A nurse is caring for a school-age client in an outpatient clinic.

Exhibits

The nurse should identify which of the client findings are manifestations of a factitious disorder? (Select all that apply.)

A. The client complains of pelvic soreness. Pelvic soreness is a common physical symptom following sexual abuse due to trauma, forced penetration, or muscle tension from psychological distress.
B. The client's urine sample is positive for chlamydia. Sexually transmitted infections (STIs), such as chlamydia, can be a result of sexual abuse. A positive test in a client who has not engaged in consensual sexual activity raises concern for recent or past assault.
C. The client has anal bleeding. Anal trauma, including bleeding, is a strong indicator of possible sexual abuse, especially if there is no medical history of other conditions like hemorrhoids or anal fissures.
D. The client has bruising around the breasts. Unexplained bruising in sensitive areas such as the breasts may suggest physical force during a sexual assault, making this a concerning finding.
E. The client's underwear is bloody. Bloodstains on underwear can indicate genital or anal trauma, which may occur during sexual abuse. This finding warrants further medical and forensic evaluation.
F. The client has a scar on their inner thigh. While scars may suggest past trauma or injury, they do not necessarily indicate recent sexual abuse. Unlike fresh injuries, scars do not provide evidence of a recent assault and are not specific to sexual abuse.

A. Withdrawn: The child's withdrawn behavior, such as looking downcast and avoiding eye contact, may indicate emotional distress or a potential psychological issue, which can be associated with factitious disorder. Individuals with factitious disorder may exhibit emotional signs that reflect their internal struggles and manipulation of health-related situations.
B. Multiple hospitalizations: Frequent hospitalizations, especially without a clear medical diagnosis, can suggest factitious disorder. This pattern often reflects a behavior where an individual seeks medical attention and care, indicating a need to assume the sick role.
C. Unexplained abdominal pain: The presence of unexplained abdominal pain, particularly when combined with a history of seeking medical attention, aligns with factitious disorder. In this condition, individuals often feign or produce symptoms for psychological reasons, leading to repeated medical evaluations without a clear medical basis.
D. Excessive thinking about health: An intense preoccupation with health issues can be indicative of factitious disorder. This behavior demonstrates a focus on illness that may lead to manipulative behaviors in seeking attention or care.
E. Recent trauma: While trauma can contribute to various psychological conditions, it is not specifically indicative of factitious disorder. Many individuals may experience trauma without developing this disorder, making it less relevant in this context.