A 28 year-old female presents in the emergency room for lower abdominal pain and hematuria, inability to move her left hand for two days. She has a history of several emergency room visits and hospitalization visits over the last three years. Over the years, innumerable urinalyses, urine cultures, blood tests, abdominal CT scans, ultrasounds were done, which yielded negative results except for hematuria in urinalysis. She insists on admission to the intensive care unit until a proper diagnosis is made of her abdominal pain and hematuria. She works as a part-time medical assistant. She has been to ‘every damn hospital in the county’. She doesn’t mind admissions to hospitals and subjecting herself to painful invasive procedures, but she is frustrated because ‘no doctor is smart enough to diagnose her condition’. She argues, ‘maybe they should update the DSM-V manual to incorporate new disorders’ like hers. As you go through her medical records, you notice there are many bracketed aliases beside her name. There are no emergency contacts on her chart. Physical examination: normal 5/5 strength in both extremities, normal reflexes in all extremities, multiple scars on the lower abdomen, a partially healed wound on the inner surface of the left wrist, minimal bloody discharge from the urethra. During this admission, the patient was transferred to a room and observed for the night. Next morning, she complained of ‘the worst abdominal pain in my entire life’. She was sent to get an emergency abdominal CT scan. While she was at the radiology department to get her CT scan, one of the room cleaning staff found disturbing objects in the rest room of her room. There are three blood-stained knitting needles wrapped in tissue paper beside the commode seat. CT scan of the abdomen came negative except for some minor injury to the lower urethra. What is the most likely diagnosis in this individual?
