What are the best medications to treat factitious disorder?

Factitious Disorder: Medication Management

There are no medications specifically indicated for factitious disorder itself, and psychotherapy—not pharmacotherapy—is the primary treatment approach. 1, 2

Primary Treatment Approach

Psychotherapy, particularly Dialectical Behavior Therapy (DBT), represents the most evidence-based intervention for factitious disorder. 3 The disorder fundamentally involves intentional production of symptoms to assume the sick role, driven by underlying psychological mechanisms rather than a primary biological dysfunction that would respond to medication. 1

Psychotherapeutic Framework

• DBT has demonstrated successful outcomes in case reports, addressing the core learning experiences and behavioral patterns that maintain factitious behaviors. 3
• Psychotherapy focused on identifying and validating the patient's subjective emotional experience may reduce factitious behavior and stabilize the sense of self, though most patients refuse treatment. 2
• A non-aggressive, empathetic therapeutic stance is essential, as confrontational approaches typically fail and may worsen outcomes. 4

Role of Medications: Treating Comorbidities Only

Medications should only be prescribed to target documented psychiatric comorbidities, not the factitious disorder itself. 1, 4

When Medications May Be Appropriate

• Psychiatric comorbidities are common in factitious disorder patients and may include depression, anxiety disorders, personality disorders, or trauma-related conditions. 4, 5
• If comorbid major depression is documented, SSRIs may be appropriate following standard depression treatment guidelines
• If comorbid anxiety disorders are present, standard anxiolytic approaches may be considered
• Avoid prescribing medications based solely on patient-reported symptoms without objective evidence, as this may inadvertently reinforce the factitious behavior pattern. 1

Critical Management Principles

Avoiding Iatrogenic Harm

• The primary goal is preventing unnecessary medical interventions, including avoiding prescriptions that lack clear medical indication. 4
• Unnecessary diagnostic workups and invasive procedures carry significant risks of complications and side effects. 1
• Death, though rare, can occur from complications of examinations, treatments, or suicide. 4

Diagnostic Considerations

• Rule out malingering, somatic symptom disorder, and anxiety disorders before confirming factitious disorder. 1
• Seek positive arguments favoring the disorder rather than relying solely on diagnosis by elimination. 4
• Underlying disturbances in reality testing and sense of self may drive the deceptive behavior, distinguishing it from simple lying. 2

Psychological Mechanisms Informing Treatment

Understanding the psychological underpinnings helps avoid counterproductive interventions:

• Early trauma and interpersonal dysfunction commonly contribute to the disorder's development. 5
• Factitious behavior may serve to stabilize a poorly consolidated sense of self by concretizing distress and evoking caregiver responsiveness in a structured context. 2
• Pathologic needs for attention and care, along with aggression and desire for dominance, represent common interpersonal themes. 5

Prognosis and Realistic Expectations

• Prognosis is often poor, at least in the short and medium term, with most patients refusing psychiatric treatment. 2, 4
• Psychosis and suicidality are potential complications during psychotherapy attempts. 2
• Countertransference management is crucial, as these patients often evoke strong negative reactions in healthcare providers. 5