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Factitious Disorder: a systematic review of 455 cases in the professional literature
Abstract
Objective:
Patients with factitious disorder (FD) fabricate illness, injury or impairment for psychological reasons and, as a result, misapply medical resources. The demographic and clinical profile of these patients has yet to be described in a sufficiently large sample, which has prevented clinicians from adopting an evidence-based approach to FD. The present study aimed to address this issue through a systematic review of cases reported in the professional literature.
Method:
A systematic search for case studies in the MEDLINE, Web of Science and EMBASE databases was conducted. A total of 4092 records were screened and 684 remaining papers were reviewed. A supplementary search was conducted via GoogleScholar, reference lists of eligible articles and key review papers. In total, 372 eligible studies yielded a sample of 455 cases. Information extracted included age, gender, reported occupation, comorbid psychopathology, presenting signs and symptoms, severity and factors leading to the diagnosis of FD.
Results:
A total of 66.2% of patients in our sample were female. Mean age at presentation was 34.2 years. A healthcare or laboratory profession was reported most frequently (N=122). A current or past diagnosis of depression was described more frequently than personality disorder in cases reporting psychiatric comorbidity (41.8% versus 16.5%) and more patients elected to self-induce illness or injury (58.7%) than simulate or falsely report it. Patients were most likely to present with endocrinological, cardiological and dermatological problems. Differences among specialties were observed on demographic factors, severity and factors leading to diagnosis of FD.
Conclusions:
Based on the largest sample of patients with FD analyzed to date, our findings offer an important first step toward an evidence-based approach to the disorder. Future guidelines must be sensitive to differing methods used by specialists when diagnosing FD.
... 3 Patients' motivation is unclear, but FD is often understood as a desire to gain attention by playing the sick role, or to achieve a sense of control by challenging and deceiving doctors. [4][5][6] Symptoms can be feigned, falsely reported, or intentionally induced. 6 The most common presentations of FDs involve dermatological, neurological, and endocrine conditions, 5,6 whereas respiratory symptoms are relatively uncommon. ...
... [4][5][6] Symptoms can be feigned, falsely reported, or intentionally induced. 6 The most common presentations of FDs involve dermatological, neurological, and endocrine conditions, 5,6 whereas respiratory symptoms are relatively uncommon. In large FD series, the prevalence of factitious respiratory symptoms ranges from 2.55 5 to 7.5%. ...
... [4][5][6] Symptoms can be feigned, falsely reported, or intentionally induced. 6 The most common presentations of FDs involve dermatological, neurological, and endocrine conditions, 5,6 whereas respiratory symptoms are relatively uncommon. In large FD series, the prevalence of factitious respiratory symptoms ranges from 2.55 5 to 7.5%. ...
... Contudo, após acompanhamento e investigação de série de casos, verificou-se que a origem dos sinais e sintomas relatados, no geral autoprovocados, não possuíam um objetivo claro ou ganho específico esperado. Fator que a diferencia da simulação (entidade não classificada como transtorno psiquiátrico) e do transtorno somatoforme [1][2][3] . ...
... Em avaliações dessa população, é possível identificar uma alta prevalência de casos de abuso sexual (variando de 21 a 79% da amostra feminina) 3,7 . Além disso, a ocorrência concomitante de alguns transtornos psiquiátricos é condição bastante prevalente, sendo mais frequentes o Transtorno de Personalidade Borderline, Transtorno Depressivo Maior (TDM) e Transtorno somatoforme 7,[11][12][13] . ...
... Corroborando com esses complicadores, Yates e Bass 8 detalham que cerca de 45% dos relatos de sintomas autoimpostos são apenas mediante relatos verbais e 57% fisicamente autoinduzidos. Isso demonstra as dificuldades da investigação etiológica, como no caso descrito, uma vez que a relação terapêutica dentro da esfera da psiquiatria se baseia na confiança mútua das informações fornecidas, a fim de se ter o sucesso desejado no tratamento psiquiátrico 3,8 . ...
Objective: To describe the case of a patient with Factitious Disorder (Munchausen Syndrome), who presented both the self-imposed and imposed-on-others forms, along with comorbidities. The challenges involved in the diagnosis and clinical management of this disorder in a specialized psychiatric service are highlighted.
Method: Information was gathered through a review of the medical record, sequential interviews with the patient, discussions with the clinical teams responsible for the case, and an extensive literature review, including 14 scientific articles from two different scientific platforms, published in the last 10 years and a reference textbook.
Results: This review underscores the importance of the topic in clinical practice, considering its financial and legal implications in the management of each case. Additionally, it was possible to delineate the clinical profile of individuals affected by this condition, revealing a marked prevalence among young, married women, predominantly healthcare professionals. Regarding perpetrators, the analysis shows that most are mothers and/or caregivers who exert their influence to impose this condition on others.
Conclusions: The association of both forms of the disorder has a significant impact on public spending and the quality of life of the patient and their families, as well as the legal implications arising from child abuse.
KEYWORDS Factitious disorder; Munchausen syndrome; Factitious disorder imposed on another; Munchausen syndrome imposed on the other; Malingering
... Factitious disorders (FD) present a unique challenge to healthcare providers, especially in the emergency department (ED), given the need to effectively triage based on illness severity and ensure swift diagnosis, crucial for effective care. Conditions involving intentional exaggeration, fabrication, simulation, aggravation, or self-induction of symptoms pose significant challenges for ED personnel, being both diagnostically complex and mentally demanding to manage [1]. ...
... Comorbid psychiatric conditions are common, with depression being the most frequently reported [1,3]. This association may stem from shared risk factors such as childhood neglect, abuse, or traumatic life events. ...
... While previous studies suggest a link between factitious disorder and suicide risk, the exact relationship remains unclear. Factors such as parental failures, substance abuse, and marital difficulties are also potential contributors to the disorder's manifestation [1,3,4]. ...
Munchausen syndrome (MS), a complex form of factitious disorder (FD), presents significant diagnostic and management challenges in emergency and hospital settings. Patients deliberately fabricate or induce symptoms to gain medical attention, often leading to unnecessary interventions, resource misallocation, and iatrogenic harm. This study highlights the diagnostic complexity and the need for multidisciplinary management of Munchausen syndrome through a detailed case report and literature review. A 30-year-old woman presented with neurological symptoms mimicking Guillain-Barré syndrome (GBS), including quadriplegia and sensory deficits. Inconsistencies during physical examination and falsified imaging reports prompted further investigation, uncovering a history of fabricated symptoms and pathological lying. The psychiatric evaluation confirmed the diagnosis of Munchausen syndrome. Differentiating Munchausen syndrome from malingering, conversion disorder, and somatic symptom disorders requires meticulous evaluation and interdepartmental collaboration. Unlike malingering, Munchausen syndrome lacks external incentives, with psychological factors such as trauma and personality disorders playing a central role. Early recognition is essential to prevent unnecessary procedures, reduce costs, and avoid prolonged hospitalizations. This case underscores the need for clinical vigilance and a systematic approach to diagnosis. A multidisciplinary strategy involving psychiatry and other specialties is vital for effective management and improved patient outcomes.
... Diagnosis of factitious disease is often difficult because of its many forms and various degrees of severity and many cases probably go unrecognized. Data about the frequency of factitious disease are scarcely available, but it is estimated that the 1-year prevalence ranges from about 1% to 5% [14][15][16][17][18]. About 90% of patients produce symptoms in a self-harming manner [3]. ...
... About 90% of patients produce symptoms in a self-harming manner [3]. As in the discussed case, the majority of affected patients are typically female in the mid-thirties with a healthcare or laboratory profession [3,18]. In the 36-year history of clinicalpathological conferences at the Medical University of Graz, this is the fifth such case (5 out of 178). ...
... Although patients with factitious disease may appear in any specialist setting, internal medicine (endocrinology, cardiology, gastroenterology, nephrology), dermatology, neurology and emergency departments tend to be more often confronted with such patients [18,20]. ...
... Although severe and widely described, the prevalence of FD/MS is poorly understood for various reasons, including the variable and complex presentations that are often challenging to distinguish from genuine medical conditions, frequent hospital escapes or discharge against medical advice before identification, and the reliance on case reports and limited case series in the literature with insufficient long-term follow-up data [1,3,7,10]. It is estimated that FD is present in approximately 1.3% of all hospitalized patients, with MS accounting for about 10% of cases [6,7,9,11,12] and the highest estimate given by a dermatologist and neurologist [6]. But it can be found in all medical specialties, as described by Yates and Feldman (2016) in their systematic review, including 455 cases of FD [12]. ...
... It is estimated that FD is present in approximately 1.3% of all hospitalized patients, with MS accounting for about 10% of cases [6,7,9,11,12] and the highest estimate given by a dermatologist and neurologist [6]. But it can be found in all medical specialties, as described by Yates and Feldman (2016) in their systematic review, including 455 cases of FD [12]. Despite its relatively low recognized prevalence, MS is associated with significant morbidity, healthcare costs, and even mortality [6,7]. ...
... It is estimated that FD is present in approximately 1.3% of all hospitalized patients, with MS accounting for about 10% of cases [6,7,9,11,12] and the highest estimate given by a dermatologist and neurologist [6]. But it can be found in all medical specialties, as described by Yates and Feldman (2016) in their systematic review, including 455 cases of FD [12]. Despite its relatively low recognized prevalence, MS is associated with significant morbidity, healthcare costs, and even mortality [6,7]. ...
Munchausen Syndrome (MS) has been widely recognized as a severe manifestation of factitious disorder, a condition where individuals intentionally fabricate or exaggerate symptoms for psychological gratification. It represents a complex diagnostic challenge due to its elusive nature and intricate relationship with various medical conditions. We present a clinical case of a 44-year-old woman observed in the context of Liaison Psychiatry, demonstrating the intricate interplay between chronic medical conditions, psychiatric factors, and the challenges in diagnosing and managing MS. The patient exhibited a history of recurrent hospitalizations, difficult-to-heal injuries, and a pronounced preference for surgical interventions. Despite diagnostic difficulties and poor therapeutic adherence, a multidisciplinary team approach involving plastic surgery, orthopedics, physical medicine, and rehabilitation, alongside Liaison Psychiatry, led to the diagnosis of MS with chronic osteomyelitis, ultimately necessitating a transtibial amputation. The case underscores the importance of early detection, a multidisciplinary approach, and the role of Liaison Psychiatry in managing MS. While early diagnosis may not alter the disease course, it can prevent unnecessary interventions and mitigate associated risks. The case also highlights the need for continuous psychiatric support and family involvement in addressing the recurrence of self-injurious behaviors. Further research is essential to enhance our understanding and develop effective treatment strategies for MS, contributing to improved diagnostic precision and overall management of this challenging psychiatric disorder.
... It is usually imposed on self; however, it can be imposed on another (factitious disorder by proxy), often targeting children [109]. It is difficult to unanimously explain the motivations behind the factitious disorder; nevertheless, many professionals agree that it could be traced back to a profound need for medical attention or even tricking medical professionals [110]. A systematic review of 455 cases of factitious disorder carried out by Yates and Feldman showed that endocrine disorders were fabricated the most frequently (59 cases, 12.97%), with factitious hypoglycemia and hypercortisolemia reported the most common, but factitious thyrotoxicosis coming third with eight described cases [110]. ...
... It is difficult to unanimously explain the motivations behind the factitious disorder; nevertheless, many professionals agree that it could be traced back to a profound need for medical attention or even tricking medical professionals [110]. A systematic review of 455 cases of factitious disorder carried out by Yates and Feldman showed that endocrine disorders were fabricated the most frequently (59 cases, 12.97%), with factitious hypoglycemia and hypercortisolemia reported the most common, but factitious thyrotoxicosis coming third with eight described cases [110]. A similar systematic review by Caselli et al. included 514 cases, among which 29 (5.6%) were endocrine-related and factitious thyrotoxicosis was observed in two patients [111]. ...
... A similar systematic review by Caselli et al. included 514 cases, among which 29 (5.6%) were endocrine-related and factitious thyrotoxicosis was observed in two patients [111]. Both systematic reviews showed that factitious disorder was more common in women who often had a history of mental illness [110,111]. However, the case series of 49 patients with a factitious disorder presented by Bérar et al. did not include any cases of thyrotoxicosis, which only highlighted the irregularity and unexpectedness of the disorder [112]. ...
Thyroglobulin (TG) is a dimeric glycoprotein produced exclusively by mature thyroid tissue and stored within the follicular lumen. It is essential for the organification of iodine and the production of thyroid hormones. The concentration of TG in the bloodstream varies between individuals and depends on factors such as thyroid mass, stimulation of the gland by thyrotropin or autoantibodies, and tissue destruction. TG is essential to monitor patients with differentiated thyroid cancer; however, its use is not limited only to this clinical entity. Measurement of circulating TG can provide better insight into numerous clinical scenarios, such as destructive thyroiditis, presence of ectopic thyroid tissue, thyroid trauma, factitious thyrotoxicosis, or iodine nutrition. Lately, TG has found its new clinical use in immune checkpoint-related thyroid dysfunction. TG measurement should be performed carefully in patients with antithyroglobulin antibodies due to possible laboratory interferences. In this review, we offer a summary of current knowledge about the clinical use of TG and the implications it brings to daily practice.
