[Munchausen's syndrome: a factitious disorder? A case report]

Munchausen's syndrome is classified as a chronic factitious disorder with predominant physical signs and symptoms. Several symptoms are specific to this disorder, such as travelling and pseudologia fantastica. Others symptoms, such as multiple physical complaints with no organic substrate, are shared with somatoform disorders. We report a case showing how difficult it is to diagnose a Munchausen syndrome. We discuss also the opportunity to classify such a syndrome as a factitious disorder. Indeed, several authors suggest classifying Munchausen syndrome as a subtype of somatoform disorders, as those two disorders share a lot of characteristics.

Functional neuro-ophthalmology

Patients with physical signs and symptoms for which no adequate organic cause can be found may receive any one of a large range of diagnostic labels, including functional illness, functional overlay, hysteria, hysterical overlay, conversion reaction, psychophysiological reaction, somatization reaction, hypochondriasis, invalid reaction, neurasthenia, psychogenic reaction, psychosomatic illness, malingering, and Münchausen syndrome. In this chapter, we describe both common and uncommon "functional" ocular symptoms and signs, including visual loss in one or both eyes, constricted visual fields and other field defects, various types of ocular motor dysfunction, including disorders of ocular motility and alignment, disorders of pupillary size and reactivity, and abnormalities of eyelid position and function. We also discuss and illustrate the methods by which the nonorganic nature of these manifestations can be determined. In many cases simple techniques performed in the clinic are sufficient to establish a diagnosis of nonorganic ocular disease, whereas in other cases ancillary studies such as electrophysiological testing may be necessary. The chapter also describes the appropriate approach that the physician should take when dealing with a patient who has proven functional ocular signs and symptoms.

Clinical Case Notes. Anaesthetic abuse keratopathy as a manifestation of ocular Munchausen's syndrome

Two patients, both with a history of major depressive disorder, presented with large bilateral corneal epithelial defects and ring-shaped stromal opacities. Both were initially treated unsuccessfully with topical antibiotic therapy for presumed infectious keratitis. One patient eventually admitted to topical anaesthetic abuse. In the second patient, signs of topical anaesthetic abuse and Munchausen's syndrome became evident. Cessation of anaesthetic use resulted in rapid resolution of the corneal epithelial defects in both patients. Anaesthetic abuse keratopathy is often a manifestation of underlying psychiatric illness, and psychiatric intervention is a very important part of management. To the authors' knowledge, this is the first report of ocular Munchausen's syndrome manifesting as anaesthetic abuse keratopathy.

Munchausen's syndrome

Munchausen's syndrome has been acknowledged for many years, receiving the name in 1951. In this article, the prevalence, patient characteristics, clinical presentations, possible concurrent conditions, aetiological factors, differential diagnosis, management and cost (to the patients and NHS) will be discussed.

Neuropsychiatric aspects in Munchausen's syndrome

The case of a 27-year-old woman with Munchausen's syndrome is presented, in whom a history of cerebral palsy and pathological findings from electroencephalogram, cranial computed tomography, and neuropsychological assessment were prominent. It is argued that neuropsychiatric aspects may play a role in the development of Munchausen's syndrome in a subgroup of patients.

Munchhausen's syndrome in urology

Munchhausen's syndrome (MHS) is classed among the self-manipulated diseases but frequently is not recognized as such. Patients suffering from MHS successfully obtain repeated invasive diagnostic management by the permanent presentation of various symptoms especially in the surgical branches of medicine. In urology the "haemorrhagic type", the "abdominal type" and the "neurological type" are predominant. In the course of his "history" the MHS patient shows definite organic lesions as a result of numerous artificial and iatrogenic procedures. Consequently diagnosis is more and more difficult. In the majority of cases psychotherapy ends after few psychiatric interviews in the initial stage of therapy. Increasing somatic lesions are predominant.

[Infantile Munchausen syndrome. Etiology, diagnostic criteria, and treatment]

In this paper, we study a special kind of child abuse, the Münchhausen Syndrome by proxy, which consists of a group of diseases that some parents invent in their own children. These parents describe false symptoms of disease in their children, or manipulate the bodies of their children in order to cause alterations. Their purpose is that the doctor will carry out diagnostic tests and medical treatments with the children who really aren't ill. Our objective is to understand this syndrome, so we can report the factors that influence its appearance, study the diagnostic guidelines and the importance of doing a correct differential diagnostic with other real pathologies, and we analyze the preventive and therapeutic measures that health professionals must carry out in children and in their parents. When these professionals understand this syndrome they will be able to detect it before children are subjected to more unnecessary suffering. And, they will be able to prevent that these aggressions on children continue.

[Factitious hypoglycemia--Munchausen syndrome in diabetes mellitus]

The medical history of a 43-year-old non-insulin-dependent diabetic patient is presented. The exact diagnosis of the cause of repetitive and severe hypoglycaemic episodes proved to be difficult. Finally, high serum insulin and low C-peptide values were found in peripheral venous blood during hypoglycaemia resulting in an elevated (> 1.0) molar ratio of insulin to C-peptide. The laboratory findings were assessed as consequences of surreptitious insulin administration. Factitious hypoglycaemia could be considered as a clinical manifestation of Munchhausen syndrome. Confronting the patient with evidences of surreptitious insulin injections, hypoglycaemic episodes abruptly discontinued to occur.

