Unexplained recurrent oral bleeding in an adolescent suggestive of factitious disorder: a case report

Factitious disorder is characterized by the intentional production or feigning of symptoms to assume the sick role without obvious external gain. It poses significant diagnostic and treatment challenges, particularly in pediatric populations where symptoms may mimic organic illness and caregiver involvement is common. We describe the case of a 16-year-old Indian female individual with 13 months of unexplained recurrent oral bleeding. Comprehensive multidisciplinary evaluation, including hematologic panels, imaging, and multiple otolaryngologic procedures, revealed no organic pathology. Psychiatric assessment identified symptom variability linked to stress and attention-seeking behavior, consistent with factitious disorder. Cognitive behavioral therapy and pharmacologic treatment for secondary anxiety were initiated. Supportive measures included limiting duration of hospitalization and educating caregivers. Over time, symptom frequency and distress improved. This case underscores the importance of early consideration of factitious disorder in children presenting with unexplained symptoms after exhaustive investigations. Multidisciplinary collaboration and early involvement of psychiatry are crucial for diagnosis, minimizing iatrogenic harm, and guiding effective management.