Treatment

Treatment of factitious disorder is often difficult, and there are no standard therapies. Because people with factitious disorder want to be in the sick role, they're often unwilling to seek or accept treatment for the disorder. However, if approached in a gentle, nonjudgmental way, a person with factitious disorder may agree to be treated by a mental health professional.

Nonjudgmental approach

Direct accusations of factitious disorder typically make the affected person angry and defensive, causing him or her to abruptly end a relationship with a doctor or hospital and seek treatment elsewhere. So the doctor may try to create an "out" that spares your loved one the humiliation of admitting to faking symptoms and offer information and help.

For example, the doctor may reassure your loved one that not having an explanation for medical symptoms is stressful and suggest that the stress may be responsible for some physical complaints. Or the doctor may ask your loved one to agree that, if the next medical treatment doesn't work, they'll explore together the idea of a possible psychological cause for the illness.

Either way, the doctor will try to steer your loved one toward care with a mental health professional. And both doctors and loved ones can reinforce healthy productive behaviors without giving undo attention to symptoms and impairments.

Treatment options

Treatment often focuses on managing the condition, rather than trying to cure it. Treatment generally includes:

  • Having a primary care doctor. Using one doctor or gatekeeper to oversee medical care can help manage needed care and the treatment plan and reduce or eliminate visits to numerous doctors, specialists and surgeons.
  • Psychotherapy. Talk therapy (psychotherapy) and behavior therapy may help control stress and develop coping skills. If possible, family therapy also may be suggested. Other mental health disorders, such as depression, also may be addressed.
  • Medication. Medications may be used to treat additional mental health disorders, such as depression or anxiety.
  • Hospitalization. In severe cases, a temporary stay in a psychiatric hospital may be necessary for safety and treatment.

Treatment may not be accepted or may not be helpful, especially for people with severe factitious disorder. In these cases, the goal may be to avoid further invasive or risky treatments. In cases where the factitious disorder is imposed on others, the doctor assesses for abuse and reports the abuse to the appropriate authorities, if indicated.

May 31, 2017
References
  1. Factitious disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed Jan. 31, 2017.
  2. Factitious disorder imposed on self. Merck Manual Professional Version. http://www.merckmanuals.com/professional/psychiatric-disorders/somatic-symptom-and-related-disorders/factitious-disorder-imposed-on-self. Accessed Jan. 31, 2017.
  3. Yates GP, et al. Factitious disorder: A systematic review of 455 cases in the professional literature. General Hospital Psychiatry. 2016;41:20.
  4. Irwin MR, et al. Factitious disorder imposed on self (Munchausen syndrome). http://www.uptodate.com/home. Accessed Jan. 31, 2107.
  5. Ferri FF. Factitious disorder (including Munchausen syndrome). In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. http://www.clinicalkey.com. Accessed Jan. 31, 2017.
  6. Marx JA, et al., eds. Factitious disorders and malingering. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2014. http://www.clinicalkey.com. Accessed Jan. 31, 2017.
  7. Kahn A, et al. Factitious disorder in Crohn's disease: Recurrent pancytopenia caused by surreptitious ingestion of 6-mercaptopurine. Case Reports in Gastroenterology. 2015;9:137.
  8. Jones TW, et al. Factitious disorder-by-proxy simulating fetal growth restriction. Obstetrics and Gynecology. 2015;125:732.
  9. Burton MC, et al. Munchausen syndrome by adult proxy: A review of the literature. Journal of Hospital Medicine. 2015;10:32.
  10. Sawchuk CN (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 28, 2017.