One of the more fascinating and complex aspects of my role as lead for IV therapy and vascular access is managing patients with factitious disorder. This is a perplexing and often mysterious condition that poses numerous challenges for health professionals. This complex disorder involves individuals intentionally faking or exaggerating symptoms of an illness, deceiving medical professionals into providing unnecessary treatments (Bass and Wade, 2019). Although factitious disorder can manifest in various forms, it becomes particularly concerning when it intersects with vascular access and IV therapy.
Vascular access and IV therapy is essential for individuals who genuinely require it, as it can be lifesaving. However, when factitious disorder comes into play, it transforms IV therapy into a tool for manipulation and deception. The risks involved in the use of indwelling vascular access devices, especially long-term catheters, are often higher in this group of patients as there is a high risk of malicious interference with the device itself in order to manifest clinical symptoms of infection (McMillan, 2020).
Unravelling the mystery of factitious disorder requires a deep dive into the motives and underlying psychology of individuals with this condition. The reasons behind faking or exaggerating symptoms can vary greatly, from a desire for attention and sympathy to a need for control or a satisfaction derived from playing the role of a patient (Carnahan and Jha, 2023). It is crucial to understand the intricacies of this disorder to effectively identify and address it.
Individuals with factitious disorder may deceive medical professionals into administering unnecessary IV therapy. This puts the individual at risk and wastes valuable medical resources and time. One misleading behaviour I frequently witness in clinical practice, is individuals with factitious disorder faking symptoms of severe nausea in order to receive cyclizine intravenously. The anti-cholinergic effects may induce hallucinations. Addictive behaviour, drug-seeking behaviour and dependence have been documented (Thursby-Pelham et al, 2009). This addiction often leads to the patient's dependency on long-term vascular access devices, which in turn manifests clinical symptoms that warrant the insertion of these catheters, thus ensuring that vascular access teams are most likely to come across these factitious, cyclizine-dependent patients.
Spotting red flags
- Unexplained and inconsistent symptoms: individuals with factitious disorder may present with symptoms that are inconsistent or don't match their medical history. Patients may exhibit symptoms that fluctuate or worsen unexpectedly, without any clear medical explanation
- Frequent hospitalisations and doctor visits: those with factitious disorder often have a history of excessive hospital admissions
- Requests for specific treatments or medications: keep an eye out for patients who repeatedly request specific treatments or medications, especially if they are seeking intravenous administration of IV cyclizine for nausea and who are unable to take oral preparations or state they are allergic to metoclopramide or ondansetron
- Knowledge of medical terminology: individuals with factitious disorder often have an extensive knowledge of medical terminology and procedures or demonstrate an unusual level of understanding of their purported condition
- Evasive or defensive behaviour: individuals may become defensive, evasive, or reluctant to provide medical records or undergo tests that could potentially expose their deception.
It is essential to maintain a high level of suspicion while also approaching patients with empathy and understanding. Building a rapport with patients can help in effectively addressing and managing factitious disorder in the context of IV therapy.
Collaboration between specialist IV therapy or vascular access teams and the wider multidisciplinary team can play a vital role in prevention and management strategies (Khanal et al, 2021). Multidisciplinary teams can provide comprehensive care that addresses both the physical and psychological needs of individuals with factitious disorder.