Blurring Fact and Fiction: A Complex Case of Recurrent Emergency Presentations, Polypharmacy, and Psychiatric Conflict

A patient in their early 20s with a complex psychiatric and medical history presented with severe electrolyte imbalance, dehydration, and progressive functional decline. After initial stabilisation, the patient developed recurrent episodes of hypotension, hypoglycaemia, and seizure-like activity despite normal neuroimaging and an established diagnosis of non-epileptic attack disorder. Repeated nursing safety checks revealed concealed medications, including antihypertensives, anticoagulants, semaglutide, and central nervous system depressants, all temporally associated with clinical deterioration and emergency responses. The patient's presentation raised concern for factitious disorder, compounded by comorbid anorexia nervosa, emotionally unstable personality disorder, and complex PTSD. This case highlights the diagnostic and ethical challenges of managing medically unstable patients whose presentations blur the boundaries between psychiatric and somatic illness. It illustrates the risks of reinforcing maladaptive behaviour through repeated interventions and prolonged hospitalisation, emphasising the importance of multidisciplinary collaboration, cautious escalation of care, and early involvement of psychological and ethical support.