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Munchausen Syndrome

Munchausen Syndrome is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • A neurotic disorder in which the patient fakes signs or symptoms without tangible personal benefit other than to experience the sick role.
  • Most dramatic form of chronic factitious disorder with a predominance of physical findings.
  • The nature of the disorder resists rigorous study but possible risk factors include:
    • Males
    • Less severe factitious disorders are more common in women
    • Unmarried
    • Age in the forties
    • Personality disorder
    • A history of sadistic and rejecting parents
    • A history of chronic childhood illness

Etiology

  • Factitious disorder:
    • 3 DSM-IV diagnostic criteria:
      • Intentional production of physical or psychological signs
      • Motivation to assume the sick role
      • Absence of external incentives
      • Predominance of symptoms rather than physical findings
  • Classic Munchausen syndrome:
    • Most severe and chronic form of factitious disorders
    • Predominantly physical findings
  • Clinical clusters:
    • Self-induced infection
    • Simulated specific illnesses with no actual disorder
    • Chronic wounds
    • Self-medication

Pediatric Considerations
  • Munchausen by proxy:
    • The patient's illness is caused by the caregiver, not the patient
    • The motivation for the caregiver's behavior is to assume the sick role by proxy
    • The caregiver inflicts injury or induces illness in their charge, usually a child
    • Commonly parents (mostly mothers)
  • May simulate injury and disease in a number of ways:
    • Inflicts injury
    • Induces Illness
    • Fabricates symptoms
    • Exaggerates symptoms of the child's illness causing overaggressive medical interventions
  • The perpetrator usually refuses to acknowledge the deception
  • Cessation of the symptoms when the patient and caregiver are separated


Geriatric Considerations
Caregivers of elderly patients may also be perpetrators in Munchausen by proxy

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Citation

Rosen, Peter, et al., editors. "Munchausen Syndrome." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307644/all/Munchausen_Syndrome.
Munchausen Syndrome. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307644/all/Munchausen_Syndrome. Accessed April 24, 2019.
Munchausen Syndrome. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307644/all/Munchausen_Syndrome
Munchausen Syndrome [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307644/all/Munchausen_Syndrome.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Munchausen Syndrome ID - 307644 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307644/all/Munchausen_Syndrome PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -