Manipulative behavior in a patient with chronic abdominal pain
A 22 year old female with medical records of ovarian cysts and 'seizures' has been in and out of hospital with chronic abdominal pain. The gynecologists say her ovarian cysts are too small to cause pain and she has had many investigations and surgical review. Still, no cause has been found.. She has been manipulating us for opioid drugs, often switching between being very nice to very mean and destructive to get what she wants. Her seizures have never been shown on any tests and in my opinion don't look like a seizures. They are always 'triggered' when it takes us too long to get her painkillers or when the doctors refuse to increase the dosages of her opioids. She is unpredictable and has lied, said that she hasn't been given her morphine when it is clearly written in her charts that she was given the dose. Would you consider a diagnosis of ficticious disorder or boderderline personality disorder? A referral to pschiatry?