health

Factitious disorders are very difficult to diagnose and treat. Because of
the persistent deceit on the part of the afflicted, it is not easy for the
doctor to determine what the problem actually is. The doctor must first
rule out the possibility that the symptoms are real. If a factitious disorder
is suspected, the doctor must determine how well the patient is familiar
with the disease being faked. The patient may know the symptoms but
not their proper order. If the patient then reports something unusual,
such as the symptoms appearing in the wrong sequence, then the doctor
may be cued that the patient does not really have the illness.
A complete diagnosis should involve a careful reading of the medical
records for any inconsistencies or abnormalities. The doctor should also
interview friends and family. Because the factitious disorder patient is
not trying to get well, there should be some system of monitoring the
patient’s compliance with treatment.
Treatment is not easy because the causes of these disorders usually
signify deep psychological problems, likely an underlying personality disorder.
The mental health professional offering therapy has to be careful at
first to develop a supportive relationship with the afflicted. There should
be no early confrontation regarding the patient’s lies except in a crisis
situation. Therapy can follow a conventional pattern after the rapport has
been established. However, the therapist has to be constantly aware that
the patient has a weak ego and low self esteem.