I work in an eating disorder psych hospital and am starting to realize that a small but not insignificant minority of our patients manufacture sx (to varying degrees of severity) in order to secure further tx and maintain the sick role. Does anyone have any good resources on how to structure tx with factitious disorder as the primary dx? Direct confrontation only provokes further escalation and contingency management seems insufficient.
Are you working in an eating disorder psych hospital as a clinician-in-training? This seems like an appropriate question for your clinical supervisor.
Direct confrontation is difficult unless you are skilled therapist (in the style of Kernberg's methods). The patient may not tolerate that type of therapy so you have to develop a different style with some patients, in the style of Kohut or Carl Rogers. But there may be more contemporary theorists who have evidence-based methods that may be more applicable (with the proper training).
For the purposes of this forum, my go-to-answer would be to do some research in peer-reviewed articles about psychotherapeutic treatment for factitious disorder
in the eating disorder population by searching pub-med or one of the psych databases. I can't imagine that you can get a short-answer here because there could be various underlying issues with factitious disorder that are motivating the person to continue whatever problematic behaviors (secondary gain) and any legitimate answer would require more background on each case, which is not appropriate on this forum. I also couldn't imagine a eating disorder case where factitious disorder was the primary diagnoses. Malingering is one thing, but manifesting into full-blown disorder has to have some organic and social factors that are influencing the overall picture. And if you are evaluating someone with factitious disorder who presents with an eating disorder, wouldn't the eating disorder be qualified as more lethal and considered as the primary diagnosis regardless of severity of the factitious disorder? And if the factitious disorder is so severe, have you evaluated all the differential diagnoses, such as personality disorders. You have to consider that the issues that are presented as 'made-up' or unclear to you may be very real for the person.
You could look into schema therapy (or treatment that emphasizes both personality and changes in cognitions and behaviors), but you need specific training in order to proceed. With all that said, I can't say more unless I know your training background and at what level you are involved in treatment. I would just consult your colleagues at your clinic who may have direct access to more relevant information.
I wish I could be more helpful.
Good luck!
