Special ArticlesMUNCHAUSEN'S SYNDROME
References (1)
- R.E. Raspe
Singular Travels, Campaigns and Adventures of Baron Munchausen
(1785)
Cited by (785)
Factitious disorder imposed on self: A retrospective study of 2232 cases from health insurance databases
2023, General Hospital PsychiatryPatients with factitious disorder imposed on self (FDIS) seek medical care for deliberately falsified problems. Although a large amount of work has been published, the scientific literature lacks robust data on FDIS. The present study aimed to estimate the annual mean of in-hospital FDIS codings in France, describe the sociodemographic characteristics of subjects with FDIS, assess healthcare utilisation and medical nomadism, and describe the pathologies most frequently associated with FDIS.
Subjects with at least one coding of FDIS in French health insurance databases between January 1, 2009, and December 31, 2017 were included. Subjects younger than 18 years of age at the time of first coding were excluded from the study. Sociodemographic data of subjects and diagnoses associated with the first coding of FDIS were collected. Healthcare utilisation and medical nomadism were analysed descriptively from one year before to one year after the first FDIS coding.
2232 subjects were included, representing an average of 248 new in-hospital FDIS codings per year. The subjects included were 58.2% female. The mean age at diagnosis was 48.5 years. In the year following the first coding of FDIS, 1268 subjects (56.8%) were re-hospitalised at least once, including 159 (7.1%) with at least one new coding for FDIS. From one year before to one year after the first coding of FDIS, 66% of the subjects included had received at least one prescription for benzodiazepines, 58.3% for antidepressants, and 42.6% for antipsychotics.
Our findings bring new data working towards a better understanding of FDIS. The consumption of psychotropic drugs is particularly frequent in patients with FDIS.
Shared Munchausen syndrome in adolescents: An in-between for a continuum from Munchausen syndrome by proxy to Munchausen syndrome
2023, Neuropsychiatrie de l'Enfance et de l'AdolescenceLe syndrome de Munchausen par procuration est défini par la production de troubles factices sur un individu par un proche, engendrant un nomadisme médical et des prises en charges somatiques plus ou moins invasives. Les cas rapportés de victimes s’étendent de la période périnatale à l’âge adulte. L’existence de cas chez l’adolescent soulève la question de la participation, consciente ou inconsciente, de la victime au syndrome de Munchausen par procuration. L’objectif de cette étude est d’étudier le type de participation adolescente à ce syndrome.
Nous avons colligé une série de 8 cas hospitalisés dans le service de psychiatrie de l’enfant et de l’adolescent de la Pitié Salpetrière durant la période de 1994 à 2022. Ces patients ont été hospitalisés dans un contexte d’expression clinique complexe pour lequel le diagnostic de syndrome de Munchausen par procuration a été discuté. Nous avons étudié les différents aspects psychopathologiques de ces 8 cas à partir des dossiers médicaux (comptes-rendus d’hospitalisation, entretiens de patients, bilans psychologiques et psychomoteurs).
Nous avons décrit 8 cas d’enfants hospitalisés, entre 9 et 17 ans. Les symptômes fonctionnels étaient d’ordre psychiatriques et parfois somatiques. Les bénéfices secondaires étaient pour la plupart d’obtenir l’attention parentale, avec une amélioration constatée chez tous les patients lors de la séparation avec le proche. Nous avons étudié la participation du patient dans les différents cas décrits, et le degré de conscience de sa participation.
Ces différentes observations cliniques permettent de soulever une dimension systémique avec un système composé de l’auteur, du patient « victime » et du médecin suggérant une participation de chacun des membres au système. Les arguments psychopathologiques retrouvés sont l’amélioration à la séparation avec le proche, des dysfonctionnements systémiques, une organisation familiale autour de la relation à deux, la plupart du temps entre l’enfant et sa mère sans tiers et plus particulièrement sans figure paternelle, favorisant une interaction dyadique mère-enfant exclusive. L’ensemble des bénéfices secondaires à la production des troubles ont majoritairement pour fonction d’entretenir une relation « fusionnelle » avec le parent articulée autour de symptômes somatiques ou psychiatriques. Dans ces cas complexes, nous questionnons la participation de l’enfant ou de l’adolescent, cherchant à répondre aux attentes de son parent qui le voit comme un malade chronique, dans cette pathologie initialement induite par un membre de la famille. Devant les arguments systémiques retrouvés dans les observations, nous proposons le terme de syndrome de Munchausen « partagé » plutôt que « par procuration » dans les cas avec participation active ou passive et partiellement consciente de l’adolescent au subterfuge.
