Patients with somatoform and factitious disorders can be unusually challenging and difficult to treat. These patients suffer greatly and are often highly distressed. Their day-to-day functioning may be markedly impaired. Nonetheless, they may be reluctant to accept psychiatric care. These patients may instead ardently pursue treatment from primary care physicians, surgeons, dermatologists, neurologists, surgeons, or other specialists, seeking a medical solution to a psychiatric problem—usually without alleviation of their symptoms. When medical or surgical colleagues refer these patients to us, the patients may feel rejected. They may even refuse to see us and instead go in search of a "better" dermatologist, neurologist, or surgeon.