FACTITIOUS DISORDERS: MUNCHAUSEN SYNDROME
In the literary world there have been numerous cases of simulated illness. For example, in Conan Doyle’s short story The Adventure of the Dying Detective, a malingering Sherlock Holmes pretends he has been infected by a contagious and lethal disease originating in Sumatra, as such a ruse appears to be the only way to get his rival to offer a full confession to a crime. In Dostoevsky’s The Brothers Karamazov, the evil Smerdiakov simulates epileptic seizures, however in this case with homicidal intent. Factitious Disorders are also commonly referred to as the Munchausen Syndrome. After years serving in the cavalry and now living in retirement on his family estate, Baron Munchausen (1720-1797) enjoyed entertaining his friends with tales in which he attributed to himself a series of extraordinary exploits. The term Munchausen Syndrome was first used in 1951 in the British medical journal The Lancet to refer to situations characterised by repeated hospital admissions for the treatment of apparently acute illnesses. Patients would provide a plausible explanation for their predicament and for the cause itself, however this would be subsequently found to be entirely false.
The DSM IV defines the syndrome as the Chronic Factitious Disorder with predominant physical signs and symptoms. It should be noted that the Factitious Disorders have a number of common characteristics:
The clinical history invented by the person is usually credible and plausible, however details provided are almost always vague and inconsistent. The narrative produced by a patient when anamnesis is taken may contain tales of heroic deeds. These patients also often bring with them copious clinical documentation that may refer to multiple surgical interventions, almost as if they were intent on challenging the physician’s ability. The age of onset is normally during early adulthood. During hospitalization these patients are typically and particularly fussy, demanding, hostile and constantly seek attention. In turn, they generally receive very few visitors. A common feature of the Factitious Disorders is the patients’ never-ending desire to be examined and even submitted to quite uncomfortable medical tests, as if they were afflicted by a desire to harm themselves.Munchausen Syndrome by Proxy. In such cases the disorder is engendered in another person. It may occur for example that, driven by a desire to be at the centre of attention, a mother may decide her daughter has a (non-existent) disease and then force her to take medicines and submit to continuous medical examinations, eventually succeeding in affecting her health in quite a substantial manner.
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Asher R. Munchausen syndrome. Lancet, 1951; 1: 339.