Munchausen Syndrome in Emergency Medicine Clinical Presentation
- Author: William Ernoehazy Jr, MD, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP more...
History
- Dramatic presentations of apparently severe illnesses
- Reported symptom patterns that fit diagnoses too perfectly and are too much like a textbook presentation
- A history of extensive surgical procedures and inpatient workups for a variety of diseases, particularly when the workup spans multiple hospitals and cities
- Notable vagueness or inconsistency in the details of the medical problems
- Evidence of pathological lying in areas other than the presenting symptoms
Physical
- Patients with Munchausen syndrome may display any combination of signs and symptoms.
- In an effort to obtain hospitalization, an invasive workup, and extensive interventions, patients with Munchausen syndrome may mimic any severe disease that generates physical findings and symptoms.
- Cardiac presentations of Munchausen syndrome are common enough to have allowed cardiologists to identify cardiac Munchausen syndrome—sometimes referred to as cardiopathia fantastica[3] —as a distinct subset of the Munchausen spectrum.
Causes
- Once it has been determined that a disease presentation is factitious, the absence of a clear source of primary or secondary gain is the hallmark that distinguishes Munchausen syndrome from other factitious illnesses. No convincing explanation of secondary gain has yet been described in patients with Munchausen syndrome.
- In contrast to Munchausen syndrome, malingering patients have a clear primary gain in their efforts to escape some task or obligation.
- Conversion and somatoform disorders also are driven by a secondary gain. Treating the underlying stressor often can alleviate the presenting symptoms.
- In contrast, a patient with Munchausen syndrome actively seeks hospitalization and invasive painful procedures as a primary goal.
- Munchausen syndrome afflicts the patient who presents with the complaint. Munchausen syndrome by proxy involves inflicting injury on a child or other dependent person in order to simulate symptoms. There is no obvious or plausible secondary gain to the caretaker who performs these actions. Munchausen syndrome by proxy is a form of abuse and must promptly be acted upon when suspected.
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