Jyothi Chitekela, M.D., Angeline Prabhu, M.D., Bilal Abaid, M.D., Steven Lippmann, M.D. 

“Is my patient really sick?”; you might have asked yourself this question! Such a circumstance may occur while assessing patients who present with Munchausen’s Syndrome. This illness is often a difficult diagnosis and/or a vexing differential. The condition was identified during the 1700s, named after Baron Von Munchausen, a literary character in Europe (1). He was famous for fictitiously presenting with various erroneous pathologies. Such patients fabricate illness histories and embellish their symptoms. The prevalence is at a mean of 0.9% with a range up to 9% (2). They incur a substantially increased morbidity and mortality. Epidemiological data is illusive because of the deceptive nature of this syndrome. More common in males during the third and fourth decades of life, this population frequently exhibits antisocial issues, employment in the healthcare industry, and has a poor medical prognosis (3,4).

This disease is characterized by simulated ailments and patients distorting their health status while seeking admission from hospital to hospital (3,4). Munchausen is associated with emotional difficulties and is considered a psychiatric illness. Coexisting disorders include those of mood and somatoform categories.

Affected patients usually are evasive about providing a precise history and notably dramatic (1-4). Often hospitalized for symptoms that are exaggerated, they demand extensive therapies and frequently leave hospitals against their physician’s recommendations. The person acts as if having a mental or physical condition, though is usually not really sick. They often have a history of disrupted childhood and substance abuse. They feign symptoms purposely, assuming a “sick role”, but secondary gain is often absent. These patients frequently exhibit substantial knowledge about their concerns and tend to express medical jargon in their discussion. Commonly, they seek to minimize contact between their doctor and previous physicians or contact with family or friends. Difficult to manage patients, they rarely adhere to treatment protocols.

Diagnosis is a challenge because of how genuine the patient presentation appears (1-4). Contributing pathology should be ruled out; always screen patients about their suicide potential and for co-morbid psychiatric and/or medical diseases. Munchausen’s Syndrome should be considered whenever the history is vague and doubtful symptoms that may become worse after initiating treatment. It is primarily identified by observation, as a clinical diagnosis.

Specific details of the patient complaints determine the exact nature of the therapeutic approach. Primary care provider collaboration with a psychiatrist is advised; a multidisciplinary approach is recommended (3,4). Immediate intervention includes hospitalizing those with serious illnesses or providing outpatient treatment. Long-term management involves empathetic, regular clinical follow-up. Psychotherapy and supportive engagement alone may not be sufficient; cooperative relationships between patients and the medical team are crucial and long-term treatment is usually indicated. Good rapport maximizes therapeutic compliance in an aim to improve clinical outcome.

References

1.Kansagara D, Tetrault J, Hamill C, Moore C, Olson B. Fatal factitious Cushing’s syndrome and invasive aspergillosis: Case report and review of literature. Endocrine Practice 2006; 12(6):651-655.

2.Fliege H, Grimm A, Eckhardt-Henn A, Gieler U, Martin K, Klapp F. Frequency of ICD-10 factitious disorder: Survey of senior hospital consultants and physicians in private practice. Psychosomatics 2007; 48(1):60-64.

3.Krahn E, Li H, O’Connor K. Patients who strive to be ill: Factitious disorder with physical symptoms. American Journal of Psychiatry 2003; 160(6):1163-1168.

4.Majeed M, Clark J. Munchausen’s Syndrome: A near fatal case. British Journal of Diabetes 2016; (1):35-36.