Factitious disorder

Diagnosis

Diagnosing factitious disorder is often very hard. People with factitious disorder are experts at faking many diseases and conditions. And while these people often look like they have real and even life-threatening medical conditions, they may have brought those conditions on themselves.

The use of many healthcare professionals and hospitals, the use of fake names, and privacy and confidentiality laws may make it hard or even impossible to gather information about previous medical experiences.

Diagnosis is based on objectively identifying symptoms that are made up, rather than the person's intent or motivation for doing so. A healthcare professional may suspect that people have factitious disorder when:

• Their medical history doesn't make sense.
• No believable reason exists for an illness or injury.
• The illness doesn't follow the usual course.
• There's no clear reason why they're not getting better, despite the right treatment.
• There are contradictory or inconsistent symptoms or lab test results.
• They don't want to give information from previous health records, other healthcare professionals or family members.
• They're caught lying or harming themselves.

To help figure out if a person has factitious disorder, healthcare professionals:

• Do a detailed interview.
• Require past health records.
• Work with family members to get more information — if the person being examined gives permission.
• Run only tests needed to look at possible physical issues.

Treatment

Treatment of factitious disorder is often hard, and there are no standard therapies. Because people with factitious disorder want to be in the sick role, they often aren't willing to seek or accept treatment for the condition. But if approached in a way that doesn't judge, people with factitious disorder may agree to have a mental health professional assess and treat them.

An approach without judgment

Directly accusing people of having factitious disorder usually makes them angry and defensive. This can cause them to suddenly end a relationship with a healthcare professional or hospital and seek treatment elsewhere. So healthcare professionals may try to create an "out" that spares people the humiliation of admitting to faking symptoms and instead offer information and help.

For example, healthcare professionals may reassure people that not having an explanation for medical symptoms is stressful and suggest that the stress may be responsible for some physical complaints. Or the healthcare professional may ask people with factitious order to agree that if the next medical treatment doesn't work, they'll explore together the idea of a possible mental health reason for the illness. The healthcare professional also may suggest that the focus of treatment be on making them better able to function and making their quality of life better rather than treating symptoms.

Either way, the healthcare professionals try to steer people with factitious disorder toward care with a mental health professional. And both healthcare professionals and loved ones can reinforce healthy, productive behaviors and not give too much attention to symptoms.

Treatment options

Treatment often focuses on managing the condition and making people better able to function, rather than trying to cure it. Treatment generally includes:

• Having a primary healthcare professional. Using one healthcare professional to oversee medical care can help manage needed care and the treatment plan. This can reduce or stop visits to many healthcare professionals that aren't needed.
• Talk therapy. Talk therapy, also known as psychotherapy, and behavior therapy may help control stress and build coping skills. Family therapy also may be suggested. Other mental health conditions, such as depression, also may be addressed.
• Medicine. Medicines may be used to treat other mental health conditions, such as depression or anxiety.
• In-hospital treatment. If factitious disorder symptoms are severe, a short stay in a mental health hospital may be needed for safety and to create a treatment plan.

Treatment may not be accepted or may not help, especially for people with severe factitious disorder. In these cases, the goal may be to stop further invasive or risky treatments. When factitious disorder is imposed on others, healthcare professionals assess for abuse and need to report the abuse to authorities.

Lifestyle and home remedies

Along with professional treatment, these tips may help people who have factitious disorder:

• Stay with your treatment plan. Attend therapy appointments and take any medicines as directed. If you feel an urge to hurt yourself or cause yourself to become ill, talk honestly to your therapist or primary healthcare professional about better ways to cope with emotions.
• Have a medical gatekeeper. Rather than visiting many healthcare professionals, specialists and surgeons, have one trusted primary health professional to manage your medical care.
• Remember the risks. Remind yourself that you could be hurt for life or even die when you have a risky test or surgery that isn't needed.
• Don't run. Resist urges to find a new healthcare professional or flee to a new town where medical professionals don't know your background. Your therapist can help you overcome these powerful urges.
• Connect with someone. Many people with factitious disorder have no friends or close relationships. Try to find someone you can confide in, share enjoyable times with and offer your own support to.

Preparing for your appointment

People with factitious disorder are likely to first get care for this condition when healthcare professionals raise concerns that mental health issues may play a part in an illness. If people have symptoms of factitious disorder, healthcare professionals may get permission to contact family members in advance to talk about their loved one's health history.

Here's some information to help you get ready for that talk.

What you can do

To get prepared, make a list of:

• Your loved one's health history in as much detail as possible. Include health complaints, diagnoses, medical treatments and procedures. If possible, bring the names and contact information of healthcare professionals or facilities that provided care. Help your loved one sign releases of information to get records and allow for talks with other healthcare professionals.
• Any current behaviors or things you observe that make you think that your loved one may have factitious disorder. Note anything your loved one has been avoiding because of symptoms.
• Key points from your loved one's personal history, including childhood abuse or other trauma and any recent major losses.
• Medicines your loved one takes, including supplements, medicines bought without a prescription and prescription medicines, and the doses.
• Misuse of substances, including alcohol, drugs and prescription medicines.
• Questions for the healthcare professional to make the most of your discussion.

For factitious disorder, some questions to ask the healthcare professional include:

• What is likely causing my loved one's symptoms or condition?
• Are there other possible causes?
• How will you make the diagnosis?
• Is this condition likely to last for a short time or a long time?
• What treatments do you recommend 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 help?
• What next steps should be taken?

What to expect from the doctor

The doctor or other healthcare professional will likely ask you several questions, including:

• What injuries or illnesses has your loved one recently complained of or been treated for in the past?
• Has your loved one ever been diagnosed with any specific medical issue?
• What treatments has your loved one had, including medicines and surgery?
• How often has your loved one changed healthcare professionals or hospitals in the past?
• Have any healthcare professionals, friends or family members had concerns that your loved one may be causing or contributing to an illness?
• Have any healthcare professionals, friends or family members had concerns that your loved one may be causing or contributing to illness in another person?
• How have your loved one's symptoms affected work, school and personal relationships?
• Do you know if your loved one has caused self-harm or hurt others, or attempted suicide?
• Did your loved one experience any trauma during childhood, such as a serious illness, loss of a parent or abuse?
• Have you talked with your loved one about your concerns?