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Munchausen's
Syndrome
Kara White
Dr. Boissonneault
Case Study
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“A Great Pretender Now Faces the Truth of
Illness”
Miss Scott age 50
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Unhappy with childhood
Sexually abused and neglected
At age 16 had her appendix taken out
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1st time in her life she was happy
Case study cont…
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Admitted herself into more than 600 hospitals
Had over 42 unnecessary surgeries
Would leave one hospital in the AM and be
admitted to another by the PM
Has spent last year and a half truly sick
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Yet no one believed her due to her reputation
Finally a doctor did some tests and she needed
immediate surgery
Miss Scott is now on her death bed
3 Types
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Munchausen's Syndrome
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Munchausen's Syndrome by Proxy (MSBP)
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Munchausen's Syndrome by Internet
(CyberMunch)
Munchausen's Syndrome
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“a condition characterized by habitual
presentation for hospital treatment of an apparent
acute physical illness, the patient giving plausible
and dramatic history, all of which is false; it is a
subtype of factitious disorder.”
Usually very knowledgeable about their “illness”
Very convincing
Most model physical disorders, even though the
disease itself is a psychological one
Munchausen’s vs. Malingerers vs.
Hypochondriacs
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Malingerers seek medical attention to get
themselves out of work, to collect drugs or
even insurance
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Munchausen's pt’s seek strictly for medical
attention
Hypochondriacs think that they are sick
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Munchausen's pt’s are fully aware that they are
not sick
Types Of Patients
They research an ailment and then fake the
symptoms through acting
1.
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Faked heart attack on a plane
They actually do physical harm to their body to
try to mimic a certain ailment
2.
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Injected drain cleaner into bladder to make bloody urine
Or they may even alter lab tests
3.
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Traded tubes after blood was drawn
MSBP
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“a form of child abuse in which a parent
induces a real or apparent symptoms of a
disease in child.”
Usually biological mothers (90%)
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Either falsify their child’s medical history or HPI
Or they inflict harm to the child to mimic a
disease state
Common presentations of MSBP
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GI bleed or UTI
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Vomiting or reflux
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Administering prunes or laxatives
Apnea (may lead to SIDS)
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Administering ipeacac or other drugs
Diarrhea
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Put blood in stool or urine sample
Suffocate child
Hypoglycemia
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Administer insulin or withhold food
Characteristics of Perpetrator
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Biological mother
Usually 20-30
Seem to be loving and caring when around
medical staff
ALL have some sort of marital conflict
50% with medical training in past
Show little emotion when their child is in
distress or pain
CyberMunch
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Join support groups on the internet and then
falsify stories about themselves so that others will
show sympathy towards them and talk to them
about their “misfortunes”
Article entitled “Cybersickness”
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Plane crash, molested and diagnosed with leukemia
One woman who talked to her commented “To discover
that my love and nurturing has been misdirected is like
being taunted with my own illness….its devastating.”
SO…..
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The big question is….how are we, as PA’s,
supposed to recognize and then treat these
patients????
Typical characteristics of
Munchausen's Patients
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Dramatic, but inconsistent medical history
Unclear symptoms that are not controllable and
that become more severe once treatment has
begun
Predictable relapses following improvement in
condition
Extensive knowledge of hospitals and/or medical
terminology
Presence of multiple surgical scars
Characteristics cont…
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Appearance of new or additional symptoms
following negative test results
Presence of symptoms only when the patient is
being observed by others
Willingness or eagerness to have medical tests,
operations or other procedures
History of seeking treatment at numerous
hospitals
Reluctance by the patient to meet with family or
prior doctors
Etiology
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Not known, considered not only a psychological
disorder, but a biological one as well
Possible link to personality disorders???
Perpetrator
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80% with psychological or mental illness
80% were once victims themselves
60% have attempted suicide
70% history of physical and mental abuse
Diagnosis
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The most important step is recognition
Some of the more common presentations
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Feign
Simulate
Exaggerate
Aggravate
Induce
A COMPLETE HISTORY is a must!!!!
Treatment
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No current treatment
Best method is to get the patient to realize
what they are doing to themselves
Cognitive behavioral therapy has been
used, however, most patients are unwilling
to try this
Pharmacological therapy has been useful
only when other co morbid conditions exist
Conclusion
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This is a REAL disorder
These patients have a very high chance of
serious health problems
~ 70% chance of dying from this condition if
lifelong sufferer
Need to be loyal and compassionate with these
patients
Take the time and get a COMPLETE HISTORY!!!!
Questions????
References upon request.