Here’s a great review of Factitious Disorder presented today by Family Medicine resident Dr. Garrett Wilcox, MD. It’s a poorly understood form of simulated illness which is distinct from somatic symptom disorders and malingering (an accusation, not a diagnosis) in which the patient deliberately feigns illness and lies to health care professionals about the origin of physical or psychiatric symptoms and signs.
Every month I’m on service as the general hospital psychiatric consultant I get called in which I and other doctors at least suspect that a patient is engaging in deliberate self-injury and deception about it.
Over the years I’ve used both confrontation and nonconfrontation, to which the Eastwood and Bisson reference in Dr. Wilcox’s presentation refers.
I’m always surprised by the results. There doesn’t seem to be much consistency in how patients react. Confrontation is necessary if the patient is doing something to himself which could result in loss of life or limb. If a consulting psychiatrist is going to do this, you have to be implacable about it and have the resources to back it up by having a secure psychiatric unit to which the patient can be admitted–usually by emergency court order. You also need to have medical resources available to manage the many medical problems patients self-induce. A medical-psychiatry unit is ideal.
Generally, non-confrontational approaches are employed if the medical problem the patient is perpetrating on himself is not immediately dangerous.
A University of Iowa physician published a case report about a patient with Factitious Disorder, the colorful Indiana Cyclone.
Always, the goal is to provide safe, compassionate care. Because patients with Factitious Disorder are motivated to deceive doctors, they will usually not admit what they’re doing.
Recovery, not confession, is the goal.
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