... The patient's motivation can be obscure and arise from a desire for affection or to provide a sense of control. The incidence of FD is unknown because it is often undiagnosed [3]. A previous review found that most patients with FD were female, with a mean age of 34 years, often worked in health care, and often had another psychiatric disorder such as depression, substance abuse, anxiety, and eating disorders. ...
... A previous review found that most patients with FD were female, with a mean age of 34 years, often worked in health care, and often had another psychiatric disorder such as depression, substance abuse, anxiety, and eating disorders. FD cases within endocrinology were reported 59 times, with the most common presentation of hypoglycemia from exogenous antidiabetic medications [3]. ...
... Factitious Cushing syndrome resulting from a surreptitious use of exogenous steroids is rare, with only 9 reported cases in the past 20 years [3]. One case, reported in 2006, involved a 33-year-old female who died from invasive pulmonary aspergillosis before it was determined she was taking daily prednisone for years, resulting in atrophied adrenal glands and cushingoid features [4]. ...
Although most patients are transparent regarding steroid use, rare patients use steroids surreptitiously, which can occasionally result in factitious Cushing syndrome or extensive diagnostic testing. We present 2 cases, 1 with factitious Cushing syndrome and the second with surreptitious steroid use resulting in abnormal laboratory results and a complicated clinical picture. Synthetic glucocorticoid urine testing was positive for triamcinolone acetonide and fluticasone propionate in case 1 and triamcinolone acetonide only in case 2, which clarified the diagnosis and minimized additional and potentially invasive testing.
... In regard to the related literature, the incidence rate of FD has yet remained unaccounted for a wide variety of reasons, including deception; however, it has been higher, as portrayed in the case reports of single women in their 30s, who have typically completed healthcare training courses or have been engaged in careers in the medical field (2)(3)(4). Assuming the vague etiology of FD, multiple causes have been taken into consideration to interpret various behaviors all through this mental condition. Generally, it has been supposed that the motivations underlying such behaviors are not conscious. ...
... In the case report presented herein, a host of issues, including the female gender, being single, inconsistency between the disease symptoms and conventional medical complaints, no reaction to routine medical treatments, absence of companions, caregivers, or visitors, need for numerous laboratory tests, normal examination results, and insistence on the second-time hospital stay for supplementary diagnostic tests, even with the reassurance by the internal medicine physician regarding no physical problems, combined with her initial reluctance to submit oneself to psychiatric diagnostic evaluations, were along the lines of the psychiatric literature on FD (2)(3)(4)(5). ...
... Throughout the physical examinations, the limbs also showed no symptoms of self-harm; therefore, the question raised here was: "Did she have any symptoms of self-harm on other parts of the body?". Furthermore, no mood conditions or personality disorders were spotted in this report; nevertheless, previous research showed the high prevalence rates of comorbid personality disorders and FD by 16.5 -43.1% (2,3,7). Likewise, the next question was: "How were her relationships with other family members and society?". ...
... These chronic forms raise the question of healthcare utilisation, associated cost and iatrogeny during FDIS. Early diagnosis of FDIS could limit these medical and economic effects, but is hampered by the lack of knowledge about the disease [12]. Indeed, the known data on FDIS are mainly based on case series with limited numbers, and on a multitude of case reports which are not necessarily representative of the entire disorder. ...
... Yet, the presence of 20% of subjects over 65 years of age is surprising in comparison with prior literature. In an extensive review of the literature, the average age was 34.2 years [12]. In several samples, the mean age was between 30 and 40 years [7,21,[24][25][26][27][28], and in many of these, the oldest subject was under 65 [7,21,[24][25][26]. ...
... However, it was not possible to define a list of pathologies in the form of which FDIS would never hide, and which could therefore have been excluded from our analysis. In fact, all areas can be affected by deceptive behaviour, even oncology [7,12,22,[30][31][32]. ...
Objective: Patients with factitious disorder imposed on self (FDIS) seek medical care for deliberately falsified problems. Although a large amount of work has been published, the scientific literature lacks robust data on FDIS. The present study aimed to estimate the annual mean of in-hospital FDIS codings in France, describe the sociodemographic characteristics of subjects with FDIS, assess healthcare utilisation and medical nomadism, and describe the pathologies most frequently associated with FDIS.
Method: Subjects with at least one coding of FDIS in French health insurance databases between January 1, 2009, and December 31, 2017 were included. Subjects younger than 18 years of age at the time of first coding were excluded from the study. Sociodemographic data of subjects and diagnoses associated with the first coding of FDIS were collected. Healthcare utilisation and medical nomadism were analysed descriptively from one year before to one year after the first FDIS coding.
Results: 2232 subjects were included, representing an average of 248 new in-hospital FDIS codings per year. The subjects included were 58.2% female. The mean age at diagnosis was 48.5 years. In the year following the first coding of FDIS, 1268 subjects (56.8%) were re-hospitalised at least once, including 159 (7.1%) with at least one new coding for FDIS. From one year before to one year after the first coding of FDIS, 66% of the subjects included had received at least one prescription for benzodiazepines, 58.3% for antidepressants, and 42.6% for antipsychotics.
Conclusions: Our findings bring new data working towards a better understanding of FDIS. The consumption of psychotropic drugs is particularly frequent in patients with FDIS.
... Particularly common presentations include fever, self-induced infection, cardiac problems, gastrointestinal symptoms, impaired wound healing, cancer, renal disease (especially hematuria and nephrolithiasis), endocrine diseases, rash, anemia, bleeding disorders, and epilepsy (Wise & Ford, 1999;Yates & Feldman, 2016). True Munchausen's syndrome requires feigning physical illness and is the most severe form of the illness. ...
... A retrospective survey of over 13,000 children seen either by a consultation liaison service or seen in a tertiary care child health center found an incidence of factitious disorder of 0.5% (Ehrlich et al., 2008). Case series suggest that the majority of people with factitious disorder are womenone review of 455 published cases found 66% of patients to be women (Yates & Feldman, 2016) and a smaller series of cases at one institution found 72% to be women (Krahn et al., 2003) while the majority of patients with the more severe Munchausen's variant are men. A case series of patients with cardiac Munchausen's syndrome (who had an average of six hospitalizations) found that 54% were men (Mehta & Khan, 2002). ...
... Predisposing factors are thought to include (1) serious childhood illness or illness in a family member during childhood, especially if the illness was associated with attention and nurturing in an otherwise distant family; (2) past anger with the medical profession; (3) past significant relationship with a healthcare provider; and (4) factitious disorder (especially factitious disorder imposed on another) in a parent (McKane & Anderson, 1997). It is known that factitious disorder is more common in people in the healthcare professions (Yates & Feldman, 2016), though it is not known if working in healthcare increases the risk for developing the disorder or if people with factitious disorder are drawn to healthcare work. ...
... In an assessment involving prisoners in the United Kingdom, being female was noted as a risk factor for self-harm, with a four-fold higher frequency rate observed for women compared to men [20]. Our results also contrast with the data described by Yates and Feldman [21] and Favril et al. [20], who reported 66.2% of self-mutilation injury cases in women. ...
... No cases were reported for Oceania. Our findings are partially in line with the data reported by Yates and Feldman [21], who also indicated a higher frequency of self-mutilation injury cases in the United States. These authors reported, however, that the most affected continent was the American one. ...
Self-mutilation lesions can represent a clinical diagnosis challenge for healthcare professionals, as patients do not admit to self-mutilation. This leads to failed diagnoses due to the similarity of this condition to other diseases. Searches on the subject were carried out at the PubMed, Periódicos Capes, Scopus, Science Direct and WoS databases, according to the following inclusion criteria: articles in English, Portuguese or Spanish, published from 2018 to June 2023, encompassing case reports, case series and literature reviews. Men are slight more affected by self-mutilation injuries, also presenting the most serious lesions. Self-mutilation injuries are reported globally, mostly in the Asian and American continents. Clinical presentations are varied, but morphology is, in most cases, associated to the form/instrument used for self-mutilation. Greater evidence of diagnosed mental disorders in women and underreporting of these cases in men due to low demands for specialized treatment are noted. A higher prevalence of self-mutilation lesions was verified for men, affecting a wide age range, with the highest number of cases in the USA. The most affected body areas are arms and external genitalia, mostly due to knife use. An association between self-mutilation injuries and mental disorders is clear, with most cases being previously undiagnosed.
... Moreover, cooperation between medical and psychiatric professionals is required to treat these patients since comorbidity diagnoses must be supported by data from studies and outcomes from practitioners in other medical and mental disciplines who have treated the same patient recently or in the past 41,42 . Furthermore, the symptoms, relationship problems, and therapeutic results are more pronounced when chronic depressive illness and personality disorders coexist 42 . ...
... Moreover, cooperation between medical and psychiatric professionals is required to treat these patients since comorbidity diagnoses must be supported by data from studies and outcomes from practitioners in other medical and mental disciplines who have treated the same patient recently or in the past 41,42 . Furthermore, the symptoms, relationship problems, and therapeutic results are more pronounced when chronic depressive illness and personality disorders coexist 42 . In this case, psychiatric management becomes challenging because unresolved conflicts, unmet long-term social needs, and a history of abuse during childhood might have made it more difficult for Com-1 patients to elicit empathy and attention from others through traditional communication techniques or by downplaying the severity of their mental and physical symptoms 43 . ...
Introduction:
In this study, we introduce the concept of comorbidity between factitious disorder (FD), borderline personality disorder (BPD), dysthymia (DY), medically unexplained physical symptoms (MUPS) and functional neurological disorder (FND) characterising patients who may tend to exaggerate physical or psychiatric symptoms of presentation to a general or psychiatric hospital with a constellation of signs that do not receive confirmation from further clinical and instrumental assessments. The similarities between these syndromes and the constant presence of borderline personality in the psychopathology make it the possible link between all these syndromes.
Materials and methods:
The authors captured the typical appearance and characterisation of FD-BPD-DY-MUPS-FND (Com-1) syndrome in adult and non-forensic acute psychiatric hospitals in the United Kingdom (UK) and adjacent liaison psychiatric teams through case vignettes. Each case vignette merged similar clinical cases and was cross-analysed using information from various mental health and medical professionals and bridging primary and secondary carers' records.
Results:
The findings suggest striking similarities between the syndromes making borderline personality the bridge pathology for FD, MUPS and FND. The complexity of the diagnosis of these cases is discussed in the study, together with prototypical presentations.
Conclusions:
Improving the management of these often-occurring diseases requires multidisciplinary coordination across psychiatry, general care, neurology and surgery departments.
... Depression and personality disorders are frequently co-morbid conditions of factitious disorders (13). A previous psychiatric diagnosis should indicate the inclusion of DA in the differential diagnosis for clinical dermatologic presentations (14). ...
... During the initial visit, it is important to provide the patient time to discuss the history of the lesions. The stressors leading to the production of lesions may be also identified at this stage through an active listening approach (9,13,19). ...
Dermatitis artefacta (DA) is a psycho-dermatologic condition based on patients' behavioral patterns, characterized by an intentional production of cutaneous lesions on their own skin. The clinical presentation can be highly variable. Patients with DA seldom seek psychological support or psychiatric consultation. More often, they seek help from their primary care physician or dermatologist. This review article aims to provide a practical guide for the diagnosis and management of AD and affected patients. A broad literature search was performed using the PubMed and Google Scholar electronic online databases, using key words "dermatitis artefacta", "diag-nosis", "management", and "psychodermatology". The search was limited to English and Spanish language articles and was supplemented with themed books and book chapters. DA can occur in a variety of clinical presentations, and physicians should suspect DA in patients with a history of psychiatric disorders or extensive use of healthcare services. The ultimate goal of DA treatment may be a proper referral to mental health services. However, the prognosis is poor even when successful mental health referrals are achieved, with low recovery rates. A useful approach may include the suggestion that a mental health provider can help with the anxiety and the distress generated by the lesions: in this case in this case it will be crucial to discuss this with the mental health provider after obtaining informed consent from the patient. Considering the difficulty in promoting patients' adherence to treatment, the ideal setting for DA treatment is a psycho-dermatologic clinic, where both dermatologic and psychological interventions can be seamlessly integrated.
... A review of sociodemographic data indicates that the majority of perpetrators are female, with an estimated 90%-95% being the biological mothers of the victims [10]. These women frequently exhibit a history of emotional instability, unresolved trauma, or factitious disorder directed at themselves [6,11]. Furthermore, perpetrators frequently appear to be highly involved in their child's care, often portraying themselves as attentive and concerned parents [12]. ...
