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I fell down a rabbit hole on the web...

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I'm still trying to figure out exactly how I fell down this rabbit hole on the internet. But for some reason, I ended up reading a bunch of pubmed articles on factitious disorder (intentionally causing symptoms that require medical treatment/assessment to meet a psychiatric/emotional need).


One of them had a model for "supportive confrontation" to use when a physician suspects that a patient has factitious disorder.


As I was reading this, I kept thinking, "Gosh, wouldn't it be better if people who present at emergency/A&E for self harm got this kind of interaction instead of some of the horror stories we hear about?"




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.



• 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.





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What a great rabbit hole to fall into!!


This kind of compassion and care would be great at all levels of the ER regardless of why someone shows up for treatment. I admire people who do work in the ER. One of my close friends from HS was a nurse in the ER for 15 yrs until she started a family. It takes a lot of calmness and understanding.


I rarely SI and I talk about it even less. I hope those that do find themselves in the unfortunate place of the ER for SI do get the care that they deserve.



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We'll for the record, most people with factitious disorder don't get that kind of treatment at all. The reality is usually the same old horror stories.

I'd heard so many stories of people with factitious disorder being - at the very least - fired, by their doctors, that I was terrified to tell my therapist and psychiatrist when I figured out that's what I had. But They were really wonderful, not only did they not fire me, they increased the support and frequency of sessions, because they felt that's what I needed.

It really depends on how good the provider is, not on the guidelines.

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That would be excellent. I've been to the "psych ER" and I have been so mistreated, like I was not human or deserving of kindness. If only we could be taken in with understanding and respect. I feel that personally when I have wound up there it was bc I was in crisis, real or imagined, it was my perception. I just wish that most staff viewed it that way instead of with judgement and inhumane treatment.

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kate, I'm so glad you got a supportive response from you team!


I would wish that for all of us who need care.


Clearly people aren't doing intentional self injury (either to consciously regulate emotions or because of factitious disorder) because we have better ways to manage things already in place. It's not a willful decision. It's a coping strategy.

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