psychiatric disorders
Factitious Disorder Imposed on Self
Treatment
No clearly effective treatments Treatment of factitious disorder imposed on self is usually challenging, and there are no clearly effective treatments. Patients may obtain initial relief by having their treatment demands met, but their symptoms typically escalate, ultimately surpassing what physicians are willing or able to do. Confrontation or refusal to meet treatment demands often results in angry reactions, and patients usually move from one physician or hospital to another (called peregrination). Recognizing the disorder and requesting psychiatric or psychologic consultation early is important, so that risky invasive testing, surgical procedures, and excessive or unwarranted use of drugs can be avoided. A nonaggressive, nonpunitive, nonconfrontational approach should be used to present the diagnosis of factitious disorder to patients. To avoid suggesting guilt or reproach, a physician can present the diagnosis as a cry for help. Alternatively, some experts recommend providing mental health treatment without requiring patients to admit their role in causing their illness. In either case, conveying to the patient that the physician and patient together can cooperatively resolve the problem is helpful. 