Mistaken Farewell: A Case Where IDT Changed the Trajectory of Factitious Disorder

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Journal of Pain and Symptom Management

Abstract

Factitious disorder is difficult to treat and controversial in medicine. With the ill-defined nature of the disorder there are limited studies, it is underdiagnosed, and the exact prevalence is unknown. The DSM-5 defines factitious disorder as deliberate falsification of physical or psychological symptoms or the induction of injury or disease. Patients can be motivated by a variety of factors. Our patient is a 55-year-old female with factitious disorder, chronic gastritis, and chronic abdominal pain, resulting in severe protein-calorie malnutrition. She had recurrent hospitalizations and multiple medical/surgical interventions, ultimately leading to feeding tube placement. Despite involvement from multiple specialists including palliative care and psychiatry she continued to decline, becoming bed bound with BMI of 14.7 and weight of 75 lbs. The patient requested hospice. The patient's family and care team were concerned with her request and the hospital-based medical ethics team consulted secondary to the complexity of her situation. Ethics determined that allowing her to pursue hospice was not medical abandonment and the patient was able to make an informed decision. She enrolled in hospice; her terminal diagnosis was dysphagia with factitious disorder being a related diagnosis. Following enrollment, she received intensive IDT support. Over the course of 2 months her condition significantly improved. Her symptoms became well controlled, weight increased to 112.2 pounds, G-tube was removed, and she was able to walk. After 59 days on service, she was able to graduate from hospice. The impact of an interdisciplinary hospice team providing compassionate psychosocial support on a weekly basis built trust, led to this patient's significant improvement, and prolongation of life. The hospice philosophy was able to reduce the detrimental effects of factitious disorder by providing empathy and a structured care plan, which allowed her to avoid unnecessary tests and procedures, improve her quality of life, and ultimately, to heal.

Volume

69

Issue

5

First Page

E652

Last Page

E653

Comments

Annual Assembly of Hospice and Palliative Care, Feb 5-8, 2025, Denver, CO

DOI

10.1016/j.jpainsymman.2025.02.341

ISSN

1873-6513

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