Mon Aug 04 2025

<p>Dr. Nicholas Kontos, Director of the Consultation-Liaison Psychiatry Fellowship at Massachusetts General Hospital and assistant professor of psychiatry at Harvard Medical School, joins us for a reflective conversation on factitious disorder, malingering, and clinical deception. </p><p>We begin by unpacking the concept of “thinking dirty”—a term used in consultation-liaison psychiatry to describe the delicate and often uncomfortable task of considering deception in clinical care. Dr. Kontos walks us through why patients may deceive providers, including both conscious and unconscious motivations, and shares strategies for approaching these situations with clinical humility, curiosity, and compassion. </p><p>We explore practical interviewing techniques to elicit more accurate histories and review key distinctions between factitious disorder and malingering, including diagnostic criteria, prevalence, and typical management strategies. Dr. Kontos discusses the concept of the “therape...