Cette série nous a donc conduits à privilégier une approche systémique en particulier chez les adolescents les plus âgés et à introduire le concept de syndrome de Munchausen partagé. Nous retrouvons des cas de syndrome de Munchausen par procuration notamment chez les patients les plus jeunes, des cas de Munchausen partagé, et des cas des patients s’auto-infligeant les lésions avec une participation consciente et active au tableau de Munchausen, il s’agit alors de patients plus âgés, faisant évoquer une évolution vers un Munchausen « classique ». Nous pouvons émettre l’hypothèse que les différents syndromes de Munchausen « par procuration », « partagé » ou « classique » se présentent comme un continuum en fonction de l’âge et de la maturité psychique.
Munchausen syndrome by proxy is defined by the production of factitious disorders on an individual by a close relative, generating a medical nomadism and more or less invasive somatic treatments. The reported cases of victims range from the perinatal period to adulthood. The existence of cases in adolescents raises the question of the victim's participation, conscious or unconscious, in Munchausen syndrome by proxy. The aim of this study was to investigate the type of adolescent involvement in this syndrome.
We collected a series of height cases hospitalized in the Children and Adolescents Psychiatry Department of the Pitié Salpêtrière Hospital, from 1994 to 2022. These patients were hospitalized in a context of complex clinical expressions for which the diagnosis of Munchausen syndrome by proxy was a possibility. We studied the different psychopathological aspects of these eight cases from the medical records (hospitalization reports, patient interviews, psychological and psychomotor assessments).
We described 8 cases of hospitalized children,aged between 9 and 17 years. Their functional symptoms were psychiatric and sometimes somatic. The additional benefits were, for the majority of them, to receive parental attention, with an improvement noted in all patients during the separation from the relative. We studied the patient's participation in the different cases described, and the awareness level of their own participation.
These different clinical observations enable us to outline a systemic dimension with a system composed of the perpetrator, the “victim” patient and the doctor suggesting a participation of each member in the system. The psychopathological arguments found are the improvement at the separation from the relative, systemic dysfunctions, a family organization around the relationship of two members, most often between the child and his mother without a third person and more particularly without a paternal figure, fostering an exclusive mother-child dyadic interaction. All of the benefits secondary to the production of the disorders are mainly aimed at maintaining a “fusional” relationship with the parent, based on somatic or psychiatric symptoms. In these complex cases, we question the participation of the child, seeking to meet the expectations of his parent who sees him as a chronic patient, in this pathology initially induced by a family member. In view of the systemic arguments, we propose the term “shared” rather than “by proxy” Munchausen syndrome in cases of active or passive and partially conscious participation of the adolescent in the subterfuge.
This series has thus led us to favor a systemic approach especially in the older adolescents and to introduce the concept of shared Munchausen syndrome. We collected cases of Munchausen syndrome “by proxy”, especially in younger patients, cases of “shared” Munchausen syndrome and cases of patients who self-inflict lesions with a conscious and active participation in the Munchausen syndrome suggesting an evolution towards a “classic” Munchausen syndrome. We can assume that the different syndromes of Munchausen “by proxy”, “shared” or “classic” present themselves as a continuum according to age and psychic maturity.