Munchausen syndrome by proxy is a rare but dangerous form of child abuse in which a caregiver exaggerates, fabricates, or induces medical symptoms in a dependent individual, typically a child. It is of the utmost importance to recognize and address this syndrome, which has significant legal and medical consequences. The failure to identify cases in a timely manner and to implement appropriate intervention strategies may result in irreparable harm or even fatal consequences. This study examined four cases involving 15 child victims and four perpetrators. All individuals were referred to the Turkish Council of Forensic Medicine for evaluation of criminal responsibility. The data were sourced from the National Judicial Network Project and case files spanning a decade. A comprehensive review of the clinical and forensic records was conducted. The four perpetrators, all females aged 27–34, exhibited histories of adverse childhood experiences, early marriage, limited education, and neglect. The clinical manifestations in children included apnea, immobility, bleeding, and bruising. Eleven children died before the abuse was detected, and four children were removed from their homes and placed under the protection of the state. MSBP is still frequently overlooked in clinical practice, which can result in irreparable harm and even death among affected children. The severe cases, as illustrated in this manuscript, demonstrate a recurrent pattern of abuse that persists until the cases are identified. An integrated multidisciplinary approach, involving medical and forensic services, is of paramount importance to facilitate the recognition and prevention of this form of child abuse.
... Factitious disorder imposed on self -Munchausen syndrome -is a syndrome in which patients consciously induce, feign, or exaggerate physical or psychiatric symptoms for the primary motive of assuming the 'sick role' and garnering attention or sympathy from caregivers causing a significant impact on public health and healthcare resources [1]. It is classified under the category "Factitious disorder "[68.1] in ICD-10 and under "Somatic Symptom and Related Disorders" [300.19] in DSM-5. ...
Introduction: Factitious disorder, due to their tendency to have varied presentations, are often well masque in adolescents and young adults. Underlying these presentations typically are psychosocial stresses such as conflicts, interpersonal relationship pressures and scholastic responsibilities, making timely diagnosis and appropriate intervention crucial. Factitious disorders are less prevalent in clinical practice and therefore harder to estimate in general population, especially in uncommon age group and well-adjusted personalities, which make this series unique. Method: The subjects in the following clinical assessment are one 22-year-old and two 16-year-old females. A complete clinical interview, psychosocial assessment and an ICD-10-based evaluation was carried out. The psychological intervention consisted of psychoeducation, psychotherapy and family counselling. Results: All cases involve significant stressors that influenced symptom fabrication. In one case, significant interpersonal conflict with a family member led to self-inflicted injuries explained as animal bites. In another, academic pressures and bullying manifested as self-induced vomiting. Finally, conflict with father led to self-induced mouth bleeding. Management strategies involve risk reduction, addressing psychological and social dimensions of distress, resulting in symptom resolution and improved coping skills. Conclusion: Factitious disorders in youth are uncommon and understudied. This series emphasizes on necessity of early identification and multidisciplinary interventions. Sociocultural milieu needs further exploration to enhance prevention and treatment strategies.
... Factious disorder manifesting as excessive and intentional ingestion of active vitamin D leading to hypercalcemia has not been previously reported. Factitious disorder is a mental health condition in which a patient fabricates illness, injury, or impairment for psychological reasons [4]. These patients often undergo extensive diagnostic evaluations, exhausting medical resources. ...
Excessive 1, 25-dihydroxy vitamin D (calcitriol) is a pathophysiological cause of hypercalcemia. This form of hypercalcemia is seen in autoimmune conditions, fungal infections, lymphoma, and rare genetic diseases. A factious disorder manifesting as intentional ingestion of calcitriol leading to hypercalcemia has not been previously reported. We report a case of a female in the fourth decade with recurrent episodes of hypercalcemia seen at multiple clinics across the United States over a period of 20 years. Several extensive medical workups were unable to identify a specific cause of her non-PTH mediated hypercalcemia. We used a novel approach to determine that her hypercalcemia was secondary to exogenous calcitriol administration. When the patient realized that the etiology had been identified, she refused all further contact with the physician. It is not uncommon for patients with a factitious disorder to deny self-inflicting behavior or to seek care somewhere else. Ingestion of calcitriol should be considered when the etiology of recurrent hypercalcemia cannot be identified by traditional medical testing.
... A manifestation of faking bad or feigning, in which personality disorders and other forms of psychopathology might be particularly pertinent, is factitious disorder. Here, individuals intentionally fabricate symptoms or impairments to gain medical attention and undergo treatment procedures, despite no obvious external incentives (Chafetz et al., 2020;Yates & Feldman, 2016). Normally, factitious disorder bears little relevance to the work of forensic psychologists. ...
In this chapter, we elaborated on the two main forms of distorted symptom reporting: symptom over- and underreporting. In certain situations, individuals might exaggerate their symptoms. For instance, defendants facing legal issues may overstate their mental health problems. This type of behavior is often described with terms such as “faking bad,” “feigning,” and “malingering,” though these should not be used interchangeably with symptom overreporting, as each term carries distinct connotations. Conversely, in other scenarios, individuals may underreport their symptoms. For example, a parent involved in a custody dispute might minimize genuine psychological issues. Symptom underreporting differs from “faking good” or “superlative self-presentation”. Symptom validity tests serve as valuable tools for clinicians and experts to identify distorted symptom reporting in patients, defendants, or plaintiffs. There are numerous symptom validity tests, each varying in diagnostic efficacy, often quantified by Likelihood Ratios. Deviant scores on these tests suggest either over- or underreporting, particularly when the Likelihood Ratio is high. Relying solely on subjective clinical impressions to detect over- or underreporting is not advisable, as it may result in missed cases and misclassification of individuals with genuine issues (i.e., false positives). Therefore, incorporating symptom validity tests into assessments, especially when results can be discussed with the individuals being tested, proves beneficial in correcting distorted symptom presentations. However, these tests alone do not provide sufficient information regarding the motivation underlying symptom over- or underreporting; thus, additional contextual information is necessary.
... 15 The prevalence of factitious disorder ranges from 0.02% to 3%, and it is more common in females among children and adolescents. 50,51 Psychogenic pseudosyncope needs to differentiate from factitious disorder with neurological symptoms. Psychogenic pseudosyncope is classified under conversion disorders, where patients often seek rewards such as care or attention and the diagnosis does not require the judgement that the symptoms are not intentionally produced (i.e., not feigned), whereas factitious disorder is absence of obvious rewards and has intentional falsification of disease in oneself. ...
Psychogenic pseudosyncope is one of the primary causes of transient loss of consciousness in children and adolescents, essentially classified as a conversion disorder that significantly impacts patients’ quality of life. Clinically, psychogenic pseudosyncope shares certain similarities with vasovagal syncope in terms of pre-syncope symptoms and triggers, making it sometimes difficult to differentiate and easily misdiagnosed. Therefore, placing emphasis upon the characteristics of psychogenic pseudosyncope is crucial for early identification and treatment, which holds significant importance for the mental and psychological health of children and adolescents. In the present review, we aimed to address psychogenic pseudosyncope with clinical features, diagnosis, and treatment.
... Artefactual dermatitis should always be considered in the differential diagnosis of chronic, problematic, and recurrent skin disorders, particularly in patients who have psychiatric problems or specific psychological traits. [6][7][8] When dermatitis presents with crusted lesions, it may be challenging to differentiate it from conditions like ecthyma and herpes simplex. In other instances, it can mimic photo-induced connectivitis, cutaneous sarcoidosis, vasculitis, and cutaneous lymphomas. ...
Dear Editor, Dermatitis factitia (DF), also known as dermatitis artefacta, is a rare condition characterized by self-inflicted skin lesions. These lesions can be a result of compulsive habits driven by emotional distress, serving as a means of emotional release during episodes of anxiety or distress. Alternatively, they may be deliberately induced by the patient with the intention of gaining medical attention. DF is essentially the physical manifestation of underlying psychiatric disorders, making it a particularly challenging condition within the realm of medical practice. Being a diagnosis primarily based on the exclusion of an underlying disorder often requires multiple investigations that can impose a significant economic burden. [...]
... Alternatively, a patient could have intentionally induced this sickness for any reason. Lesions induced in both ways can be mistaken as primary dermatological diseases or coexist with them, which makes it even harder to differentiate [7,8]. ...
The self-induced dermatoses represent even about 2% of dermatology patient visits. Dermatological factitious disorder includes actions which lead to the damage of the body tissues without any suicidal intentions. It occurs rarely; thus, it can be misdiagnosed as a more common disease. It most often coexists with an emotionally unstable and immature personality. Accurate interviews and histopathology are of superior importance in diagnosis. Psychotherapy, antidepressants or antipsychotics are crucial in treatment.
... При рецидивирующих гипогликемиях на фоне коррекции или полной отмены инсулинотерапии стоит помнить о синдроме Мюнхгаузена как одной из причин в ряду дифференциальной диагностики гипогликемического синдрома у пациентов с СД [8]. По данным зарубежных авторов, эндокринология является медицинской специальностью с самым высоким уровнем зарегистрированных случаев симулятивных расстройств, из которых наиболее частым проявлением является артифициальная гипогликемия [9]. ...
Artificial hypoglycemia (Munchausen syndrome) is a condition caused by low blood glucose due to the deliberate taking of insulin or oral hypoglycemic drugs. Artificial hypoglycemia remains one of the problems that endocrinologists face in their practice; a diagnostic search for its etiological factor can lead to expensive and unnecessary studies. Diagnosis of artificial hypoglycemia in patients with diabetes mellitus on insulin therapy seems to be a labor-intensive task, since unlike most factitious disorders, which may be indicated by atypical manifestations of the disease or conflicting medical information about the patient, in patients with diabetes mellitus hypoglycemic syndrome is an expected unwanted event due to insulin therapy. Therefore, deliberate insulin administration is often not diagnosed until self-induced hypoglycemia becomes recurrent and/or severe. If artificial hypoglycemia is suspected, a number of authors currently recommend testing С peptide and a combination of two methods for quantitative determination of insulin in the blood using different analyzer systems. Active collaboration between clinical and laboratory specialists is the key to successfully solving such a diagnostic problem.
This article presents a clinical case of Munchausen syndrome in a 28-year-old patient with type 1 diabetes mellitus with recurrent hypoglycemia during 21 years, repeated severe hypoglycemia, including loss of consciousness, and proven intentional administration of an insulin analog drug during hospital stay; the complex diagnostic path passed before making the correct diagnosis is described.
... This finding is contrary to the findings of previous studies, which can be the result of more beds for men in the hospitals studied in this article. The present study showed that the average age of the patients is 32.7 which is consistent with the findings of previous studies (4, 6,15,16). ...
Background
Diagnosing factitious disorder (FD) poses significant medical challenges; delays impact patient care and costs. Cultural factors of each country also affect illness and behavior disorders. This study examines the prevalence, demographics, and clinical features of factitious disorder patients in Iranian psychiatric hospitals.
Methods
This cross-sectional study reviewed patient data from three psychiatric hospitals in Tehran from 2017 to 2022, confirming FD diagnoses by psychiatry faculty. Inclusion criteria were the diagnosis of FD according to ICD-10 in the last five years. We recorded demographic data, main stressors, symptoms and diagnoses and analyzed them with SPSS-25. Data are presented as numbers and percentages and compared between groups by chi-square test.
Results
A total of 17 cases with the diagnosis of factitious disorder were investigated in 5 years (4.315 per 10,000 patients). The highest frequency age range was between 20-30 years, and most of them were male. Our results showed that in only 7 cases, there was initial suspicion of factitious disorder or factitious disorder imposed on another (factitious disorder by proxy). Most of the patients had psychiatric comorbidities, among which the most common comorbidity was substance use disorder and cluster B personality disorder. Among the evidence of suspicion for the diagnosis of factitious disorder in 65% of cases was a history of multiple previous hospitalization and more than 40% of the cases were based on the pattern of repeated symptoms.
Conclusion
This study showed that FD is underdiagnosed, and more attention is needed to the signs of this diagnosis in the assessments. Also, the clinical features showed that treatment should account for comorbid disorders.
... Nghiên cứu của chúng tôi cho thấy một nửa số trường hợp giả các triệu chứng của trầm cảm. Kết quả này phù hợp với nghiên cứu trước đây thông qua việc phân tích 455 trường hợp được chẩn đoán rối loạn giả bệnh từ nhiều nguồn tài liệu chuyên khoa, kết quả cho thấy rối loạn tâm thần phổ biến nhất liên quan đến rối loạn giả bệnh là trầm cảm (41,8%) [6]. Một nghiên cứu khác về rối loạn giả bệnh tại một Bệnh viện Quân đội ở Ả Rập Saudi cho kết quả khoảng 14% các trường hợp giả các triệu chứng của trầm cảm, phần lớn (57%) là có tổn thương da tự tạo, đa số được phát hiện tại Khoa Cấp cứu ban đầu trong bệnh viện [7]. ...
