The Role of Psychotherapy: Addressing Underlying Factors in Factitious Disorder Treatment

The purpose of this article is to emphasize the importance of psychotherapy as a crucial component in the treatment of factitious disorder.

Factitious Disorder (sometimes called Munchausen syndrome) is a mental health disorder that falls under the category of somatic symptoms and related disorders. Factitious Disorder is subdivided into two categories:

1. Factitious Disorder imposed on the self
2. Factitious Disorder imposed on another

In other situations, individuals with this diagnosis struggle with the falsification of psychological or physical signs associated with their intended deception. Someone with Factitious Disorder might, for example, cause harm to themselves or present someone else as injured or ill. This behavior is often most noticeable because it does not come with any external rewards. 

Those who have a factitious disorder imposed on another person will make up symptoms about another individual being ill. In these cases, the victim needs additional support to ensure their safety and protection in some situations, and that might mean moving to another location where they can have constant monitoring for their symptoms and participating in appropriate therapy. 

This condition has a complex nature characterized by the fabrication or exaggeration of symptoms for psychological reasons. There are many challenges in diagnosing and treating factitious disorders, and for that reason, it is important to get a comprehensive treatment approach that includes psychotherapy.

Treatment for factitious disorder involves psychotherapy like CBT and psychodynamic therapy, as well as integrative approaches and supportive therapy. 

At present, studies indicate that the only effective treatment for the factitious disorder is psychotherapy. Medication has not been shown to significantly improve symptoms. The only exception to this is situations where individuals struggle with co-occurring conditions like factitious disorder and depression, in which case medication can improve secondary symptoms of other conditions.

The most effective strategy for clinicians is to minimize accusations and embarrassment for the individual. This can include participation from other people beyond just the psychotherapist, extending to nurses, doctors, and even family members.

Some experts believe that the most effective treatment strategy taken by clinicians today requires confrontation prior to starting treatment. This confrontation is similar to an intervention and, much like an intervention for addiction, this type of confrontation might result in individuals denying their behavior or refusing to get treatment.

Other experts believe that after someone has been diagnosed, the recommended treatment strategy is to build a relationship between the therapist and the client centered on trust rather than a confrontation. This type of therapeutic treatment strategy has a slightly higher success rate in reducing factitious behaviors and symptoms of other co-occurring mental health disorders. 

Factitious disorder treatment usually involves CBT. Cognitive behavioral therapy is a form of psychotherapy that helps individuals who struggle with factitious disorder to identify any harmful thought patterns that are leading to deceptive and false behaviors. By identifying these patterns, individuals can develop healthy coping mechanisms that replace harmful thought patterns with supportive thought patterns. 

Doing so can help with mild to severe cases, replacing unrealistic beliefs with something more positive and grounded in reality.

In other cases, treatment for factitious disorder includes psychodynamic therapy. Studies have confirmed that for some people, psychodynamic therapy can provide insight into early trauma that led to the development of the interpersonal dysfunction associated with factitious disorder and, as a result, help individuals resolve the trauma that may have contributed to their pathological need for continued attention.

A big part of the success centers on exploring previous experiences, particularly those from childhood. When individuals meet with a therapist for psychodynamic therapy, they have an opportunity to explore experiences from their childhood that have directly influenced how they think and behave today. This can be particularly important in resolving interpersonal dysfunction, early trauma, or maladaptive gratification that was learned at a young age.

Treatment of factitious disorder may involve supportive therapy. A big part of supportive therapy is to address the way an individual with a factitious disorder thinks and behaves. Therapists can help individuals learn to replace unhealthy coping skills with healthy alternatives, control their stress, and work with family members through things like family therapy if necessary.

Supportive therapy might take the form of family therapy, as mentioned. In these cases, family therapy offers an educational opportunity for other family members to learn how to best support the progress that has been made and how to avoid reinforcing the negative behaviors associated with factitious disorder.

Supportive therapy might extend to group therapy, particularly support groups for individuals with this disorder. This can offer an environment where an individual feels comfortable sharing their experiences with other people who have a shared background and potentially learning coping mechanisms and things like stress reduction techniques from people in the group.

Treatments for factitious disorder should involve integrative approaches, too. For many people, an integrative approach is designed to help treat secondary issues like depression, which is very common.

There are a lot of considerations for future directions in factitious disorder treatment. As of late, those who are seeking treatment should avoid invasive or risky treatment options. Given the fact that factitious disorder symptoms can potentially relate to childhood trauma, there might be opportunities for future research to center on trauma-based therapies like EMDR, which could potentially help resolve trauma contributing to ongoing symptoms.

There are currently no direct medications that can be used to treat factitious disorders, although medication has been proven effective for secondary disorders like anxiety or depression. More research could potentially reveal neurobiological changes that contribute to the development of factitious disorder and, from there, the use of things like transcranial magnetic stimulation or medication to achieve necessary improvement or symptom management. 

Psychotherapy plays a critical role in factitious disorder treatment. If you or someone close to you is struggling with a factitious disorder, don’t be afraid to get help through psychotherapy. It takes a collaborative and comprehensive treatment approach tailored to the individual’s unique needs and circumstances to offer long-term help and improvement. That said, there remains the need for further research and clinical efforts to enhance our understanding and management of factitious disorder.