Factitious disorder is diagnosed when an individual consciously and intentionally makes up the symptoms of a disease. Whereas creating the symptoms is an intentional behavior, the drive to gain the emotional support of health care workers, family and friends is compulsive. Factitious disorder tends to be a chronic behavioral problem and is not easily treated with traditional methods of therapy, but focusing on the needs of the person instead of his actions appears to offer hope.
Background
Psychiatric texts throughout the late 20th century state that factitious disorder is either not amenable to treatment or is very difficult to treat. "Somatoform and Factitious Disorders," edited by Katharine Phillips, M.D., takes a more positive approach. This 2008 release proposes that health care providers use "face-saving" approaches, focusing less on the feigned symptoms and more on the underlying needs of the client.
People with borderline personality disorder, or BPD, often exhibit factitious disorder, leading some psychologists to theorize that it is a trait of BPD instead of a separate disease. Writing in the May 2008 issue of the "Journal of Clinical Psychiatry," Randy Sansone, Ph.D. reported that "Medically self-sabotaging behaviors, the intentional creation of medical symptoms, are commonly encountered in psychiatric inpatients with borderline personality disorder." BPD is a disease characterized by a frantic attempt to avoid abandonment and intense, volatile relationships, and one way that plays out is the creation of fictitious diseases.
Acceptance as a Form of Treatment
In the November 2007 edition of "American Family Physician," researchers from the University of South Florida wrote that "Delivering the diagnosis of factitious disorder is the most important therapeutic step." Treating the person's needs rather than his behaviors is essential.
This step in treatment is deemed successful when the client can openly acknowledge that he needs support or care and that he used the symptoms he presented to get that very real need met. At this level of insight, the client can begin to actively seek treatment that optimizes his chance of living a richer, healthier life.
Medications
When considering the benefits of medication for the treatment of factitious disorder, knowledge from work with clients challenged by its common coexisting disease, borderline personality disorder, provides insight and direction.
Medications commonly used for BPD include SSRI antidepressants, like Prozac and Celexa, anticonvulsants, like Depakote, Tegretol and Lamactil, and agents that increase the activity of the prefrontal cortex, including Provigil.
Psychotherapy for Factitious Disorder
There is little evidence that factitious disorder can be effectively treated by psychological therapy without focusing on building a network of support. "The Spectrum of Factitious Disorders," edited by Marc D. Feldman, M.D., and Stuart J. Eisendrath, M.D., proposes a treatment protocol that "Emphasizes respect for the patient, no matter what the symptomatology." In this text for clinical practitioners, the authors compare various therapeutic methods and find that none of them are successful without this core value of respect.
Coaching for Factitious Disorder
Professional life and health coaching are emerging professions that focus on forward motion and action instead of analysis. In a coaching model, why factitious disorder has developed or how it has affected the individual's life to date takes a back seat to how this particular person can now become strong, resilient and authentically happy. Because coaches neither diagnose nor treat diseases, their work with a person challenged by factitious disorder must involve a physician or other medical treatment provider.
References
- "Diagnostic and Statistical Manual of Mental Disorders, 4th Edition"; Frances, Allen, Harold Alan Pincus and Michael B. First; 1994
- "The Spectrum of Factitious Disorders"; The Spectrum of Factitious Disorders The Spectrum of Factitious Disorders Marc D. Feldman, M.D., and Stuart J. Eisendrath, M.D.; 1996
- SpringerLink: Update on Pharmacotherapy of Borderline Personality Disorder
- PubMed: Relationship Between Medically Self-Sabotaging Behaviors and Borderline Personality Disorder
- "Annual Review of Clinical Psychology"; The Treatment of Borderline Personality Disorder: Implications of Research on Diagnosis, Etiology, and Outcome; Joel Paris, Ph.D.; April 2009
