Factitious Disorder – Diagnosis and Treatment

Diagnosis

Diagnosing factitious disorder is challenging. People with this psychiatric disorder often go to great lengths to appear ill, sometimes even causing physical signs themselves.

Healthcare professionals look past the surface symptoms and focus on patterns and inconsistencies in the person’s medical story.

Some red flags include:

• Medical history that does not match known diseases.
• Symptoms that change or do not fit usual patterns.
• Recovery that never happens, even with correct treatment.
• Refusal to provide past health records or let staff contact family.
• Falsifying information or harming themselves.

Often, people with factitious disorder visit multiple healthcare providers and hospitals, sometimes under fake names.

This, combined with privacy laws, makes it hard to check their medical background. Clinicians use strong observational skills and careful note-taking.

Steps Used in Diagnosis

1. Detailed Interviews: Professionals ask specific questions to find details that don’t add up.
2. Reviewing Health Records: Gathering documents, when possible, helps spot inconsistencies across visits.
3. Speaking With Family: If the patient agrees, loved ones can provide useful history.
4. Essential Tests Only: Professionals focus testing to verify real medical conditions and avoid unnecessary risks.

Diagnosis does not involve guessing someone’s motives. Instead, clinicians look for proof that symptoms are made up or self-inflicted. Healthcare workers use criteria from sources like the DSM-5 and ICD-10.

They also consider conditions such as borderline personality disorder, conversion disorder, and pain disorder to make an accurate psychiatric diagnosis.

Treatment

Building Trust Through a Respectful Approach

Addressing factitious disorder requires careful communication and respect. When caregivers focus on building trust instead of confrontation, they lower defensiveness. Patients may be more willing to accept support if they don’t feel accused or blamed.

Instead of suggesting someone is faking their health problems, healthcare professionals acknowledge that not having clear answers is stressful. They gently suggest that stress or other psychological factors might contribute to physical symptoms.

Professionals encourage looking at ways to improve daily life, such as focusing on functioning at school, work, or home, rather than just stopping symptoms.

Sometimes, a healthcare provider will ask the patient to agree that if regular medical treatments do not work, together they will think about possible mental health reasons behind the symptoms.

These conversations support the patient without making them feel embarrassed or exposed.

Caregivers and loved ones play an important role. They support healthy routines and celebrate small progress, while avoiding reinforcing illness behaviors. Encouragement and positive feedback help build self-esteem and trust.

Supportive Methods for Treatment and Management

Treatment for factitious disorder focuses on management, since a direct cure is rare. Therapy and care are tailored to each person. Here’s what management might include:

Method	Goal
Assigned main provider	One trusted professional to coordinate care and limit unnecessary visits.
Psychotherapy	Individual or family therapy to increase awareness and develop coping skills.
Medication	Prescribed if needed for anxiety, depression, or other related psychiatric issues.
Hospital Support	Short stays if there are severe symptoms or to develop a plan for safety and care.

• Ongoing Monitoring: One main health professional, such as a trusted doctor, tracks the patient’s needs. This approach reduces unnecessary tests and hospitalizations.
• Talk Therapy: Behavioral therapy and individual sessions with a mental health provider help the person identify triggers and learn ways to manage stress and somatic symptoms. Family or group therapy might help if the disorder affects loved ones.
• Medications: While no medicine cures factitious disorder itself, doctors prescribe medications if the person shows signs of depression, anxiety, or other psychiatric symptoms. Medicines are only used when clearly needed.
• Hospitalization: In severe situations, a short hospital stay at a mental health facility ensures the patient’s safety and helps create a plan. This is especially true if the person is at risk of self-harm or needs supervision to stop risky behaviors.

Not all patients accept treatment. In cases of severe malingering or where risk is high, clinicians focus on minimizing harm and stopping dangerous or invasive treatments.

If someone creates symptoms in another person (factitious disorder imposed on others), professionals watch for possible abuse and report concerns for safety.

Everyday Actions and At-Home Support

People living with factitious disorder benefit from daily routines and choices that support their overall well-being.

They need to follow their therapy guidelines and take any prescribed medicines as instructed.

If strong feelings or emotional distress come up, they should talk openly with their healthcare provider or counselor about safer ways to handle these emotions.

Having one main medical professional, or a “medical gatekeeper,” helps prevent unnecessary visits to many doctors. This person manages all medical care and keeps track of treatments.

Remembering that unneeded medical tests and surgeries can cause serious harm may help some people avoid risky behavior.

Building positive relationships is useful, as many people with factitious disorder feel alone or disconnected. Connecting with a trusted friend, caregiver, or support group may offer comfort and reduce social isolation.

These steps may help with coping after childhood trauma or victimization, and improve resilience during adolescence or adulthood.

Here is a checklist to support a positive daily routine:

Daily Action	Why It Helps
Follow treatment plan.	Builds trust and stability.
Stay with one main doctor.	Reduces risks and confusion.
Talk about emotions.	Improves coping skills.
Connect with others.	Lowers isolation.

Getting Ready for the Appointment

Steps You Can Take Beforehand

Being well-prepared helps the visit go smoothly and ensures that all important concerns are addressed. Gather and organize the following information:

• Detailed Health History: Write down all past and present health complaints, diagnoses, treatments, and procedures. Bring names and contact details of any healthcare professionals or clinics involved in the person’s care. Collect old medical records, lab tests, and reports to help prevent repeated or unnecessary investigations.

• Current Observations: Note any current behaviors or situations that suggest factitious disorder, like reporting unusual symptoms or avoiding certain activities. Record the dates and specifics of these behaviors if possible.

• Personal Background Highlights: Include important life events, especially past trauma or major losses, which can sometimes affect mental and physical health.

• Medication and Substance Use: List everything the person uses, including over-the-counter medications, vitamins, supplements, and prescribed drugs. Mention the doses. Also, write down any use or misuse of alcohol, recreational drugs, or prescription medications.

• Questions for the Healthcare Team: Bring a list of questions to use during the visit. Sample questions might be:

Question	Purpose
What could be causing these symptoms?	Understand possible reasons for the illness.
Could there be other explanations?	Explore all options.
How is this disorder diagnosed?	Learn about the process and any tests needed.
What treatments do you suggest?	Know about care plans.
Can therapy or family support help?	See if counseling is worthwhile.
What happens next?	Find out about follow-up steps.

Having these details ready lets everyone focus on the person’s health instead of searching for missing information during the appointment.

How Healthcare Professionals Will Guide the Visit

During the visit, the healthcare professional will take time to ask questions and learn about the full picture. Expect them to ask about:

• Medical Complaints and Diagnoses: They may want to know what the person has been treated for, what diagnoses doctors have given, and what treatments or surgeries have occurred. This helps them rule out or discover patterns in symptoms.
• Medical Record Review: They may request to review previous medical records and laboratory tests. This helps prevent repeated tests or unnecessary procedures.
• Healthcare Professional and Hospital Visits: They might ask how often the person has changed doctors or gone to different hospitals.
• Concerns Raised by Others: The professional will likely ask if friends, family, or other clinicians have expressed concern that the illness might be made up, exaggerated, or self-induced.
• Effects on Daily Life: Expect questions about how symptoms have affected work, school, family, or relationships.
• Self-Harm or Harm to Others: The clinician will check for any history of self-injury, attempted suicide, or causing illness in someone else.
• Life Events and Trauma: They often ask if the person has experienced difficult events or trauma, especially in childhood, such as abuse, the death of a loved one, or serious past illness.
• Family Conversations: You may be asked if you have talked to your loved one about your concerns and what you observed.