Mục tiêu: Mô tả một số đặc điểm lâm sàng của rối loạn giả bệnh ở nam quân nhân. Phương pháp nghiên cứu: Nghiên cứu hồi cứu, mô tả, chọn mẫu toàn bộ trên 44 nam quân nhân được chẩn đoán rối loạn giả bệnh theo ICD-10, điều trị nội trú tại Khoa Tâm thần, Bệnh viện Quân y 103 từ tháng 12/2022 - 12/2023. Kết quả: Tuổi trung bình của đối tượng nghiên cứu là 21,41 ± 2,63, hầu hết (88,64%) trong độ tuổi 18 - 25, đa số (61,36%) là chiến sĩ có cấp bậc thấp. Hơn một nửa (52,28%) đối tượng nghiên cứu khởi phát trong vòng 3 tháng đầu sau nhập ngũ. Các triệu chứng giống trầm cảm và giống cơn co giật kiểu động kinh gặp nhiều nhất (lần lượt 50% và 38,63%), 50% với mục đích là không tiếp tục phục vụ trong quân đội. Kết luận: Đặc điểm lâm sàng của rối loạn giả bệnh trong quân đội diễn biến đa dạng, hay gặp ở đối tượng trẻ, cấp bậc thấp. Các triệu chứng giống trầm cảm và giống cơn co giật kiểu động kinh gặp nhiều nhất, với mục đích chủ yếu là không tiếp tục phục vụ trong quân đội.
... Μητέρα Σχήμα 6.19 Ιστορικό Ψυχικών Διαταραχών Θύτη Η πλειοψηφία των Κοινωνικών Λειτουργών, με βάση την κλινική τους εμπειρία, δήλωσε πως σε ποσοστό 69% (18 απαντήσεις) είναι πολύ σύνηθες ο θύτης να έχει ιστορικό ψυχικών διαταραχών και αμέσως μετά σε ποσοστό 31% (8 απαντήσεις) ότι είναι σύνηθες Σύμφωνα με την βιβλιογραφική ανασκόπηση, οι ερευνητές συμφωνούν ότι ο γονέας δράστης εμφανίζει ψυχικές διαταραχές, όμως τις περισσότερες φορές η ύπαρξη αυτών παραμένει άγνωστη.Ερώτημα 4. Αν θεωρείτε πως είναι σύνηθες, επιλέξτε τη συχνότερη ψυχική διαταραχή, που έχετε δει, να παρουσιάζει ο θύτης.Σχήμα 6.20 Συχνότερη ψυχική διαταραχή του δράστη Η συχνότερη ψυχική διαταραχή που παρουσιάζει ο θύτης είναι: 69% (18 απαντήσεις) διαταραχή προσωπικότητας, 12% (3 απαντήσεις) κατάθλιψη, 11% (3 απαντήσεις) ψύχωση, 4% (1 απάντηση) διπολική διαταραχή και στο 4% (1 απάντηση) των περιπτώσεων, δεν είχε κάποια επίσημη διάγνωση. Σύμφωνα με τη βιβλιογραφική ανασκόπηση οι έρευνες τωνRosenberg (1987),Sheridan (2003),Yates & Feldman (2016) καιYates & Bass (2017) κατέληξαν στο αποτέλεσμα ότι η κατάθλιψη είναι η πιο συχνή διαταραχή και στην αμέσως επόμενη θέση βρισκόταν οι διαταραχές προσωπικότητας. Βέβαια το να πάσχει κάποια μητέρα από διαταραχή προσωπικότητας δεν αποκλείει το γεγονός ότι μπορεί παράλληλα να πάσχει και από κατάθλιψη, όπως καταδεικνύεται και από την βιβλιογραφία.Ο δράστης συνήθως επικαλείται πως το παιδί έχει: αιμορραγία (31%), επιληπτικές κρίσεις (23%), γαστρεντερικά προβλήματα (15%), πυρετός (11%), τροφική αλλεργία (4%), άπνοια (4%), οφθαλμολογικά προβλήματα(4%), πληγές (4%) και αναπτυξιακές διαταραχές (4%).Τα αποτελέσματα αυτά συμφωνούν με την έρευνα τουRosenberg (1987), η οποία έδειξε ότι πιο συχνά επινοούνται η αιμορραγία και η επιληπτική κρίση με ποσοστό 44% και 42% αντίστοιχα και ακολουθούν η άπνοια με ποσοστό 15% και η διάρροια με ποσοστό 11%.Θεματική Ενότητα 5. ΘύματαΕρώτημα 1. Ποιο φύλο κακοποιείται ποιο συχνά; Σχήμα 6.22 Φύλο κακοποίησης ...
Η παρούσα εργασία πραγματεύεται το ζήτημα της παιδικής κακοποίησης και εστιάζει σε μία ειδική μορφή σωματικής κακοποίησης, το σύνδρομο Munchausen Δι’ Αντιπροσώπου.
Στο πρώτο μέρος της Πτυχιακής παρέχεται βιβλιογραφική ανασκόπηση για την ολιστική προσέγγιση του θεωρητικού υπόβαθρου καθώς και την αποτύπωση μίας ολοκληρωμένης εικόνας αυτού του κοινωνικού φαινομένου με απώτερο στόχο την ενδελεχή πληροφόρηση των κοινωνικών λειτουργών για την ιδιαίτερη φύση και πολυπλοκότητα του.
Στο δεύτερο μέρος ακολουθεί ερευνητική μελέτη στην οποία διερευνάται το επίπεδο γνώσης των κοινωνικών λειτουργών -στον ελλαδικό χώρο- αναφορικά με το συγκεκριμένο αυτό σπάνιο σύνδρομο και επιχειρείται μέσω της κλινικής τους εμπειρίας η επιβεβαίωση προηγούμενων ερευνητικών ευρημάτων συναφών μελετών στο εξωτερικό αλλά και πιθανή ανακάλυψη νέων ευρημάτων. Από μεθοδολογικής πλευράς χρησιμοποιήθηκε η μέθοδος του αυτο-συμπληρούμενου ερωτηματολογίου το οποίο απαντήθηκε από κοινωνικούς λειτουργούς Ιδιωτικού Τομέα, Δημοσίου Τομέα και ΜΚΟ διαφόρων περιοχών της Ελλάδας.
... This review found depression to be highly prevalent in factitious disorder, affecting around 30% of the samples. This result provides support for an association between factitious disorder and mood disturbance (34). According to evidence gathered in this review, signs and symptoms of depression in factitious disorder are identical to those expressed by patients with depression who do not have a factitious disorder. ...
Objective
Factitious disorder is characterized by a pattern of abnormal behavior in which patients deliberately produce, falsify, or exaggerate physical and/or psychological symptoms that have no, or little, organic basis, to assume the sick role. In the context of a factitious disorder, depression can be both a feigned disease and an associated comorbidity. We performed a systematic review to provide an overview of the relationship between factitious disorder and depression, describe the prevalence of depression in factitious disorder, and identify factors that can contribute to the development of depression in patients suffering from factitious disorder.
Methods
A literature search was performed using the electronic databases PubMed, EMBASE and Cochrane Library following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were eligible for inclusion in this review if they investigated factitious disorder or Munchausen Syndrome with comorbid depression.
Results
Depression was found to be highly prevalent in factitious disorder, affecting around 30% of the samples. Risk factors for depression in factitious disorder included having suffered from childhood and adulthood traumatic experiences and having a history of psychosocial problems.
Conclusion
The treatment of factitious disorder is challenging and requires a multidisciplinary team approach. Given the high levels of depression in patients with factitious disorder, we recommend to always screen for depression once a factitious disorder is diagnosed.
... Apart from providing care what is actually required, secondary gains should be cut down and a possibility of Malingering should be ruled out. 7,8 Such patients usually have a precipitating factor of sudden cessation of attention from people, thus trying to feign symptoms in order to gain medical attention. Detailed physical evaluation should be done immediately as a diagnosis of Munchausen's does not exclude a concurrence of a medical disease. ...
Haemolacria, also known as Bloody Tears due to its evident physical presentation, is a rare condition, which causes sudden panic and distress in both, the patient party and the health care providers. The patient, in her late teens, presented in the Department of Emergency Medicine of our tertiary care hospital, with a thin bloodstained streak from her left eye, without any active bleeding. Munchausen's Syndrome is usually a diagnosis of exclusion due to its rarity. Haemolacria, an uncommon but worrying phenomenon, is one of the rare presentations of Munchausen syndrome.
... Only 1% of in-patients present with criteria matching the disorder, but the prevalence of factitious disorder throughout the general population is unknown. Case studies suggest that the two main groups of people most commonly affected by factitious disorder are women between the ages of 20 and 40 with a healthcare background, and unmarried white men aged between 30 and 50 (4,5). ...
... The risk factors to present a factitious disorder include female sex, employment in the healthcare field, and being unmarried [9]. Most often, factitious disorder onsets in early adulthood or middle age [10]. Factitious disorder with physical symptoms is a psychiatric disorder in which sufferers intentionally fabricate illness, injury, or impairment to gain hospital admission and undergo medical procedures without any obvious gain [3]. ...
Background
There is a high prevalence of somatoform disorders and medically unexplained symptoms. When it comes to deciding whether a patient is able to work, it is essential to differentiate a somatoform disorder from a factitious disorder. The case presented demonstrates the impact on disability benefits and the subsequent psychosocial repercussions of misdiagnosing between a factitious disorder and a somatoform disorder.
Case presentation
A 42-year-old Caucasian woman worked as a 100% fiduciary accountant until the age of 32 when she was placed on medical leave due to persistent trigeminal neuralgia. Afterward, she developed total blindness, not explained by a physiological process, accompanied by distress in a crucial emotional context. We evaluated the patient for a revision of a disability income after a diagnosis of factitious disorder with severe consequences such as disability income suspension and family conflict. Our psychiatric examination concluded the diagnoses of pain disorders related to psychological factors and a dissociative neurological symptom disorder with visual disturbance.
Conclusions
Blindness not explained by a physiological process may accompany trauma and psychological distress. Differentiating this pathology from factitious disorder or simulation is essential from an insurance medicine point of view, but also for its treatment.
Somatic Symptom and Related Disorders (SSRD) are a very heterogeneous group of mental health disorders. They include disorders characterized by persistent somatic symptoms with associated distress and disability (SSD, FNSD), by a cognitive preoccupation of having or gaining a somatic condition (IAD), by psychological factors that impact the onset and perpetuation of somatic symptoms (PFAOMC), or by induced somatic or mental symptoms (FD). Compared to many other mental disorders, it is important to consider that SSRD are phenomena in the intersection between medicine, psychology, and other healthcare disciplines. That makes the diagnostic process unique compared to other disorders, and, in addition to the application of common diagnostic tools in mental health (e.g., structured interviews, self-report, and observational tools), it is central to establish a strong collaborative relationship with the patient’s healthcare providers. If possible and if time is given, the diagnostician should also involve other informants (e.g., spouse, family members).
Objetivo: Investigar os desafios éticos e legais associados aos pacientes com Síndrome de Münchhausen na prática médica. Métodos: Realizou-se uma revisão integrativa da literatura, utilizando as seguintes bases de dados: EMBASE, SciELO, Scopus, Web of Science, Lilacs, Medline, Cochrane). Incluiu-se artigos em português, inglês e espanhol, sem restrição de ano de publicação, que abordassem questões éticas e legais relacionadas à síndrome de Munchausen na prática médica. A pesquisa foi orientada pela questão: "Quais são os desafios éticos e legais envolvendo os pacientes com síndrome de Munchausen na prática médica?". Resultados: Dos 3059 artigos inicialmente identificados, 654 foram analisados após a exclusão de duplicatas e artigos não pertinentes. Após a seleção e análise, 7 artigos foram incluídos na amostra final, abordando diversas questões éticas e legais associadas ao manejo da síndrome de Munchausen. Considerações finais: Este mapeamento de publicações, que adota a metodologia das boas práticas para a tomada de decisão, pode beneficiar familiares, gestores e profissionais envolvidos no atendimento de pacientes com Síndrome de Münchhausen. Contudo, é importante destacar que não houve pesquisa na literatura cinzenta, bem como em bases de dados específicas da área de saúde mental e do direito.
Self-inflicted skin disorders without external incentives are conditions in which patients induce, feign, or exaggerate physical or psychiatric symptoms. The anomalous behaviour of these subjects can be linked to various dysmorphic symptoms, such as tension, loneliness, anxiety, and aggression. Patients produce the symptoms artificially using various means, ranging from mechanical to chemical and biotic injuries. Dermatitis artefacta is a disorder consisting of continual self-manipulation of the skin, appendices (hair, nails), and mucosae. The patient denies any responsibility for the problem and presents a clinical history inconsistent with the laboratory findings and physical examination. The lesions are morphologically varied, depending on the simulator’s creativity and the methods employed, and are often in easily accessible areas. Dermatitis simulata is most common in children, who make use of makeup or topical printing dyes to produce a rash or a birthmark. Dermatitis passivata is a result of deliberate failure to wash specific areas of the body: in these cases, a build-up of sebum, dirt, and keratin accumulates on the skin. In dermatological pathomimicry, the lesions are those of a known complaint, achieved through exposure by contact or ingestion to the same agent that had provoked the spontaneous disease. Gardner-Diamond syndrome is characterized by recurrent atraumatic spontaneous, tender skin lesions that develop into ecchymosis, correlated with episodes of severe psychiatric disorders. Morgellons syndrome is morphologically characterized by superficial ulcerations, linear excoriations, and excoriated papules; the patient believes that the cause of the disorder is an infection or infestation, and obsessively self-manipulates the skin. Münchausen syndrome is a chronic, severe type of factitious disease, observed in patients who constantly demand medical care, laboratory tests, and surgery. Münchhausen syndrome by proxy refers to illness induced in children by a parent, often the mother, for the purpose of indirectly acting out the sick role. The management of the above-mentioned disorders is generally extremely complex: the patients usually have a poor prognosis, and the only treatment that could be efficacious is appropriate psychotherapy.
