FOSNOS (short for full of sh*t not otherwise specified) is a new diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders, Sixth Edition (DSM-6).
FOSNOS has been described with increasing frequency over the past two decades, though it only been formally labeled recently. What is unusual about FOSNOS is that it is not specific to any one specialty. One can practice in a primary care clinic, subspecialty clinic, emergency room, medical floor, or procedure suite and likely encounter it with unrelenting regularity.
In the past, FOSNOS has been referred to as BS, BS syndrome, BS disorder, malingering, FOS, and fibromyalgia. In its most classic form, according to the DSM-6, a patient diagnosed as FOSNOS has at least 2 of the 8 following features:
- presents from out of state with their medications recently stolen or accidentally left on public transportation, most commonly a bus or train;
- repeatedly asks for double portions of meals despite persistent complaints of abdominal pain;
- cites allergies to [Tylenol (Acetaminophen)|acetaminophen]], ibuprofen, oral narcotics, and morphine;
- becomes belligerent or histrionic when not offered intravenous narcotics;
- cites allergies to steroid or antihistamines;
- has no objective abnormalities on vital signs, blood work, or imaging;
- becomes highly symptomatic on the day of discharge;
- has a pathognomonic crescendo-decrescendo pattern of exaggerated and inconsistent physical exam findings when a healthcare provider is present-absent.
Informing the patient about the diagnosis carries its own problems; patients become extraordinarily defensive. For this reason, the DSM-6 recommends approaching the patient with a multidisciplinary team including internal medicine, psychiatry, nursing, administration, and security in order to quickly enforce a prompt diagnosis and discharge.
People Who Are FOSNOS
- Dr. Oz