eMedicine Specialties > Emergency Medicine > Psychosocial

Munchausen Syndrome: Differential Diagnoses & Workup

Author: William Ernoehazy Jr, MD, FACEP, Medical Director, Emergency Department, Ed Fraser Memorial Hospital, Florida
Contributor Information and Disclosures

Updated: Feb 14, 2008

Differential Diagnoses

Conversion Disorder
Munchausen Syndrome
Munchausen Syndrome by Proxy

Other Problems to Be Considered

Malingering

Workup

Laboratory Studies

  • Depending upon the presenting complaint, any laboratory test used in the ED may be indicated in the initial evaluation of patients with underlying Munchausen syndrome.
  • Laboratory results that are atypical in pattern (eg, dramatically positive results, paradoxically normal results) may be an early indication of the presence of a factitious illness. Efforts may then be made to refine the diagnosis.

Imaging Studies

  • As with laboratory testing, almost any imaging technique used in the ED may be indicated in the initial workup.

Procedures

  • If the initially credible impression suggests severe enough disease or the attempts the patient has made to mimic organic illness have themselves produced sufficient illness and/or injury, appropriate procedures for workup and/or treatment must be undertaken.
  • Clinicians often become frustrated at the thought of performing invasive procedures on healthy people.
  • Persons with Munchausen syndrome often develop remarkable skill in inducing or duplicating symptoms. Further, the ED physician has a duty not to ignore organic disease where it is plausibly believed to exist. These factors, in concert, often make the performance of such procedures unavoidable.

More on Munchausen Syndrome

Overview: Munchausen Syndrome
Differential Diagnoses & Workup: Munchausen Syndrome
Treatment & Medication: Munchausen Syndrome
Follow-up: Munchausen Syndrome
References
[ CLOSE WINDOW ]

References

  1. Olry R. Baron Munchhausen and the syndrome which bears his name: history of an endearing personage and of a strange mental disorder. Vesalius. Jun 2002;8(1):53-7. [Medline].

  2. Steinwender C, Hofmann R, Kypta A, Leisch F. Recurrent symptomatic bradycardia due to secret ingestion of beta-blockers--a rare manifestation of cardiac Münchhausen syndrome. Wien Klin Wochenschr. Sep 2005;117(18):647-50. [Medline].

  3. Park TA, Borsch MA, Dyer AR, Peiris AN. Cardiopathia fantastica: the cardiac variant of Munchausen syndrome. South Med J. Jan 2004;97(1):48-52; quiz 53. [Medline].

  4. Elmore JL. Munchausen syndrome: an endless search for self, managed by house arrest and mandated treatment. Ann Emerg Med. May 2005;45(5):561-3. [Medline].

  5. Asher R. Munchausen's syndrome. Lancet. Feb 10 1951;1(6):339-41. [Medline].

  6. Bretz SW, Richards JR. Munchausen syndrome presenting acutely in the emergency department. J Emerg Med. May 2000;18(4):417-20. [Medline].

  7. Canogullari G, Ulupinar E, Teyin M, Balci Y. A forensic case of Munchausen's syndrome. J Forensic Leg Med. Apr 2007;14(3):167-71. [Medline].

  8. Eisendrath SJ. When Munchausen becomes malingering: factitious disorders that penetrate the legal system. Bull Am Acad Psychiatry Law. 1996;24(4):471-81. [Medline].

  9. Falagas ME, Christopoulou M, Rosmarakis ES, et al. Munchausen's syndrome presenting as severe panniculitis. Int J Clin Pract. 2004;58(7):720-2. [Medline].

  10. Feldman MD. Munchausen by Internet: detecting factitious illness and crisis on the Internet. South Med J. Jul 2000;93(7):669-72. [Medline].

  11. Feldman MD, Peychers ME. Legal issues surrounding the exposure of "Munchausen by Internet". Psychosomatics. Sep-Oct 2007;48(5):451-2. [Medline].

  12. Gregory RJ, Jindal S. Factitious disorder on an inpatient psychiatry ward. Am J Orthopsychiatry. Jan 2006;76(1):31-6. [Medline].

  13. Hall DE, Eubanks L, Meyyazhagan LS. Evaluation of covert video surveillance in the diagnosis of munchausen syndrome by proxy: lessons from 41 cases. Pediatrics. Jun 2000;105(6):1305-12. [Medline].

  14. Hopkins RA, Harrington CJ, Poppas A. Münchhausen Syndrome simulating acute aortic dissection. Ann Thorac Surg. Apr 2006;81(4):1497-9. [Medline].

  15. Huffman JC, Stern TA, Huffman JC, Stern TA. The diagnosis and treatment of Munchausen's syndrome. Gen Hosp Psychiatry. 2003;25(5):358-63. [Medline].

  16. Lad SP, Jobe KW, Polley J, et al. Munchausen's syndrome in neurosurgery: report of two cases and review of the literature. Neurosurgery. 2004;55(6):1436. [Medline].

  17. Rabinerson D, Kaplan B, Orvieto R, et al. Munchausen syndrome in obstetrics and gynecology. J Psychosom Obstet Gynaecol. 2002;23(4):215-8. [Medline].

  18. Smith MS. Factitious illness, malingering, and conversion disorder. In: Harwood-Nuss AL, Linden CH, Luten RC, et al, eds. The Clinical Practice of Emergency Medicine. 2nd ed. Philadelphia, Pa: Lippincott-Raven; 1996:986.

  19. Zuger A, O'Dowd MA. The baron has AIDS: a case of factitious human immunodeficiency virus infection and review. Clin Infect Dis. Jan 1992;14(1):211-6. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Munchausen syndrome by proxy, MSBP, Munchausen syndrome, factitious illness, factitious disorder, cardiopathia fantastica, faking illness, factitious symptoms, self-injury, self-poisoning, unnecessary medical procedures, mental illness, malingering, psychiatric illness

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

William Ernoehazy Jr, MD, FACEP, Medical Director, Emergency Department, Ed Fraser Memorial Hospital, Florida
William Ernoehazy Jr, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Eric Kardon, MD, FACEP, Associate Staff, Division of Emergency Medicine, Athens Regional Medical Center
Eric Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Robert C Harwood, MD, MPH, Program Director, Chair, Department of Emergency Medicine, Christ Hospital and Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago Medical School
Robert C Harwood, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Chicago Medical Society, Illinois State Medical Society, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.