Self-inflicted disorders, or factitious diseases, can be observed in all branches of specialist medicine and represent one of the most challenging problems in clinical medicine. Among them, self-induced dermatoses are inflicted using multiple different means (physical, chemical, or biotic in nature), for various different purposes. In the great majority of cases, the simulation of cutaneous disorders is dictated by psychiatric problems; sometimes, however, simulators are motivated by an illicit intent. Self-inflicted cutaneous disorders are due to excessive manipulation of the skin and appendages, hair, and nails. The anomalous behaviour is typically repetitive, and it is this reiteration that generally leads to chronic damage. Manipulation of the skin can cause a de novo disease, or else complicate the course of a primary dermatological disease, as in the case of pre-existing acne, psoriasis, or other itchy skin conditions. Skin artefacts in subjects with psychiatric disorders, without any venal intent, are described as “pathomimic”; instead, artefact skin disorders caused with illicit intent, aiming to gain various advantages, are true simulations (“malingering”). In both cases, affected subjects deny or deliberately hide their anomalous behaviour. Apart from these cases, there is also a group of body-focused repetitive behavioural disorders (“impulsive-compulsive disorders”) that are inflicted by aware subjects who, in most cases, are very ready to confess their urge to induce self-inflicted lesions. Generally, the lesions are localized on easily accessible areas (face, back of the hands, forearms). Except in situations where the patient wishes to perpetuate or mimic a known dermatosis, the lesions do not show the characteristics of known dermatological afflictions. In all cases of primary self-inflicted skin afflictions, the various laboratory tests are within normal limits; instrumental diagnostic investigations also yield negative results. All these patients need both psychiatric and dermatological treatments.
Being dismissed or disparaged by medical professionals can be shocking and demoralizing for patients, leading to unnecessary harms (e.g., avoidance of medical treatment; depression; shame). This difficulty is further compounded when patients are also the target of wide-ranging stigmatization due to the nature of the medical and behavioral diagnoses they carry, and/or the social identities attributed to them by medical providers. Incorporating both clinical psychology and medical ethics perspectives, two clinical cases are presented demonstrating the insidious nature of the harms incurred to patients from traumatic medical experiences like those described above. Both cases are shown to illustrate the role that a particular form of gaslighting– medical gaslighting– plays in creating the conditions that result in a form of medical trauma. The term “medical gaslighting” currently lacks a clear and stable definition in the larger literature; the authors develop and establish a definition here. The case of Alex is offered, illustrating a standard form of medical trauma recognized in the literature, and the significance of epistemic injustice in preparing the grounds for medical gaslighting. Next, the case of Kiara is considered, in order to demonstrate how medical gaslighting becomes the vehicle for a more subtle form of medical trauma, not currently captured in standard diagnostic criteria. The claims presented here are testable, and the authors suggest that further work expanding the conceptual reach of medical trauma, and incorporating the concept of medical gaslighting into standard practice, is warranted.
A Síndrome de Munchausen (SM), conhecida como transtorno factício, caracteriza-se por indivíduos que simulam sintomas médicos, muitas vezes de forma dramática e exagerada, com o objetivo principal de receber atenção e cuidados hospitalares. O objetivo deste estudo é apresentar os desafios tanto para os indivíduos afetados quanto para os profissionais de saúde que os tratam. Os profissionais de saúde que enfrentam os casos de pacientes com SM devem fazer um diagnóstico preciso para que possam identificá-la e abordála adequadamente. O tratamento, geralmente, envolve intervenções psicológicas para ajudar o indivíduo a lidar com suas necessidades emocionais e psicológicas subjacentes que levam à busca por atenção médica de forma fictícia. Utilizou-se da metodologia qualitativa se valendo de pesquisa bibliográfica realizada coletando dados de fontes secundárias de informação, desenvolvida em buscas nas bases de dados eletrônicos Scientific Eletronic Library Online (SCIELO), Sistema Online de Busca e Análise de Literatura Médica (MEDLINE/PUBMED) e Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS), além de artigos referenciados nessas publicações. Como critério de pesquisa, buscou-se a seleção de artigos científicos publicados entre 2018 e 2023. Destaca-se que essas simulações não são motivadas por um ganho material, como benefícios financeiros. Relatos demonstram casos que corroboram o fato de a SM ser mais observada em mulheres, equivalente a 66,2% do total de casos já analisados em uma revisão. Após a definição do diagnóstico provável, o diagnóstico diferencial mais importante é, obviamente, uma doença física verdadeira. O diagnóstico de SM não exclui a coexistência de outra doença, portanto, a avaliação clínica detalhada é essencial antes do diagnóstico definitivo. O tratamento, geralmente, envolve intervenções psicológicas para ajudar o indivíduo a lidar com suas necessidades emocionais e psicológicas subjacentes que levam à busca por atenção médica de forma fictícia.
Factitious disorder (FD) is a diagnostic entity in which patients intentionally manipulate clinicians by creating false physical or mental symptoms. Although the disorder is rare, having an early diagnosis is critical because it causes unnecessary health expenditures and tends to become chronic. In this article, we discuss two case reports of ophthalmic manifestations of FD. Although the management of FD is challenging, early detection and referral to a psychologist improves the outcome.
Psychiatry is often consulted in the general hospital to assess for underlying psychiatric contributions to a patient’s physical symptoms. Such questions are typically prompted after a medical or neurological evaluation has not identified the etiology of the physical symptoms, if the symptoms are incompatible with or disproportionate to existing medical or neurological pathology, or if the patient is engaging in maladaptive health-related or interpersonal behaviors in the hospital. Provider countertransference in response to patients presenting with psychiatric disorders that feature somatic symptoms—as well as the maladaptive behaviors that may accompany these symptoms—can lead to provider distress or impact patient care and is a critical area for liaison interventions from the consulting psychiatrist. This chapter demonstrates the approach to the hospitalized patient whose physical symptoms may arise secondary to psychological processes or whose psychological response to medical symptoms gives rise to pathological distress, behaviors, and impairment. It highlights some of the psychological factors that may contribute to the experience of and response to somatic symptoms, as well as some of the challenging interpersonal dynamics that occur in the hospital setting. Clinical cases involving somatic symptom disorder, conversion disorder, and factitious disorder present strategies for making complex diagnoses, therapeutic interventions, and effectively engaging these patients in psychiatric evaluation and treatment.
Amaç: Yapma bozukluk, hastanın bilinçli olarak hastalık rolü yaptığı bir ruhsal hastalıktır. Hastanın işbirliğine yatkın olmaması, farklı branşları ilgilendiren farklı hastalık görünümlerinde karşımıza çıkabilmesi nedeniyle tanı konması, takip edilmesi ve bilimsel çalışma yürütülmesi güç bir hastalıktır. Halen yapma bozukluğun epidemiyolojisi, etiyolojisi, tanı ve tedavisi alanlarında yeni çalışmalara ihtiyaç duyulmaktadır. Bu çalışmada, bibliyometrik yöntemler kullanılarak yapma bozukluk araştırma alanının geçmişini gözden geçirmek ve gelecekteki eğilimini anlamak ve bu alanda yürütülecek çalışmalara referans sağlamak amaçlanmıştır. Gereç ve Yöntem: Web of Science çekirdek koleksiyonundan yapma bozukluk ile ilişkili çalışmalar derlenerek, bu çalışmaların yazarları, kurumları, ülkeleri, yayınlayan dergileri, alıntıları ve anahtar kelimeleri hakkında VOSviewer programında bibliyometrik analiz yapılmıştır. Bulgular: Toplam 1573 çalışmadan, çalışmaya dahil edilme kriterlerini karşılayan 676 çalışma analize alındı. Yapma bozukluk alanında yapılan çalışmaların büyük kısmının Amerika (n: 259) ve İngiltere’de (n: 87) yürütüldüğü, Alabama Üniversitesi, Harvard Üniversitesi, California San Francisco Üniversitesi’nin alandaki en etkili kurumlar olduğu, bu kurumlar arasında güçlü bir iş birliği ağı olduğu, Mark D. Feldman (n: 28) ve Roy Meadow’un (n: 15) en çok çalışma yürüten yazarlar olduğu saptanmıştır. Literatürde yıllık ortalama atıf sayısı en yüksek olan çalışmaların, vaka serileri ve derlemelerden oluştuğu, etkili ve yeterli analitik çalışmanın bulunmadığı gösterilmiştir. Sonuç: Bu çalışmada, yapma bozukluk alanında ülkeler, kurumlar ve yazarlar arasında güçlü bir işbirliği ağı olduğu gösterilmiştir. Yürütülen en etkili çalışmaların literatürdeki vaka sunumlarının derlemelerinden oluştuğunun belirlenmesi, etkili ve analitik çalışmalara ihtiyaç olduğunu düşündürmüştür. Son dönemde seçilen anahtar kelimeler, hastalığın epidemiyolojisi, yaygınlığı, adli ve etik yönleri, internet üzerinden yapma bozukluğunun ve bakım verenin yapma bozukluğundan etkilenen çocuklara yönelik multidipliner yaklaşımların güncel çalışma konuları olduğunu işaret etmiştir.
Mental fitness is a country of stability among the individual & the girding world, a country of concord among oneself & others. Mental sicknesses may be labeled in colourful orders & this Factitious grievance comes below the F80 of ICD10 bracket.1 The investigator found that secondary school teachers have lack of knowledge regarding factitious disorder the primary level as they are neglecting the lifestyle changes. Hence, the researcher is interested to educate the Secondary school teacher regarding factitious indications through Self-Instructional Module. The study was conducted to assess the knowledge regarding factitious disorder with the help of Self-Instructional Module among secondary school teachers of CRIST CHURCH INTER COLLEGE. 60 sample were collected by using non probability purposive sampling technique through structured knowledge questionnaire the data collected and analyzed based on descriptive and inferential statistics. The result of the study showed that the post-test mean score (22.31) was high when compared to the pre-test mean (13.85) score of knowledge. The obtained "t" value (9.92) was greater than table value p < 0.05 at df 118 which was p < 0.05 level of significance, which shows that there is significant difference between pre-test and post-test level of knowledge regarding factitious disorder among secondary school teachers. Hence H1 was accepted and H01 was rejected. The test revealed that there was no significant association of knowledge with selected demographic variables such as age in years age, gender, education, income, previous knowledge, and source of information. The study concluded that Self-instructional Module was effective and improves knowledge regarding Factitious disorder among secondary school teachers.
Are psychosomatic disorders a utopian category? About Functional Neurological Disorders and the discretization error hypothesis. Among psychosomatic conditions, functional neurological disorders (FND) are very common, sometimes in the form of conversion, sometimes in that of somatization. They should be differentiated from factitious disorders and malingering. Four clinical cases are presented to illustrate the current state of our knowledge on the subject. Secondly, the use of placebo for diagnostic or therapeutic purposes is discouraged in FND. However, a link is established here between functional disorders and the placebo effect. This link is confirmed by functional brain imaging (the region of the dorsolateral prefrontal cortex is of particular interest), as well as genetics studies (tryptophan hydroxylase 2 [TPH2] gene polymorphism G703T). This results in FND and the placebo effect belonging to the same utopian family, sharing a similar physiology: the House of Utopia. Finally, the aetiology of FND is discussed and an original hypothesis is presented: the implication of a discretization error in the unconscious management of interoceptive and proprioceptive sensory data, which would result in the transmission at the conscious level of an altered avatar of the bodily representation, mistakenly identified as a somatic disorder. The same process would be at work in the placebo effect.
