[Confronting patients about a factitious disorder].

Publications on the technique of confrontation in the treatment of factitious disorder are rare. Two serious cases of factitious disorder are discussed, one of a 25-year-old woman who was admitted after having suffered an epileptic insult in the street. When her general practitioner was contacted it turned out that she had a habit of being admitted to emergency departments presenting with pseudo-insults. The neurologist confronted her rather bluntly with these facts and she disappeared, without proper treatment. The other case was a woman aged 40 who suffered from a leg wound that would not heal. She was encouraged to consult a psychiatrist as well as a surgeon. When it was discovered that she kept the wound open herself, and when a second opinion was to amputate the leg, she was told that in order to give the leg a chance to heal, it needed to be emplastered. She consented but continued to see the psychiatrist and was reassured that the consultations would continue even if the leg had healed, which it did, without recurrence. The technique of the confrontation is of crucial importance for the prognosis of patients with factitious disorder. Factors include ample communication between surgeon and psychiatrist before a psychiatric consultation and confrontation are performed, mild confrontation together with the proposal of a comprehensive treatment plan by the same surgeon and psychiatrist who developed a working relationship with the patient, coordination with the nurses, and so on. The cases suggest that with the right confrontation technique, even serious patients can be treated successfully. Somatic specialists should be aware of the importance of communication with the psychiatrist before they attempt any kind of confrontation in patients with factitious disorder.