چالش ها در درمان اختلال ساختگی: مطالعه موردی

Factitious disorder is difficult to diagnose and effectively treat. It is often met with intense emotion by both the care provider(s) and the client when suspected. However, if missed or untreated, it can become a chronic syndrome that is expensive and potentially dangerous. This article examines barriers to successful treatment of factitious disorder as manifested by a woman who received services from an urban community mental health center over a 7-year period for the management of multiple mental health issues. The unique role of the advanced practice psychiatric nurse is discussed through application of the nursing theory modeling and role modeling. WHAT ARE THE benefits of being sick? Some might be time off from work, “TLC” from a loved one, sympathy for enduring pain and suffering, or relief from certain expectations of daily life while not being blamed for laziness. For most people, these benefits are temporary and become less desired as illness improves. However, there does exist a psychological disorder in which an individual purposefully feigns or induces symptoms of illness, either physical or psychological, to assume the sick role and attain the emotional benefits of being cared for by another, usually a medical professional or a team of health care providers (HCPs). The American Psychiatric Association (APA, 2000) refers to this phenomenon as factitious disorder (FD).

FD is a complex and baffling condition that often leads to the provider's experience of countertransference that can interfere with how the HCP or a team of providers responds to the client (Krahn et al., 2003). Failure to treat FD can lead to harmful, expensive, and potentially lethal consequences and might be the result of a lack of understanding about what makes people do what they do. Therefore, it is necessary to connect with the client who has this disorder on an empathetic level and remember that this person is suffering and deserves compassion. Treatment success may need to be redefined as the goal in FD is not to cure but to help individuals act out their distress in a more healthful manner (Feldman, 2006, O'Shea, 2003 and Slovenko, 2006). Due to the complexity of FD, it is recommended that a team approach be implemented. One of the key members of this team is the APPN who can bridge the gap between the medical and the psychological aspects of the disorder. The APPN is specifically prepared to treat the whole person and through the use of important nursing theory, such as MRM, it is possible to overcome challenges in the treatment of FD. MRM provides a meaningful framework in which the APPN is able to apply the concepts of nurturance and acceptance, which ultimately leads to cohesion among the health care team and facilitates the client's behavior in a growth-directed manner.