Systems Interventions and Ethical Considerations

The above treatment approaches are aimed at the factitious disorder patient. In the broader context, it is also important to include the system treating the patient in any therapeutic interventions. Once a diagnosis of factitious disorder is made or even suspected, it is appropriate for the primary medical team to obtain psychiatric consultation. The psychiatric consultant can help the team evaluate the psychiatric information the patient provides to see if it is consistent with a factitious disorder. In addition, once a firm diagnosis of factitious disorder is made, the psychiatrist plays a key role in the caregiving system.

It is natural for the medical and nursing staff to react with anger and a sense of betrayal toward factitious disorder patients. The patient, who as part of the societal sick role was supposed to be honest with caregivers and want to recover, is now regarded as an antagonist. It is important for the staff members to explore and ventilate their natural feelings of anger toward the patient. The psychiatrist can play an important role by serving as a leader of a group support meeting in which these feelings can be expressed. If these feelings are not dealt with in this manner, the staff may act out their feelings in some other way (e.g., through premature discharge or through inappropriate medical decisions). The psychiatrist can also educate physicians and nurses about the concept of factitious disorders. This often allows the staff to view the patient with less anger and more appropriately as having a serious psychiatric disorder. The staff meeting also allows for clear intrastaff communication; this is important because factitious disorder patients tend to split staff into opposing factions. Staff meetings often develop the following management guidelines: