Munchausen syndrome/Munchausen syndrome by proxy

A toxic triangle of destructive leadership at Bristol Royal Infirmary: A study of organizational Munchausen syndrome by proxy

Although leadership literature increasingly recognizes that leadership is a complex, co-creational process among leaders, followers, and context, destructive leadership scholarship has only recently embraced this paradigm. This article contributes to the toxic triangle debate by linking destructive leadership theory and disaster research in a case study of Bristol Royal Infirmary, a UK hospital that experienced a crisis in its pediatric cardiology unit resulting in the death of dozens of babies undergoing surgery. Thus, the article expands the literature on organizational failure by offering an assessment of how seemingly good, well-intentioned professionals can nonetheless create destructive leadership dynamics and proposes a new, more nuanced theoretical framework called organizational Munchausen syndrome by proxy as a way to analyze what went wrong.

Munchausen's syndrome presenting as severe panniculitis

Factitious disorders may trouble any physician during his/her career. A considerable number of cases of Munchausen's syndrome (self-induced disorder) are misdiagnosed in clinical practice. A 36-year-old woman was admitted to our hospital because of fever and abdominal pain. Physical examination showed signs of inflammation of the abdominal wall, and histological examination revealed severe panniculitis. We investigated various aetiologic factors that could probably be related to fat necrosis, but we found no explanation of the phenomenon until we verified the diagnosis of Munchausen's syndrome. 2 years later, the patient underwent surgery for removal of needles, which she herself had deliberately located under her skin. High index of suspicion and physician's persistence are necessary to make the correct diagnosis in the various protean manifestations of Munchausen's syndrome.

Diagnostic, expanatory, and detection models of Munchausen by proxy: extrapolations from malingering and deception

OBJECTIVE

The overriding objective is a critical examination of Munchausen syndrome by proxy (MSBP) and its closely-related alternative, factitious disorder by proxy (FDBP). Beyond issues of diagnostic validity, assessment methods and potential detection strategies are explored.

METHODS

A painstaking analysis was conducted of the MSBP and FDBP literature as it relates diagnostic and assessment issues. Given the limitations of this literature, extrapolations were provided from the extensive theory and research on malingering as a related response style.

RESULTS

Diagnostic formulations for both MSBP and FDBP de-emphasize the clinical characteristics of the perpetrator. In the case of FDBP, inferential judgments about motivation (e.g., adoption of a sick role) are challenging on conceptual and clinical grounds. When explanatory models from malingering are applied, most research has focused pathogenic models, often allied with psychodynamic thought. Finally, clinical methods for the assessment of MSBP and FDBP are not well developed.

CONCLUSIONS

Refinements in the conceptualization of MSBP and FDBP can be provided through prototypical analysis. Drawing from malingering research, explanatory models should be expanded to include adaptational and criminological models. Finally, detection strategies for MSBP and FDBP must be formally operationalized and rigorously validated.

Hematoma Mimicking Ruptured Testis After Self-Inflicted Orchiectomy

Testicular rupture is a potentially serious sequela of scrotal trauma. Physical examination is often quite limited in these cases. Sonography contributes significantly by directly visualizing the testis and intrascrotal contents. False-positive sonograms can occur, particularly when a hematocele displaces or distorts the testis beyond recognition or when a hematoma is mistaken for a damaged testis. This report describes the ultrasonographic appearance of a hematoma that mimicked a ruptured testis. The testis had actually been removed by the patient himself, who was suffering from a psychiatric disturbance called Munchausen syndrome.

Postpartum depression and factitious disorder: a new presentation

This article discusses a presentation of Munchausen Syndrome by Proxy. It is believed this factitious disorder was precipitated and grew out of the context of a postpartum depression. To our knowledge, no such case has been reported in the past and implications for new exclusion criteria defining a fictitious disorder are raised. Furthermore, reintegration of the perpetrator back to family is discussed and suggestions are made for follow-up.