Self-induced hematuria

Two patients, an adult and a child, are reported who presented with factitious hematuria secondary to self-induced finger sticks with contamination of unwitnessed urine samples. Feigned illness of this kind may be more common than generally appreciated.

Ocular Münchhausen syndrome induced by incest

This report describes a young female patient whose long-lasting ocular problems were ultimately found to be due to self-induced damage of the corneas with chemicals, and later, self-inflicted perforation of the eye with a safety pin. More than one year after these ocular symptoms were presented, it was discovered that the eye diseases were in fact attempts by the patient to escape from the psychic anxieties which were the result of an incestuous relationship between the patient and her father.

The onset of Munchausen's syndrome

Although Munchausen's syndrome is well known, its mode of onset and development are poorly understood. The authors describe an individual whose developmental history was notable for dyslexia and pathological lying from early childhood, and who later developed Munchausen's syndrome following an explosive separation from his terminally ill father. The patient's simulated genitourinary problems related directly to his father's renal malignancy. The development of his Munchausen syndrome is discussed with reference to his traumatic separation from his father as well and to his preexisting character pathology and probable central nervous system dysfunction.

The Munchausen syndrome and its symbolic significance: an in-depth case analysis

The 'gains' of Munchausen syndrome cannot readily be understood on a rational level, and are presumed to be intra-psychic. The presenting fabrications often follow a remarkably similar pattern, and some psychodynamic insight might be gained by analysis of the general themes and contents. The case of one typical patient is reported here, and the aetiology and symbolic significance discussed.

[Munchausen syndrome induced as recurrent imipramine poisoning]

A nine-year-old girl with Munchausen syndrome by proxy is reported. She had been admitted to different hospitals for 17 times in the last seven years. Clinical complaint were complex neurological symptoms and the first diagnosis was acute intermittent porphyria. It was demonstrated later that this symptoms were due to imipramine poisoning given by her mother.

Surgical addiction. A complication of modern surgery?

Today the concept of surgery has changed dramatically. No longer is surgery limited to emergency or lifesaving procedures. We now have surgery by choice, which, despite marked advantages, may well encourage a certain type of individual to have surgery for reasons for which it is not intended. This article discusses the underlying characteristics of the patient who seeks repetitive surgery. The author points out that it is the surgeon's, not the patient's, responsibility to prevent unnecessary surgery.

Munchausen syndrome by proxy

Information is presented about 19 children, under age 7 years, from 17 families, whose mothers consistently gave fraudulent clinical histories and fabricated signs so causing them needless harmful medical investigations, hospital admissions, and treatment over periods of time ranging from a few months to 4 years. Episodes of bleeding, neurological abnormality, rashes, fevers, and abnormal urine were commonly simulated. Often the mothers had had previous nursing training and some had a history of fabricating symptoms or signs relating to themselves. Two children died. Of the 17 survivors, 8 were taken into care and the other 9 remained at home after arrangements had been made for their supervision. Study of these children and their families has enabled a list of warning signs to be compiled together with recommendations for dealing with suspected acts. The causes and the relationship of this form of behaviour to other forms of non-accidental injury, iatrogenic injury, and parental-induced illness are discussed.

Factitious Hymenoptera allergic emergency: a report of a new variant of Munchausen's syndrome

We report of the case of a young woman with three hospitalizations and six emergency room visits for treatment of bronchospasm and angioedema first thought to be the result of Hymenoptera venom allergic reactions. Because several features of her illness were not consistent with the usual course of Hymenoptera anaphylaxis and because of a known history of anaphylactic-type reactions following aspirin ingestion, a presumptive diagnosis of factitious anaphylaxis was considered, the medical staff was alerted to evaluate this possibility, and the diagnosis was established. Serologic testing supported the diagnosis. This variant of Munchausen's syndrome is a third type described as an allergic emergency. The others are peanut anaphylaxis and self-induced laryngeal stridor.

An observation on the genesis of Münchausen syndrome: a case report

A case of Münchausen Syndrome diagnosed in an antenatal ward is reported. This patient, while pregnant, presented a variety of factitious obstetric complications to her medical attendants. Examination of the patient's hospital records threw light on the natural history of Münchausen Syndrome, and suggested the possibility that the nature of her interactions with hospitals were of aetiological significance. The implications of this hypothesis are considered.

Münchausen syndrome: a review and two case reports

In the light of the pertinent literature, 2 illustrative cases of the Münchausen syndrome are presented. In both patients there had been dynamically significant losses in the oedipal age leading to an intense feeling of being rejected. Both patients also exhibited problems of dependence, perfectionistic attitudes toward the self, and fear of social failure. In addition, characteristics typical of alexithymia could be noted. As a dynamical interpretation it is proposed that in these patients basic helplessness and inadequacy of expressing feelings have been channelled into multiform psychosomatic symptoms. The latter in turn have caused continuous seeking for acceptable somatic etiology and treatment of the symptoms. Thus, gradually, the clinical picture of the Münchausen syndrome has developed.

The Munchausen syndrome: a report of four new cases and a review of psychodynamic considerations

Four new cases of Munchausen syndrome are described and compared to prior reports in the literature. Remarkable is the high frequency of childhood histories which include rejecting or sadistic parents, exposure to death or chronic illness and institutional placement. It is proposed that the symptoms comprising the syndrome are a defense against psychosis or infantile anxiety and are precipitated by either real or threatened separations from ambivalently regarded object relations. Hospitalization allows gratification of dependency wishes while the pseudologia and malingering serve to deny the feelings of impotence.