Multiple surgical interventions: Diagnosis and psychopathology in recurrent operated patients

In this paper we presented a psychopathological and diagnostical review about patients treated with multiple surgical interventions, through the analysis and discussion of four case reports. These conditions are interesting for general medicine and surgery, apart from psychiatry. Indeed, patients with these characteristics are almost invariably subjected to psychiatric evaluation by internal doctors and surgeons and this is evident in our case reports, despite the rarity of the phenomenon in latest decades aside from plastic surgery. According to previous classification of mental disorders in the DSM IV-TR, they are included in the diagnostical category of "Factitious Disorders with Predominantly Physical Signs and Symptoms", even though a careful analysis, through some different parameters, shows their different characteristics and negative prognostical evolution according to the surgical treatment's possible extension to several organs. In the DSM-5 typical clinical manifestations of recurrent operated patients are excluded from diagnostical criterions of "Factitious Disorders". The new manual moves away classic nosographic traduction and highlights a bigger importance of an objective clinical observation of patients than the only clinical history: the most suitable diagnosis is "Somatic Symptom Disorder".