There is little aetiological information, as large studies are lacking and the self-reported histories of many patients are fallacious. However, a number of themes are apparent: ^M^

• parental abuse, neglect, or abandonment

• early experiences of chronic illness or hospitalization

• a significant relationship with a physician in the past

• experiences of medical mismanagement leading to a grudge against doctors

• paramedical employment

• organic brain disorder.

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