Diagnosis

Diagnosing factitious disorder can be exceptionally challenging due to the individual’s adeptness at simulating various illnesses and conditions. Furthermore, some individuals with factitious disorder may genuinely have life-threatening medical conditions, even though they may have self-inflicted these conditions.

Multiple doctors and hospitals may be involved in the individual’s medical history, often under a fake identity, making it difficult to obtain accurate information about previous medical experiences.

The diagnosis of factitious disorder is based on objectively identifying symptoms that are fabricated, rather than focusing on the person’s intent or motivation for doing so. A doctor may suspect factitious disorder when:

• The person’s medical history is inconsistent or doesn’t make sense
• There is no plausible reason for the reported illness or injury
• The illness does not follow the typical course expected for a genuine condition
• Healing is lacking despite appropriate treatment
• Contradictory or inconsistent symptoms or lab test results are evident
• The person resists sharing information from previous medical records or discussing their condition with other healthcare professionals or family members
• The person is caught in the act of lying or causing self-injury

Seeking Help: Diagnosis and Treatment Options

Medical professionals undertake a comprehensive approach to determine if someone has factitious disorder. This may include:

• Conducting a detailed interview to gather information
• Reviewing past medical records to understand the individual’s medical history
• Working with family members to gain insights, with the patient’s consent
• Running only necessary tests to address possible physical problems
• Using the diagnostic criteria for factitious disorder as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Treatment of Factitious Disorder

Treating factitious disorder can be challenging, as individuals with this condition often do not seek or accept treatment willingly, as they prefer the role of a patient. However, a nonjudgmental approach may be helpful in encouraging the affected individual to consider treatment with a mental health professional.

The Nonjudgmental Approach

Directly accusing the person of factitious disorder can evoke anger and defensiveness, leading to the termination of the doctor-patient relationship. Instead, medical professionals try to offer information and assistance while avoiding humiliation.

For instance, the doctor may suggest that the stress of not having an explanation for medical symptoms may be contributing to physical complaints. Alternatively, the doctor might propose exploring possible psychological causes for the illness if the current medical treatment proves ineffective.

The primary goal is to steer the individual towards care with a mental health professional. Doctors and loved ones can also promote healthy behaviors without giving undue attention to symptoms and impairments.

Treatment Options

Treatment for factitious disorder usually focuses on managing the condition rather than attempting to cure it. Common approaches may include:

• Appointing a primary care doctor to oversee medical care and treatment plans, reducing multiple visits to different doctors and specialists
• Psychotherapy and behavior therapy to manage stress and develop coping skills, potentially involving family therapy as well
• Medications to address any additional mental health disorders, such as depression or anxiety
• In severe cases, temporary hospitalization in a psychiatric facility may be necessary for safety and treatment

However, it’s important to note that treatment may not always be accepted or effective, especially in severe cases. The focus may shift to avoid further invasive or risky treatments. In cases where the individual imposes the disorder on others, the doctor must assess for abuse and report it to the appropriate authorities, if necessary.

Lifestyle and Home Remedies

While professional treatment is essential, individuals with factitious disorder may benefit from the following tips:

• Stick to the treatment plan, attending therapy appointments and taking prescribed medications as directed
• Have a designated primary care doctor to manage medical care, avoiding visits to multiple doctors and hospitals
• Remember the risks of self-inflicted injuries or unnecessary medical procedures
• Avoid seeking new doctors or relocating to evade past medical history, and instead seek help from a mental health professional
• Try to connect with someone trustworthy to confide in and offer support

Preparing for an Appointment

Getting an accurate diagnosis for factitious disorder usually occurs when a doctor suspects psychological factors contributing to the individual’s illness. If you suspect that your loved one may have factitious disorder, the doctor may contact you in advance, with the patient’s consent, to discuss the patient’s health history.

What You Can Do

If you are contacted by your loved one’s doctor, take the following steps to prepare for the discussion:

• Compile your loved one’s detailed health history, including complaints, diagnoses, medical treatments, and procedures
• Note any current behaviors or circumstances that raise concerns about factitious disorder
• Provide key points from your loved one’s personal history, including any childhood trauma or recent significant losses
• Document all medications your loved one is currently taking, including supplements and prescriptions
• Prepare your questions for the doctor to make the most of your discussion

Questions for the Doctor

Consider asking the doctor the following questions during your conversation:

• What is likely causing my loved one’s symptoms or condition?
• Are there other possible causes?
• How will you determine the diagnosis?
• Is this condition likely temporary or long-lasting?
• What treatments are recommended for this disorder?
• How much do you expect treatment could improve the symptoms?
• How will you monitor my loved one’s well-being over time?
• Do you think family therapy will be helpful in this case?
• What are the next steps we should take?

What to Expect from the Doctor

The doctor may ask you several questions, including:

• Recent injuries or illnesses your loved one has complained of or been treated for
• Specific medical diagnoses your loved one has received
• Details about past treatments, including medications and surgeries
• How often your loved one has changed doctors or hospitals
• Any concerns raised by doctors, friends, or family about your loved one causing or contributing to their illness
• Any concerns raised by doctors, friends, or family about your loved one causing illness in another person
• How the symptoms have affected your loved one’s personal and professional life
• Any history of self-inflicted injuries or suicide attempts
• Details about any childhood trauma or abuse your loved one may have experienced
• If you’ve discussed your concerns with your loved one