfarin or other anticoagulants | |
| Infectious disease | ||
| Abdominal abscess | Injection of feces into abdominal wall | Unusual pathogens in microbiology tests |
| AIDS | False history | Collateral information |
| Neoplastic | ||
| Cancer | False medical and family history, shaving head to simulate chemotherapy | Collateral information, examination |
| Neurologic | ||
| Paraplegia or quadriplegia | Feigning, fictitious history | Imaging studies, electromyography |
| Seizures | Feigning, fictitious history | Video electroencephalogram |
| Obstetrics/gynecology | ||
| Antepartum hemorrhage | Vaginal puncture wounds, use of fake blood | Examination, test blood |
| Ectopic pregnancy | Feigning abdominal pain while self-injecting human chorionic gonadotropin | Ultrasound |
| Menorrhagia | Using stolen blood | Type blood |
| Placenta previa | Intravaginal use of hat pin | Examination |
| Premature labor | Feigned uterine contractions, manipulation of tocodynamometer | Examination |
| Premature rupture of membranes | Voiding urine into vagina | Examine fluid |
| Trophoblastic disease | Addition of human chorionic gonadotropin to urine | |
| Vaginal bleeding | Self-mutilation with fingernails, nail files, bleach, knives, tweezers, nutpicks, glass, pencils | Examination |
| Vaginal discharge | Applying cigarette ash to underwear | Examination |
| Systemic | ||
| Fever | Warming thermometer against a light bulb or other heat source, drinking hot fluids, friction from mouth or anal sphincter, false recordings, injection of pyrogens such as feces, vaccines, thyroid hormone, or tetanus toxoid | Simultaneous taking of temperature from two different locals (orally and rectally), recording the temperature of freshly voided urine, the appearance of cool skin despite high thermometer readings, normal white blood cell count, unusually high or inconsistent temperatures |
| Urinary | ||
| Bacteriuria | Contamination of urethra or specimen | Unusual pathogen |
| Hematuria | Contamination of specimen with blood or meat, warfarin ingestion, foreign bodies in bladder (pins) | Collect specimen under observation |
| Proteinuria | Inserting egg protein into urethra | |
| Stones | Feigning of renal colic pain, bringing in stones made of exogenous materials or inserting them into urethra | Pathology report |
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