Psychogenic non-epileptic seizures may resemble epileptic ones, but bioelectric activity is not recorded on the electroencephalogram. In some cases, psychogenic non-epileptic seizures and epilepsy are diagnosed simultaneously. The frequency of epilepsy in patients with diagnosed psychogenic non–epileptic seizures is 22%, and the incidence of psychogenic non-epileptic seizures among patients with epilepsy is 12%. The article describes a clinical case of a patient with diagnosed epilepsy, in whom psychogenic non-epileptic seizures were detected simultaneously with epileptic seizures. Polymorphic non-convulsive and convulsive seizures were observed in the clinical presentation. The patient received anti-epileptic therapy in high doses for a long time without significant effect. Convulsive seizures in most cases occurred during the day in crowded places in the presence of people. Most often, the patient managed to attract the attention of others and ask for help. A pathopsychological examination revealed a pronounced sharpening of hysteroid and epileptoid traits with excessive fixation on the state of the patient's health. For the first time in years of being treated by different doctors, the patient admitted during psychotherapy that convulsive seizures that occur with her are "useful". It was advantageous for her to take on the role of a person out of health in order to protect herself from her husband's aggression and get sympathy, feel special, get rid of extra burden at work. The article provides a differential diagnosis between factitious disorder, conversion disorder, simulation and aggravation. It is concluded that convulsive seizures in the patient occurred by the mechanism of a factitious disorder. The following facts speak in favor of this: motivation for this behavior is not clear to others and is of an internal nature, the desire to accept the role of a person out of health, awareness of seizures "usefulness", lack of attention in the family, hysteroid character traits. It is concluded that for the successful treatment of comorbidity conditions of psychogenic non-epileptic seizures and epilepsy, close interaction of a neurologist, a psychiatrist, a psychotherapist and a psychologist is extremely important.
The article presents a case of Munchausens syndrome featuring complaints of progressive vision loss not previously reported in Russian literature. Within the research scope, we performed psychopathological enquiry, analysed the medical examination records of the involved specialists, as well as review of modern literature. Existing obstacles in the diagnostics of the syndrome in question were investigated including particularities of ophthalmological practice and it is concluded that alertness of doctors of all specialties in respect of feigned symptoms cases should be increased to properly manage such patients and prevent prescription of unnecessary potentially harmful medical interventions.
This study reports a rare case of high-dose midazolam abuse and Munchausen Syndrome. A 48-year-old female physician was referred by a psychiatrist to the Toxicology Department of Imam Reza Hospital for abstaining from 300 mg/day of parenteral midazolam. She had mimicked the symptoms of Crohn's disease; therefore, she had undergone 15 colonoscopies and 40 times MRI or CT scan, all of which were normal. Six months earlier, she had switched oral methadone to 30 mg/day of intravenous midazolam. She also had several skin lesions on injection sites that she considered pyoderma gangrenosum. When the total daily dose of intravenous midazolam was switched to oral bioequivalence of clonazepam, she could not tolerate withdrawal (Clinical Institute Withdrawal Assessment Scale-Benzodiazepines = 68). Therefore, she received midazolam again as a continuous intravenous infusion. Within 7 days, the whole dose was replaced by the bioequivalence oral dose of clonazepam. She was also treated with carbamazepine and cognitive behavior therapy. Afterward, she was transferred to the psychiatric ward for further psychiatric treatment. Dependency on a high dose of midazolam could be treated by tapering off the long-acting benzodiazepine.
Limb subcutaneous emphysema secondary to a Munchausen syndrome represents a rare and severe entity because it involves the functional prognosis of the limb and vital prognosis of the patient.
We report the case of an 18-year-old Moroccan woman patient who presented to our hospital with a subcutaneous emphysema of the shoulder girdle and the right arm, caused by our patient. Treatment was aggressive, with a wide surgical debridement, parenteral antibiotic therapy and hyperbaric oxygen therapy. The results have been favorable.
The correlation of anamnestic data and clinical and para-clinical exams were essential for the diagnosis of Munchausen syndrome in this case. In this regard, we report a rare case of subcutaneous limb emphysema secondary to Munchausen syndrome.
Factitious disorder is a rare psychiatric illness characterized by the willful and deceptive induction of illness for the purpose of assuming the sick role. It presents a substantial diagnostic challenge, as patients often go to great lengths to conceal their deception. Accordingly, its presence in the full spectrum of gastrointestinal diseases is likely underappreciated. While factitious gastrointestinal bleeding, abdominal pain and diarrhea are relatively common, factitious non-gastrointestinal symptoms in the setting of gastrointestinal illness have been infrequently reported. We present the case of a patient with Crohn's disease with recurrent pancytopenia attributed to the surreptitious ingestion of 6-mercaptopurine. In patients with possible access to immunomodulatory drugs, a high suspicion for and early identification of factitious disorder may improve patient outcomes and avoid invasive and costly diagnostic evaluations.
Mistaking psychogenic nonepileptic paroxysmal episodes (PNEPEs) for epileptic seizures (ES) is potentially dangerous, and certain features should alert physicians to a possible PNEPE diagnosis. Psychogenic nonepileptic paroxysmal episodes due to factitious seizures carry particularly high risks of morbidity or mortality from nonindicated emergency treatment and, often, high costs in wasted medical treatment expenditures. We report a case of a 28-year-old man with PNEPEs that were misdiagnosed as ES. The patient had been on four antiseizure medications (ASMs) with therapeutic serum levels and had had multiple intubations in the past for uncontrolled episodes. He had no episodes for two days of continuous video-EEG monitoring. He then disconnected his EEG cables and had an episode of generalized stiffening and cyanosis, followed by jerking and profuse bleeding from the mouth. The manifestations were unusually similar to those of ES, except that he was clearly startled by spraying water on his face, while he was stiff in all extremities and unresponsive. There were indications that he had sucked blood from his central venous catheter to expel through his mouth during his PNEPEs while consciously holding his breath. Normal video-EEG monitoring; the patient's volitional and deceptive acts to fabricate the appearance of illness, despite pain and personal endangerment; and the absence of reward other than remaining in a sick role were all consistent with a diagnosis of factitious disorder.
The diagnosis of anaphylaxis is often based on reported symptoms which may not be accurate and lead to major psychosocial and financial impacts. We describe two adult patients who were diagnosed as having recurrent anaphylaxis witnessed by multiple physicians based on recurrent laryngeal symptoms. The claimed cause was foods in one and drugs in the other. We questioned the diagnosis because of absent documentation of objective findings to support anaphylaxis, and the symptoms occurred during skin testing though the test sites were not reactive. Our initial skin testing with placebos reproduced the symptoms without objective findings. Subsequent skin tests with the suspected allergens were negative yet reproduced the symptoms without objective findings. Disclosing the test results markedly displeased one patient but reassured the other who subsequently tolerated the suspected allergen. In conclusion, these 2 patients' symptoms and evaluation were not supportive of their initial diagnosis of recurrent anaphylaxis. The compatible diagnosis was Munchausen stridor which requires psychiatric evaluation and behavior modification, but often rejected by patients.
Factitious Disorder (FD) is poorly understood because of the elusiveness of sufferers. What is known is based on speculation from observational case studies and this is evident by the manifold diagnostic and treatment issues associated with FD. This study sought to fill the gap in the literature and overcome the elusiveness of FD sufferers by analysing their text communications in two online communities. 124 posts by 57 members amounting to approximately 38,000 words were analysed using grounded theory. The analysis showed that contrary to current theories of FD, motivation is conscious and not unconscious, members did experience symptoms associated with the disorder, and they were also upset by their behaviour and wanted to recover but were deterred by fear. Furthermore, using the excessive appetitive model by Orford (2001) it is hypothesised that the characteristics of FD described by the members were congruent with those associated with addiction.
Factitious disorder is amongst the more intriguing but less-studied psychological disorders. Studies from different parts of the world have reported of varying prevalence rates. Here, we try to study the prevalence of factitious disorder in a specific sample of patients attending a neuropsychiatric center in India.
We did a retrospective review of our institute's database for cases with a diagnosis of factitious disorder in the 10-year duration from 2001 to 2010. We reviewed the available clinical and socio-demographic data.
Of the 81,176 patients seen in the 10-year duration, only 8 patients had been assigned the diagnosis of factitious disorder, leading to a prevalence rate of 0.985 per 10,000 patients in this sample. Most of the patients were lost to follow-up; hence.
Factitious disorder remains highly underdiagnosed in developing countries like India. Mental health professionals need to be more aware and inquisitive about this particular disorder, so that they do not miss the diagnosis.
Compared with other psychiatric disorders, diagnosis of factitious disorders is rare, with identification largely dependent on the systematic collection of relevant information, including a detailed chronology and scrutiny of the patient's medical record. Management of such disorders ideally requires a team-based approach and close involvement of the primary care doctor. As deception is a key defining component of factitious disorders, diagnosis has important implications for young children, particularly when identified in women and health-care workers. Malingering is considered to be rare in clinical practice, whereas simulation of symptoms, motivated by financial rewards, is regarded as more common in medicolegal settings. Although psychometric investigations (eg, symptom validity testing) can inform the detection of illness deception, such tests need support from converging evidence sources, including detailed interview assessments, medical notes, and relevant non-medical investigations. A key challenge in any discussion of abnormal health-care-seeking behaviour is the extent to which a person's reported symptoms are considered to be a product of choice, or psychopathology beyond volitional control, or perhaps both. Clinical skills alone are not typically sufficient for diagnosis or to detect malingering. Medical education needs to provide doctors with the conceptual, developmental, and management frameworks to understand and deal with patients whose symptoms appear to be simulated. Central to the understanding of factitious disorders and malingering are the explanatory models and beliefs used to provide meaning for both patients and doctors. Future progress in management will benefit from an increased appreciation of the contribution of non-medical factors and a greater awareness of the conceptual and clinical findings from social neuroscience, occupational health, and clinical psychology.
Child sexual abuse is considered a modifiable risk factor for mental disorders across the life course. However the long-term consequences of other forms of child maltreatment have not yet been systematically examined. The aim of this study was to summarise the evidence relating to the possible relationship between child physical abuse, emotional abuse, and neglect, and subsequent mental and physical health outcomes.
A systematic review was conducted using the Medline, EMBASE, and PsycINFO electronic databases up to 26 June 2012. Published cohort, cross-sectional, and case-control studies that examined non-sexual child maltreatment as a risk factor for loss of health were included. All meta-analyses were based on quality-effects models. Out of 285 articles assessed for eligibility, 124 studies satisfied the pre-determined inclusion criteria for meta-analysis. Statistically significant associations were observed between physical abuse, emotional abuse, and neglect and depressive disorders (physical abuse [odds ratio (OR) = 1.54; 95% CI 1.16-2.04], emotional abuse [OR = 3.06; 95% CI 2.43-3.85], and neglect [OR = 2.11; 95% CI 1.61-2.77]); drug use (physical abuse [OR = 1.92; 95% CI 1.67-2.20], emotional abuse [OR = 1.41; 95% CI 1.11-1.79], and neglect [OR = 1.36; 95% CI 1.21-1.54]); suicide attempts (physical abuse [OR = 3.40; 95% CI 2.17-5.32], emotional abuse [OR = 3.37; 95% CI 2.44-4.67], and neglect [OR = 1.95; 95% CI 1.13-3.37]); and sexually transmitted infections and risky sexual behaviour (physical abuse [OR = 1.78; 95% CI 1.50-2.10], emotional abuse [OR = 1.75; 95% CI 1.49-2.04], and neglect [OR = 1.57; 95% CI 1.39-1.78]). Evidence for causality was assessed using Bradford Hill criteria. While suggestive evidence exists for a relationship between maltreatment and chronic diseases and lifestyle risk factors, more research is required to confirm these relationships.
This overview of the evidence suggests a causal relationship between non-sexual child maltreatment and a range of mental disorders, drug use, suicide attempts, sexually transmitted infections, and risky sexual behaviour. All forms of child maltreatment should be considered important risks to health with a sizeable impact on major contributors to the burden of disease in all parts of the world. The awareness of the serious long-term consequences of child maltreatment should encourage better identification of those at risk and the development of effective interventions to protect children from violence. Please see later in the article for the Editors' Summary.
Background
Dermatitis artefacta (DA) is a dermatologicopsychiatric illness that is a conscious self-infliction of lesions to accessible regions of the body. The lesions usually do not resemble those of any know skin disease and there are no specific diagnostic tests to recognize them. This makes dermatitis artefacta a very slow, challenging and expensive disease to diagnose.
Case Report
We present 5 different clinical cases of dermatitis artefacta treated in the Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk in 2011. Detailed anamnesis and physical examination were performed at the day of admission. All patients had biochemical and hematological blood tests, skin biopsies and swabs for bacteriological examination, and photographs were taken. Psychiatric consultation was recommended in all cases.
Clinical symptoms before diagnosis lasted from 1 to 10 years. The female-to-male ratio is 1:0.7, with age range of 57–62 years. Of our patients, only 2 refused a psychiatric consultation. Three out of 5 patients denied self-mutilation (2 of those 3 patients finally admitted to self-manipulations). Lesions were usually within the reach of the dominant hand. Two patients have other personality disorders. In 4/5 cases visible improvement after treatment with occlusive dressings were observed.
Conclusions
We discuss and attempt to depict issues associated with collaboration between dermatologists and psychiatrists, reasons for poor recognition of the disease, very long diagnosis and high costs. To conclude, we found that close collaboration between dermatologists and psychiatrists is important in diagnosing and treating DA patients.
