Munchausen Syndrome (Factitious Disorder)

Munchausen Syndrome (Factitious Disorder) is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • A disorder in which the patient fakes signs or symptoms without tangible personal benefit other than to experience the sick role
  • Referred to as factitious disorder in the DSM-5
  • The nature of the disorder resists rigorous study and prevalence is unknown but possible risk factors include:
    • Males
    • Unmarried
    • Age in the thirties/forties
    • Personality disorder
    • A history of sadistic and rejecting parents
    • A history of chronic childhood illness
    • A history of employment in the medical field

Etiology

  • Factitious disorder:
    • DSM-5 diagnostic criteria:
      • Intentional production of physical or psychological signs associated with deception
      • Patients presents as ill, impaired, or injured
      • Absence of external incentives
      • The behavior is not better explained by another mental disorder
  • Onset is usually early adulthood often after hospitalization for a mental disorder or medical condition
  • Clinical clusters:
    • Self-induced infection
    • Simulated specific illnesses with no actual disorder
    • Chronic wounds
    • Self-medication

Pediatric Considerations
  • Munchausen by proxy (Factitious Disorder Imposed on Another):
    • 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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Basics

Description

  • A disorder in which the patient fakes signs or symptoms without tangible personal benefit other than to experience the sick role
  • Referred to as factitious disorder in the DSM-5
  • The nature of the disorder resists rigorous study and prevalence is unknown but possible risk factors include:
    • Males
    • Unmarried
    • Age in the thirties/forties
    • Personality disorder
    • A history of sadistic and rejecting parents
    • A history of chronic childhood illness
    • A history of employment in the medical field

Etiology

  • Factitious disorder:
    • DSM-5 diagnostic criteria:
      • Intentional production of physical or psychological signs associated with deception
      • Patients presents as ill, impaired, or injured
      • Absence of external incentives
      • The behavior is not better explained by another mental disorder
  • Onset is usually early adulthood often after hospitalization for a mental disorder or medical condition
  • Clinical clusters:
    • Self-induced infection
    • Simulated specific illnesses with no actual disorder
    • Chronic wounds
    • Self-medication

Pediatric Considerations
  • Munchausen by proxy (Factitious Disorder Imposed on Another):
    • 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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