The authors report a case of factitious cyanosis in a psychiatric inpatient. To their knowledge, this is the first report of factitious cyanosis in the medical literature. They discuss the relationship of isolated factitious signs and symptoms to Munchausen syndrome and other psychiatric diagnoses. They explore the underlying dynamic of displaced anger in this patient. They suggest that avoiding confrontation with these patients may lead to a better therapeutic outcome and caution physicians to be alert to the possibility of factitious etiology when presented with confusing symptom clusters.