The medical examiner and the diagnosis and management of Münchhausen syndrome by proxy: About one case
2022, Revue de Medecine LegaleThe Münchhausen syndrome by proxy is a psychological disorder in which an abusive adult who wishes to play the sick character through a child, induces pathological symptoms in the latter, it's a sort of abuse that the health-care system should be aware of. We present the case of a nine and a half year old girl, hospitalised three times in the Ibn Sina Hospital's endocrinology department in Rabat to investigate seizures caused by recurrent hypoglycaemia. A diagnosis of child maltreatment was suspected due to a clinical-biological discrepancy discovered during a biological assessment performed by the endocrinology department, namely blood sugar, insulinemia and the determination of peptide C, those assessments were verified by the forensic unit of the Ibn Sina Hospital in Rabat. Thus, diagnostic vigilance and interdisciplinary collaboration are essential for the diagnosis and prevention of complications, as well as raising judicial authorities’ awareness to allow for the necessary child protection measures.
Le syndrome de Münchhausen par procuration est un trouble psychologique dans lequel un adulte violent qui souhaite incarner le personnage malade à travers un enfant, induit des symptômes pathologiques chez ce dernier, c’est une sorte de maltraitance dont le système de santé doit être conscient. Nous présentons le cas d’une fillette de neuf ans et demi, hospitalisée trois fois au service d’endocrinologie de l’hôpital Ibn Sina de Rabat pour l’exploration de crises convulsives dues à des hypoglycémies récurrentes. Un diagnostic de maltraitance infantile a été suspecté devant la discordance clinicobiologique découverte lors d’un bilan biologique effectué par le service d’endocrinologie, à savoir la glycémie, l’insulinémie et le dosage du peptide C, ces bilans ont été vérifiés par l’unité de médecine légale de l’Hôpital Ibn Sina de Rabat. Ainsi, la vigilance diagnostique et la collaboration interdisciplinaire sont essentielles pour le diagnostic et la prévention des complications, ainsi que la sensibilisation des autorités judiciaires pour permettre les mesures nécessaires de protection de l’enfant.
Factitious Disorder in Children and Adolescents
2022, Comprehensive Clinical Psychology, Second EditionThe case literature confirms cases of FD in children and adolescents, however there is little scientific evidence related to its epidemiology or etiology. In this article we provide a framework for thinking about excessive illness behavior generally, and apply it to understand FD in children and adolescents. This framework may help pediatricians prevent FD in young people and guide mental health professionals in their assessment and treatment of these cases.
Factitious Gastrointestinal Bleeding: A Case Series and Review
2021, American Journal of the Medical SciencesCitation Excerpt :The term “factitious disease” was first used by Hector Gavin in 1843 to describe patients who repeatedly feign or induce illness then seek diagnostic tests and medical treatments “…to attain compliance with their wishes, or to excite interest, or for the pleasure of deceiving”.4 British endocrinologist and hematologist Dr. Richard Asher later named the disorder “Münchausen syndrome” in The Lancet in 1951 after Baron Hieronymus Karl Friedrich von Münchausen.5 Münchausen was a page during the Russo-Austro-Turkish War who became famous for his exaggerated descriptions of his 18th century activities in Russia.
Factitious gastrointestinal bleeding (GIB) is a manifestation of factitious disorder (FD) wherein patients feign GIB in the absence of external gain. As it can be a challenging diagnosis to make, factitious GIB often leads to multiple tests, exposure to contrast agents and radiation, invasive endoscopic and surgical procedures, an increased risk of iatrogenic complications, and increased healthcare costs. Patients who feign GIB often demonstrate characteristic behaviors that may go unnoticed unless they are explicitly addressed. We report a series of patients admitted to our institution for further evaluation of obscure overt GIB with an eventual diagnosis of factitious GIB and review of the epidemiology and development of FD, a diagnostic approach to factitious GIB, and current management strategies.
Munchausen syndrome by proxy and early childhood professionals
2023, Metiers de la Petite EnfanceLe syndrome de Münchhausen par procuration est considéré comme une maltraitance, mais celle-ci est particulièrement complexe à repérer et à prendre en charge. Elle vise des personnes vulnérables, c’est-à-dire en incapacité de s’exprimer, de se défendre et de décrire ce qu’elles vivent. Il peut s’agir d’enfants, de personnes en situation de handicap ou âgées. Lorsque des tout-petits sont concernés, les professionnels de la petite enfance peuvent repérer ces maltraitances. Comment y parvenir et, ensuite, comment intervenir ?