How should physicians use their authority to name a stigmatizing diagnosis and respond to a patient’s experience?

Abstract

Patients with delusional infestation are unlikely to agree to take the mainstay of treatment—antipsychotic medication. While stressing the general importance of truth telling in medicine, we suggest that, in some cases of delusional infestation, patients’ lack of decision-making capacity will—provided a series of criteria are met—justify briefly withholding their diagnosis. We acknowledge this action as a kind of deception with ethical pitfalls and discuss those related to prescribing antipsychotic medication without frank disclosure. We recommend full disclosure of a delusional infestation diagnosis when the patient is recovered, despite this action’s potential to exacerbate stigma.