Discussing Factitious Behavior

When the time comes to acknowledge explicitly the concern about self-inflicted symptoms, patients may be hurt or indignant. I have found it useful to make several points. First, factitious behavior is in fact a phenomenon that doctors encounter with some regularity. Second, certain clinical presentations (eg, recurrent fevers of unknown etiology) make it necessary and prudent to evaluate factitious behavior, and the failure to do is negligent. Third, there is no specific constellation of personal traits that is associated with factitious disorder—patients with this behavior are most often not "crazy" or bizarre in their behavior. I have found it helpful to say that I am strongly inclined to believe the patient's denials, and that I usually believe what patients tell me. However, I have learned that

I make mistakes in this regard, and that it would be irresponsible of me to wager patients welfare on an uncertain intuition. It may also be helpful to tell the patient, if possible, about other medical explanations that remain under investigation.

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