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A 29-year-old married nurse with pancytopenia was discovered to be surreptitiously ingesting alkylating agents. Despite her life-threatening behavior, there was no evidence that she was psychotic, depressed, or cognitively impaired. Psychological testing was indicative of a sociopathic personality.The patient and her behavior elicited considerable affect and controversy among members of her health team.It is hypothesized that the patient's behavior resulted from longstanding low self-esteem. The production of a dramatic illness gratified dependency needs and fooling physicians gave her a sense of power.