What Are the Treatments for Factitious Disorder?

Factitious disorder compels those afflicted to repeatedly visit medical facilities seeking diagnoses for imaginary or feigned illnesses. Disappointed when deemed to be in good health, they move on to another doctor or a hospital across town. They cheerfully undergo painful tests and procedures the average person would hope to avoid. A clinician diagnosing and treating factitious disorder must accept that statistics do not indicate a favorable prognosis.

History

• The Medical Basis of Psychiatry, 3rd. ed; S. Hossein Fatemi and Paula J. Clayton; 2008 recommends treating factitious disorder with the combined efforts of a general practitioner and psychiatrist. Anxiety disorder is often comorbid with factitious disorder. Treating them concurrently improves the chance for a successful outcome. This patient responds poorly to a confrontational approach. He is more likely to remain in treatment long enough to make progress when he does not feel punished for his behavior.

Treatment Methods

• Treatment begins with establishing a stable relationship between patient and physician with trust as an integral component. Most clinicians use a non-confrontational approach. The factitious manifestations are viewed as a plea for help and no blame is attached to them.

  The contract-conference approach requires the psychiatrist to ask the patient to use terminology relating to difficult relationships; he is encouraged to avoid talking in terms of the factitious illness as he strives for problem resolution. Stopping the patient from seeking unnecessary medical attention is of primary importance.

  CBT (Cognitive Behavioral Therapy) can be an effective treatment only when the patient accepts the fact that he needs help. The patient must agree to work actively with the therapist and complete "homework assignments."

Management

• Psychiatrist EJ Eisendrath reports in the results of a Mayo Clinic study (Eisendrath et. al. 1996) that non-confrontational therapy is the preferred method. It keeps the patient in the hospital long enough to receive help. A psychiatrist decides what treatment is appropriate on a case-by-case basis.

  Counseling and psychotherapy are used as treatments to facilitate management of the disorder. Comorbid disorders are treated concurrently for optimal results. Effective management is the realistic goal with factitious disorder because complete recovery is rare.

Pharmacotherapy

• Antipsychotic drugs are prescribed in some cases. Clinicians who view factitious disorder as similar to OCD (Obsessive Compulsive Disorder) choose to prescribe SSRIs (Serotonin reuptake inhibitors). The August 3, 2009 issue of Mayo Clinic reports some success with the pharmacotherapy in the article, Selective serotonin reuptake inhibitors (SSRIs), by the Mayo Clinic staff writers.

Considerations

• The malingering patient exhibits symptoms similar to those found in the individual with factitious disorder. Clinicians have difficulty in differentiating between the two conditions. factitious disorder is not intentional and has no benefit for the patient except gaining attention whereas, malingering is deliberate and done to gain money, time off work or some other desired benefit.