Low self-esteem and depression are strongly related, but there is not yet consistent evidence on the nature of the relation. Whereas the vulnerability model states that low self-esteem contributes to depression, the scar model states that depression erodes self-esteem. Furthermore, it is unknown whether the models are specific for depression or whether they are also valid for anxiety. We evaluated the vulnerability and scar models of low self-esteem and depression, and low self-esteem and anxiety, by meta-analyzing the available longitudinal data (covering 77 studies on depression and 18 studies on anxiety). The mean age of the samples ranged from childhood to old age. In the analyses, we used a random-effects model and examined prospective effects between the variables, controlling for prior levels of the predicted variables. For depression, the findings supported the vulnerability model: The effect of self-esteem on depression (β = -.16) was significantly stronger than the effect of depression on self-esteem (β = -.08). In contrast, the effects between low self-esteem and anxiety were relatively balanced: Self-esteem predicted anxiety with β = -.10, and anxiety predicted self-esteem with β = -.08. Moderator analyses were conducted for the effect of low self-esteem on depression; these suggested that the effect is not significantly influenced by gender, age, measures of self-esteem and depression, or time lag between assessments. If future research supports the hypothesized causality of the vulnerability effect of low self-esteem on depression, interventions aimed at increasing self-esteem might be useful in reducing the risk of depression. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Psychiatric comorbidity is associated with many dermatological disorders. It may be the cause for skin problem or may be the effect of a skin problem as skin being a visual organ. A 28-year-old female presented with multiple red lesions on the skin with unusual morphology and was diagnosed as dermatitis simulata. She gave history of multiple episodes of similar illnesses with admissions in various hospitals and being evaluated and dropping off in between treatments. After detailed psychological evaluation, patient was diagnosed as case of Munchausen syndrome.
In Western countries, a history of major depression (MD) is associated with reports of received parenting that is low in warmth and caring and high in control and authoritarianism. Does a similar pattern exist in women in China?
Received parenting was assessed by a shortened version of the Parental Bonding Instrument (PBI) in two groups of Han Chinese women: 1970 clinically ascertained cases with recurrent MD and 2597 matched controls. MD was assessed at personal interview.
Factor analysis of the PBI revealed three factors for both mothers and fathers: warmth, protectiveness, and authoritarianism. Lower warmth and protectiveness and higher authoritarianism from both mother and father were significantly associated with risk for recurrent MD. Parental warmth was positively correlated with parental protectiveness and negatively correlated with parental authoritarianism. When examined together, paternal warmth was more strongly associated with lowered risk for MD than maternal warmth. Furthermore, paternal protectiveness was negatively and maternal protectiveness positively associated with risk for MD.
Although the structure of received parenting is very similar in China and Western countries, the association with MD is not. High parental protectiveness is generally pathogenic in Western countries but protective in China, especially when received from the father. Our results suggest that cultural factors impact on patterns of parenting and their association with MD.
To examine the literature on the associations between alcohol use disorders (AUD) and major depression (MD), and to evaluate the evidence for the existence of a causal relationship between the disorders.
PsycInfo; PubMed; Embase; Scopus; ISI Web of Science database searches for studies pertaining to AUD and MD from the 1980 to the present. Random-effects models were used to derive estimates of the pooled adjusted odds ratios (AOR) for the links between AUD and MD among studies reporting an AOR.
The analysis revealed that the presence of either disorder doubled the risks of the second disorder, with pooled AORs ranging from 2.00 to 2.09. Epidemiological data suggest that the linkages between the disorders cannot be accounted for fully by common factors that influence both AUD and MD, and that the disorders appear to be linked in a causal manner. Further evidence suggests that the most plausible causal association between AUD and MD is one in which AUD increases the risk of MD, rather than vice versa. Potential mechanisms underlying these causal linkages include neurophysiological and metabolic changes resulting from exposure to alcohol. The need for further research examining mechanisms of linkage, gender differences in associations between AUD and MD and classification issues was identified.
The current state of the literature suggests a causal linkage between alcohol use disorders and major depression, such that increasing involvement with alcohol increases risk of depression. Further research is needed in order to clarify the nature of this causal link, in order to develop effective intervention and treatment approaches.
We report the case of a woman with Münchausen syndrome who surreptitiously injected epinephrine causing recurrent ventricular tachyarrhythmias accompanied by dramatically high plasma levels of epinephrine and normal norepinephrine levels.
A 71-year-old man who presented to hospital with chest pain and a history of cardiovascular disease was repeatedly hospitalised over the course of a month for care that included multiple investigations, intensive care, transfer to and from a metropolitan hospital, discharge, and readmissions for collapse, hemiparesis, and vision change. The medical team excluded underlying disease related to his initial chest pain and subsequent neurological symptoms. A search for (undisclosed) prior hospitalisations revealed multiple previous admissions and invasive investigations at hospitals across Australia, resulting in a diagnosis of Munchausen syndrome. Assuming that, despite interventions, patients with Munchausen syndrome or somatoform disorders often continue to seek care at other hospitals, we discuss the implications of this patient's behaviour for the health care system, society, and the risk to his own health. In our view, this case highlights conflicts between privacy legislation and doctors' mandates to protect the patient from harm, as well as their duty to attend to the financial viability of health services by communicating with other potential health care providers. The health care system and similar patients may benefit from efforts to educate doctors about this spectrum of disorders and from considering the implementation of a highly confidential, structured notification system.
A syndrome of malingering, pseudologia fantastica, and peregrination was first described by Asher (1951) and subsequently confirmed by case reports from all over the world (Chapman, 1957; York, 1960; Blackwell, 1965; Chugh, 1966; Ireland et al, m1967). Asher dedicated the syndrome to the Baron von Miinchhausen, an infamous storyteller of 18th-century Germany. Despite objections in the literature that the eponym is inappropriate and inaccurate, it has persisted, probably because of its whimsical nature. Alternative names for the syndrome such as peregrinating problem patients (Chapman, 1957), hospital hoboes (Clark and Melnick, 1958), and hospital addicts (Barker, 1962) have fallen by the wayside.
Factitious disorder is where patients repeatedly seek medical care for feigned illnesses in the absence of obvious external rewards; 'Munchausen's syndrome' is the historical name for this disorder.
We report on a case that was presented to a tertiary oncology center as a suspected rare bone cancer.
Psychosocial clinicians working in oncology settings should be aware of the complexities of diagnosing factitious disorder in cancer settings where empathy is prominent and suspicion unusual. Moreover, comorbidity can cloud the diagnosis (in this case substance abuse), and, even when accurately diagnosed, there are no evidence-based management approaches to offer to the patient. What seems to linger most after the patient is discharged, usually in a huff, are strong counter-transference feelings and substantial medical bills. Copyright © 2015 John Wiley & Sons, Ltd.
Copyright © 2015 John Wiley & Sons, Ltd.
The factitious disorders (FDs) include a large group of dermatological conditions characterized by skin lesions that patients themselves self-inflict but deny their active participation. FDs usually represent a diagnostic challenge, and their therapeutic management is usually based on a multidisciplinary approach because most FRD patients also suffer from undiagnosed behavior and personality disorders. We report two cases of FD: one patient that was suffering from severe depression and induced third-degree chemical burns on his own lower limbs, and another patient affected by obsessive-compulsive disorder and anorexia nervosa that presented with deep self-inflicted ulcers on her face. Our multispecialist approach, based on close cooperation between dermatologists and psychiatrists, led to a significant improvement of clinical conditions in both cases. Dermatologists need to be aware that FDs are complex disorders and a multidisciplinary approach is usually recommended to control their clinical course.
Patients with Munchausen syndrome purposefully injure themselves, often with the injection of foreign materials, to gain hospital admission and the attention associated with having a difficult-to-identify condition. Munchausen syndrome by proxy occurs when a child's caregiver, typically the mother, injures the child for the same reasons. Cases of Munchausen syndrome and Munchausen syndrome by proxy with primary cutaneous involvement appear to be rarely described in the literature suggesting either that diagnosis is not made readily or that it is, in fact, an uncommon disorder. At the center of both conditions is significant psychological pathology and treatment is difficult as many patients with Munchausen syndrome when confronted with these diagnostic possibilities simply leave the hospital. Little is known about the long-term outcome or prognosis of these patients.
Factitious Cushing's syndrome is extremely rare. The diagnosis is challenging as cross-reactivity of synthetic corticosteroids or their metabolites in immunoassay measurements of plasma or urinary cortisol can make distinguishing between true and factitious Cushing's syndrome difficult. Adrenocorticotropin (ACTH) is usually suppressed in factitious Cushing's syndrome.
A 54 year old woman presented with clinical and biochemical features of Cushing's syndrome and an unsuppressed ACTH concentration. She denied recent exogenous corticosteroid use.
Initial investigations revealed a markedly elevated urinary free cortisol, mildly elevated midnight salivary cortisol and normal morning cortisol concentration. Plasma ACTH was not suppressed at 13 ng/L (RR 10-60 ng/L). A pituitary MRI was normal, but inferior petrosal sinus sampling (IPSS) revealed a post corticotrophin releasing hormone ACTH ratio >20:1 in the left petrosal sinus. Ketoconazole therapy amplified discordance between the urinary free and morning plasma cortisol concentrations. Further investigation of this discordance using high pressure liquid chromatography tandem mass spectrometry (HPLC-MS/MS) revealed a urinary free cortisol excretion of only 20 nmol/24 hours, but prednisolone excretion of 16200 nmol/24 hr.
Factitious Cushing's syndrome can mimic endogenous ACTH-dependent hypercortisolism during initial investigations and IPSS. This case highlights the importance of 1) recognising the significance of discordant results; 2) using an ACTH assay capable of reliably differentiating ACTH-dependent from ACTH-independent Cushing's syndrome; and 3) appreciating that IPSS is only useful to localise the source of ACTH in confirmed ACTH-dependent Cushing's syndrome. In this case measurement of corticosteroids by HPLC-MS/MS was essential in reaching the correct diagnosis. This article is protected by copyright. All rights reserved.
Objective: The professional literature on Munchausen by Proxy (MBP) abuse consists of more than 400 articles, chapters, and books. Most have come from a handful of English-speaking industrialized countries. Our aims were to establish the extent to which published work about MBP has emerged from outside these countries, and to determine the characteristics of any reported cases.Method: Numerous health care computer databases were queried, and the results supplemented by materials accumulated less formally.Results: We identified 59 articles from 24 countries describing at least 122 cases in 9 different languages. Among cases in which the information was available, the mother was the sole perpetrator in 86%, the victim was aged between 3 years and 13 years in 52%, and the victim was male in 54%. The presentations of MBP appear to be similar across the world with the exception of induced apnea, which emerged as notably uncommon in this review. An extensive table presents the characteristics of each case.Conclusions: MBP clearly is not a phenomenon unique to Western or highly medicalized societies. This form of abuse is being increasingly recognized and reported throughout the world. The literature from the US, Canada, UK, Australia, and New Zealand often presupposes access to resources, such as subspecialists and social service agencies, that may be seriously constrained in other countries. The contributions of professionals elsewhere will be vital in ensuring that the efforts in English-speaking industrialized settings to develop standards of care encompass an international perspective.
Dermatitis artefacta is defined as a self-inflicted condition in which the responsibility for the lesions is uniformly denied by the patient. We report the case of a 43-year-old woman with a 13-year rheumatological history, presenting at our hospital with atypical crops of blisters and pustules with an extremely symmetric distribution, located in periocular and perioral regions, of one year evolution. Psychiatric assessment confirmed a diagnosis of factitious disease. The combined dermatological and psychiatric in-hospital management of the patient is here described. Psychiatric relationship was established employing a supportive and empathic approach and avoiding direct confrontation. Therefore, cooperation between dermatologists and psychiatrists is strongly advocated.
Nineteen review articles and case reports were identified and reviewed through August 1996 in Index Medicus, MEDLINE (English and foreign language), conference abstracts, and bibliographies from major articles, textbooks and reviews, to review Munchausen's syndrome in obstetrics and gynecology. In these 19 articles, 30 reported cases of the syndrome were identified in obstetric and gynecological patients. This survey found that the presentation varied, diagnosis was difficult, treatment was unclear, and the economic burden was enormous. Increasingly, this syndrome is becoming an important clinical entity in the specialty, and requires a high index of suspicion to improve detection and optimize treatment.
The term Munchausen syndrome is used to describe the patient who chronically fabricates or induces illness with the sole intention of assuming the patient role. Such persons often have a close association with the medical profession and thus use their knowledge to falsify symptoms and laboratory specimens to mimic disease. Cases of factitious disease have appeared in the literature originating from all medical specialties, and include such rare disorders as phaeochromocytoma and Bartter's syndrome. The laboratory can play a key role in the detection and diagnosis of factitious disorders. Indeed discrepant biochemistry results may provide the first clue to the diagnosis. Laboratory staff should be particularly aware of highly variable test results and extreme abnormalities that are not consistent with the wider biochemical profile, suggesting sample tampering. Factitious disorder should also be included in the clinician's differential diagnosis when disease presentation is unusual or an underlying cause cannot be found. Investigation to exclude or confirm factitious disorder at an early stage can prevent unnecessary testing in the search for increasingly rare diseases. Appropriate analyses may include screening tests for the detection of surreptitious drug administration or replication of a fabricated sample to confirm the method used. In all cases close communication between the clinician and laboratory is essential. This will ensure that appropriate tests are conducted particularly with regard to time critical and repeat tests.
