See also: Stockholm Syndrome, DID

Munchausen syndrome and Munchausen syndrome by proxy: a narrative review

ABSTRACT

The Munchausen syndrome and Munchausen syndrome by proxy are factitious disorders characterized by fabrication or induction of signs or symptoms of a disease, as well as alteration of laboratory tests. People with this syndrome pretend that they are sick and tend to seek treatment, without secondary gains, at different care facilities. Both syndromes are well-recognized conditions described in the literature since 1951. They are frequently observed by health teams in clinics, hospital wards and emergency rooms. We performed a narrative, nonsystematic review of the literature, including case reports, case series, and review articles indexed in MEDLINE/PubMed from 1951 to 2015. Each study was reviewed by two psychiatry specialists, who selected, by consensus, the studies to be included in the review. Although Munchausen syndrome was first described more than 60 years ago, most of studies in the literature about it are case reports and literature reviews. Literature lacks more consistent studies about this syndrome epidemiology, therapeutic management and prognosis. Undoubtedly, these conditions generate high costs and unnecessary procedures in health care facilities, and their underdiagnose might be for lack of health professional's knowledge about them, and to the high incidence of countertransference to these patients and to others, who are exposed to high morbidity and mortality, is due to symptoms imposed on self or on others.

Keywords: Munchausen syndrome, Munchausen syndrome by proxy, Child abuse, Factitious disorders

INTRODUCTION

The term “Munchausen syndrome” was first described in 1951 by Asher( 1 ) to characterize individuals who intentionally produce signs and symptoms of a disease and who tend to seek medical or hospital care. Later, in 1977, Meadow used the term “Munchausen syndrome by proxy” to describe children whose mothers produce histories of illness to their children and who support such histories by fabricated physical signs and symptoms, or even by alter laboratory tests.( 2 )

The term “Munchausen” is associated with Baron Münchhausen (Karl Friedrich Hieronymus Freiherr von Münchhausen, 1720-1797), to whom fantastic and unreal stories about his life and experiences were attributed.( 2 )

Our study reviews the literature about Munchausen syndrome and Munchausen syndrome by proxy. This is a narrative, non-systematic review including case reports, series of case reports, and reviews indexed in PubMed from the first paper published on this subject in 1951 to November 2015. We used the following keywords “Munchausen syndrome”, “Munchausen syndrome by proxy” and “factitious disorders”.

Each study was reviewed by two psychiatric specialists who later, in consensus, selected relevant studies to be included in the review, considering clinical, epidemiogical and treatment-related aspects of these syndromes. In addition, other relevant studies based on judges’ experience by the specialists were included in our review, i.e., state of the art papers about those conditions.

This review seeks to provide basic information on both syndromes for students and health professionals (mainly non-specialists) interested in a general panel of these conditions generally unknown or misdiagnosed, however, seen in emergency rooms, clinical or surgical units or other health care settings. Munchausen syndrome and its variant forms are challenges faced in clinical and surgical practice. For this reason, to briefly review these conditions is important and justified in order to further understand these frequently unrecognized affections.

CLASSIFICATION AND CLINICAL PRESENTATION

Currently, despite the disseminated use of the term “Munchausen syndrome,” no nosological entity for these two syndromes is described in the International Classification of Diseases. Munchausen syndrome was included in the tenth edition of the International Classification of Diseases( 3 ) and classified as intentional production or feigning of symptoms or disabilities either physical or psychological (factitious disorder). Munchausen syndrome by proxy is classified in the category T74.8, i.e., abuse of children, although this term is also used to refer to elderly or disabled person and/or dependent adults who signs or physical symptoms are created by a caregiver and whose laboratory tests were altered.( 4 )

Munchausen syndrome has also been called “hospital addiction”, “polysurgical addiction,” and “professional patient syndrome"

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), defines factitious disorders as those imposed on self and on other (previously called “factitious disorders by proxy”).( 5 )

If you're not seeing patterns, I can't help you. Somethings are real. by proxy. Substance abuse is not my problem. The problem lies closer to home(s). Are we catching up yet? Trying to help you, here. I'm not the only one. There are definitely others. They may not be aware. The hospital system is wasting money on diagnostic bullshit when it could solve problems. Just ask IMA. Ask City Center. Clozaril is not my medicine. Prichards is not a magic maker, and this shit ain't kosher. WASTE OF PUBLIC FUNDING. Overmedicalization. DSM vagueness. Perfectionism in medicine. I bet SB sees patterns.