Table 3.
Principles of a supportive confrontation of patients suspected of factitious disease∗
| Basis for this confrontation approach: |
| • Factitious disease represents the patient's attempt to cope with emotional distress (although the patient may not recognize this). |
| • The patient is in desperate need of help. |
| • An understanding and supportive attitude by the staff will make it possible for the patient to cope with and live through the shame and shattered self-image that will result from the confrontation. |
| Procedure: |
| • Let the patient know what you suspect but without outright accusation. |
| • Support the suspicion with facts. |
| • Provide empathetic and face-saving comments such as “Maybe you took it in your sleep,” “What you did was a cry for help, and we understand,” “We realize you must be in great distress,” and “We want to continue to take care of you.” |
| • Avoid probing to uncover the patient's underlying feelings and motivations so as to minimize disruption of emotional defenses that are essential to her function. |
| • Assure the patient that only those who need to know will be informed of the suspicion of factitious disease. |
| • Make sure the staff demonstrate continued acceptance of the patient as a person worthy of their help. The attending physician should not abandon the patient but should continue to show interest and concern. |
| • Encourage psychiatric help, but if the patient resists, do not force the issue. |