The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastroenterological disorders seen most often in patients. Published with practicing clinicians in mind, the journal aims to be easily accessible, organizing its content by topic, both online and in print. www.amjgastro.com, *2007 Journal Citation Report (Thomson Reuters, 2008)
Background:
Previous studies consistently identified a relationship between parenting behavior and psychopathology. In this study, we extended prior analyses performed in female twins to a large sample of twins from male-male pairs.
Methods:
We used interview data on 2,609 adult male twins from a population-based twin registry. We examined the association between three retrospectively reported parenting dimensions (coldness, protectiveness, and authoritarianism) and lifetime history of seven common psychiatric and substance use disorders. Using univariate structural equation modeling, we also examined the influence of the genetic and environmental factors on parenting.
Results:
Examined individually, coldness was consistently associated with risk for a broad range of adult psychopathology. Averaged odds of psychiatric disorders associated with parenting were increased between 26 and 36 %. When the three parenting dimensions were examined together, coldness remained significant for major depression, phobia, and generalized anxiety disorder. Controlling for other disorders, the associations between the parenting dimensions and psychopathology were non-specific. Twin fitting model demonstrated that modest heritability accounted for parenting, whereas most variance resulted from the non-shared environment.
Conclusions:
Based on our current and prior findings, there is broad similarity in the impact of parenting on adult psychopathology between men and women.
Examined the frequency, psychopathological phenomenology, and Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) diagnostic classification of patients with factitious disorder presenting as neurological syndromes. Ss were drawn from a sample of 1,538 patients who were hospitalized at the Freie Universität Berlin Department of Neurology during a 1 yr period. Five of 1538 patients (aged 32–51 yrs) were diagnosed as having factitious disorder with feigning of neurological syndromes. Four of the 5 Ss presented with Munchausen syndrome. All Ss had similar, characteristic psychopathological features including self-discharge, aggressive behavior, pseudologia phantastica, and hospital wandering. It is concluded that factitious disorder presenting with neurological syndromes may be more prevalent than is generally assumed. Results confirm the frequent coincidence of factitious and personality disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Investigated published authors' reasons for the file drawer problem (i.e., the view that studies that fail to attain significance are more likely to end up in file drawers than in pages of journals). Questionnaires were sent to 740 authors of empirical articles that had appeared in 75 journals. Contingency tables and multivariate analyses of responses from 63.2% of those surveyed disclosed a preference for publishing in refereed journals, but there was little consensus about which journals qualified as refereed. Ss had decided against publishing 15% of their productions. Regarding 1st publication, 74.1% of the 452 Ss answering this question reported a 1st submission being accepted. The most frequently given reason for not publishing was nonsignificant results, but authors also cited inexplicable results and unfavorable reviews as reasons for deciding against publishing. Thus, the file drawer problem in psychology exists to some degree. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In the investigation of simulated diseases, it is necessary to bear in mind, that, though every feigned disease is pretended, or used as a pretext, in the sense which that word bears, as a means to the accomplishment of an end, still every pretended disease is not always feigned: that is to say, a disease may really exist, and yet be made to serve as a pretext. In such a case it is for the physician to judge of the value of the pretext; or, in other words, to determine the amount of exaggeration, and whether the nature and intensity of the actual disease are such as to accord to the patient the advantages which he claims. Alleged corporeal disabilities may be arranged under four heads: 1st, Feigned or purely fictitious diseases. 2nd. Exaggerated diseases. 3rd. Factitious diseases. 4th. Aggravated diseases. In this essay it is our object chiefly to consider the feigned and factitious diseases of the first two classes; but for its general utility, some remarks upon the frequency of the simulation of various diseases, and the modes of imitating and producing them must be made, having relation to the other classes of impostors. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The aim of this study was to elucidate the clinical characteristics and frequency of psychiatric consultation in a routine clinical setting after kidney transplantation.
Subjects were 1,139 consecutive recipients who received kidney transplantation at our hospital between January 1997 and September 2006. The hospital patient database was searched to determine whether these recipients received psychiatric consultation after their transplantation during this period.
Among 1,139 recipients, 118 (10%) received psychiatric consultation after their transplantation. There were significantly more women among these recipients (p = 0.036). Many of the recipients had received psychiatric consultation before transplantation (p < 0.0001) and had received dialysis for a long time (p = 0.018). There were three main psychiatric diagnoses according to ICD-10 diagnostic criteria in these 118 recipients: 42 (36%) had neurotic, stress-related, and somatoform disorders (F4); 35 (30%) had organic, including symptomatic, mental disorders (F0); and 27 (23%) had mood (affective) disorders (F3). The median length of time between kidney transplantation and initial psychiatric consultation was 57 days (interquartile range: 10-650 days). The lengths were 7 days (6-17 days) for F0, 75 days (18-650 days) for F4, 243 days (35-1,004 days) for F3, and 253 days (10-1,393 days) for other diagnostic groups. Significant differences were observed among these four groups (Jonckheere-Terpstra test, p < 0.001).
Our results show that appropriate psychiatric intervention is necessary not only in early stages after kidney transplantation but also over the long term.
Three adult patients with factitious acute sickle cell painful episodes are presented and the literature is reviewed. The prevalence of this disorder among patients with sickle cell disease in our program was found to be about 0.9%. The patients described to date were all young adults who demonstrated pathological lying (pseudologico fantastico) and most of them had an underlying authentic medical illness to which the feigned signs and symptoms of sickle cell disease were added, thus making the diagnosis more plausible. It is recommended that all patients who present themselves with the signs and symptoms of sickle cell painful episodes be carefully studied in order to confirm the diagnosis. © 1996 Wiley-Liss, Inc.
During a 18-year-period 93 patients (f=76, m=17) with a factitious disorder were identified in the psychiatric consultation service of a university hospital (incidence: 0.62%). 50% of women were working in medical professions whereas only 6% of men. Chronic courses of illness were prevailing, but at least one quarter of female patients showed an intermittent type. There was a classical Munchhausen syndrome in 11% of patients. Depressive and anxiety disorders (10%, 4%) were to be respected as psychiatric comorbidity. Ca 25% of the patients suffered from a somatic illness in addition to the factitious disorder, and one third of the women had symptoms of psychosomatic, especially of eating disorders. Previous somatoform disorders, deliberate self harm and attempts of suicide were to be noted in the psychiatric history of many patients. There were frequent traumatizing events (foster home, disturbing family disharmony, physical and sexual abuse, early losses, serious illnesses) in the early biography. Various psychosocial stressors could be identified in the actual eliciting situation. The results are discussed in respect of epidemiology, development and clinical phenomenology of factitious disorders, psychodynamics and psychopathology of deception and self harm, and therapeutic options in the psychiatric consultation service.
The causes of recalcitrant cutaneous ulcerations are various and complex. Self-injury is one of them, and self-injected substances
have also been reported. In our case, autologous menstrual blood was used, resulting in incurable cutaneous ulcerations and
inappropriate operations being performed several times by plastic surgeons. Meticulous care is indispensable for treatment
of patients with Munchausen’s syndrome.
To report a patient with bilateral corneal perforations and autoproptosis in a case of ocular Munchausen's syndrome.
Case report.
A 26-year-old white male referred to the oculoplastics service with one month history of decreased vision bilaterally and painful right eye. Multiple eyelid scars and right corneal opacity were noted. The patient was previously seen at another institution for rapid loss of vision in both eyes. Interventions: An orbit decompression among many procedures failed to controlled extreme pain and proptosis.
Resolution of proptosis, stabilization of vision, pain resolution.
Three weeks after enucleation of the right eye was offered, patient presented with spontaneous left ruptured globe. After multiple episodes of self-mutilation and infections, both eyes were exenterated.
Munchausen syndrome can be seen with ophthalmic manifestations and should be considered in the differential diagnosis when ocular abnormalities cannot be explained after a thorough evaluation. Recognition of this psychiatric disease is not only important for correct medical diagnosis and treatment, but also essential in protecting the patients from unnecessary invasive and aggressive medical procedures.
Munchausen's syndrome (MS) is a form of severe, chronic, factitious disorder with physical symptoms. Some essential features define MS, such as recurrent, feigned, or simulated illness; peregrination (traveling or wandering); pseudologia fantastica; and drug abuse. Munchausen's syndrome by proxy (MSBP) classically involves a parent or other caregiver who inflicts injury or induces illness in a child. The aim of the present study was to summarize and study the main ear, nose, and throat (ENT) manifestations of MS and MSBP.
A systematic literature review carried out in a tertiary university referral center.
An appropriate string was run on PubMed to retrieve articles dealing with ENT manifestations of MS and MSBP. A double cross-check was performed on citations and full-text articles found using selected inclusion and exclusion criteria.
In total, 24 articles were finally included in the study, describing 30 cases of MS or MSBP involving the ENT region; 15/30 (50%) cases involved the face, most often presenting as facial pain or facial swelling; and 7/30 (23.3%) cases presented with symptoms involving the ear. Six cases out of 30 (20%) were MSBP.
MS and MSBP may present with symptoms involving the head and neck area, particularly the face and external ear canal. The ENT specialist should suspect MS in patients with strange and long-lasting symptoms, so as to avoid misdiagnosis and unnecessary treatments that waste time and money in the healthcare sector.
To assist clinicians in the diagnosis of factitious disorder.
This is a systematic review of the role of laboratory, radiologic, procedural, and pathological modalities to assist in the diagnosis of factitious disorder (Munchausen's syndrome). The review evaluated 3104 article titles and abstracts that were identified from MEDLINE as of January 2010.
We found 190 articles that demonstrated techniques that will assist clinicians in recognizing fabricated manifestations of disease. The results are divided into 13 areas of clinical medicine for easy reference. They are further sub-divided by the diseases or conditions that patients have been reported to simulate and the diagnostic techniques suggested by the literature in each case.
Factitious disorder is difficult to diagnose and may present as a wide array of fabricated conditions, but there are a range of laboratory and technical means available to assist clinicians in the 21st Century.
Factitious disorder, often referred to as Munchausen's syndrome, is a condition in which sufferers present to healthcare professionals seeking investigation and treatment for signs and symptoms that they have consciously fabricated for no obvious reason. Factitious presentations have been described all over the world, in every medical specialty and in every age group, yet by its very nature factitious disorder is difficult to study. There is therefore a dearth of evidence in the literature relating to epidemiology, aetiology and therapeutics. The disorder is notoriously difficult to recognise in clinical practice and there are as yet no definitive treatment options available. This article provides a brief overview of the literature before offering guidance on the diagnosis and management of factitious disorder presenting in the general hospital. It also considers fabricated or induced illness, also known as Munchausen's syndrome by proxy.
To systematically assess the evidence for an association between sexual abuse and a lifetime diagnosis of psychiatric disorders.
We performed a comprehensive search (from January 1980-December 2008, all age groups, any language, any population) of 9 databases: MEDLINE, EMBASE, CINAHL, Current Contents, PsycINFO, ACP Journal Club, CCTR, CDSR, and DARE. Controlled vocabulary supplemented with keywords was used to define the concept areas of sexual abuse and psychiatric disorders and was limited to epidemiological studies. Six independent reviewers extracted descriptive, quality, and outcome data from eligible longitudinal studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled across studies by using the random-effects model. The I(2) statistic was used to assess heterogeneity.
The search yielded 37 eligible studies, 17 case-control and 20 cohort, with 3,162,318 participants. There was a statistically significant association between sexual abuse and a lifetime diagnosis of anxiety disorder (OR, 3.09; 95% CI, 2.43-3.94), depression (OR, 2.66; 95% CI, 2.14-3.30), eating disorders (OR, 2.72; 95% CI, 2.04-3.63), posttraumatic stress disorder (OR, 2.34; 95% CI, 1.59-3.43), sleep disorders (OR, 16.17; 95% CI, 2.06-126.76), and suicide attempts (OR, 4.14; 95% CI, 2.98-5.76). Associations persisted regardless of the victim's sex or the age at which abuse occurred. There was no statistically significant association between sexual abuse and a diagnosis of schizophrenia or somatoform disorders. No longitudinal studies that assessed bipolar disorder or obsessive-compulsive disorder were found. Associations between sexual abuse and depression, eating disorders, and posttraumatic stress disorder were strengthened by a history of rape.
A history of sexual abuse is associated with an increased risk of a lifetime diagnosis of multiple psychiatric disorders.
Factitious disorder (FD) is the deliberate production or simulation of symptoms in order to adopt the sick role.
The authors look at FD in the neurology setting.
The authors examined documented, published cases.
FD cases in neurology are strikingly different from those in other specialties in terms of their demographics. Whereas the paradigm of FD in medicine as a whole is of the socially stable female healthcare worker, neurology continues to report largely the classic itinerant "Munchausen's" type.
The authors explore two possible explanations for this: either that female healthcare workers with FD do not present neurologically, or that, if they do, they are diagnosed with conversion disorder.