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How Should Physicians Use Their Authority to Name a Stigmatizing Diagnosis and Respond to a Patient's Experience?

Patients with delusional infestation are unlikely to agree to take the mainstay of treatment-antipsychotic medication. While stressing the general importance of truth telling in medicine, we suggest that, in some cases of delusional infestation, patients' lack of decision-making capacity will-provided a series of criteria are met-justify briefly withholding their diagnosis. We acknowledge this action as a kind of deception with ethical pitfalls and discuss those related to prescribing antipsychotic medication without frank disclosure. We recommend full disclosure of a delusional infestation diagnosis when the patient is recovered, despite this action's potential to exacerbate stigma.