Munchausen Syndrome in Emergency Medicine
- Author: William Ernoehazy Jr, MD, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP more...
Background
Patients who present with overt symptoms who subsequently prove to have factitious disease are particularly challenging to physicians.
Munchausen syndrome is distinguished from other factitious diseases by the lack of secondary gain. The patient's reason for engaging in deception is not to escape some consequence in life. Instead, the patient suffers from an apparent deep-seated need to be sick; a need which can impel the sufferer to injure or poison themselves in an effort to sustain the illusion of organic illness.
Richard Asher coined the eponym in 1951. Asher named the syndrome after Karl Friedrich Hieronymus, Baron Munchausen (1720-1797), a man who traveled widely and was renowned in his time for telling fantastic and exaggerated stories about his life.[1]
Pathophysiology
The pathophysiology of this disorder is unknown. Patients with Munchausen syndrome often are noted to have associated personality disorders (eg, poor impulse control, self-destructive behavior, borderline or passive-aggressive personality trait or disorder). However, the relationship of these constellations of personality disorders to the primary syndrome is unclear. Patients with Munchausen syndrome are adept at concealing the fact that their diseases are factitious and are markedly resistant to psychiatric evaluation. Information is often difficult to obtain.
Epidemiology
Frequency
United States
Rare
International
Rare
Mortality/Morbidity
The potential for significant morbidity and mortality exists, as patients with Munchausen syndrome go to extreme measures to simulate true organic diseases and may cause real disease in the process. For example, injection of exogenous material to produce febrile symptoms may result in local or systemic infection. One case report discusses beta-blocker ingestion in a patient who wished to maintain the diagnosis of sick sinus syndrome.[2] Morbidity and mortality may also arise from unnecessary medications and procedures when physicians are taken in by the patient's factitious symptoms.
Sex
- The majority of patients suffering from Munchausen syndrome are male.
- The typical presentation of Munchausen syndrome is characterized by a restless journey from physician to physician and hospital to hospital, an ever-changing list of complaints and symptoms, and an alarming variety of self-intoxications and self-injuries designed to better portray the illness that the patient asserts he or she has.
- There is a subset of women patients who vary from the classic presentation in that they reproduce a single set of symptoms, repeatedly. Patients in this subset exhibit less evidence of comorbid personality dysfunction than the average patient with Munchausen syndrome, and they have a strong tendency to form personal bonds with a single physician or group of physicians.
Age
- Incidence of Munchausen syndrome peaks in young–to–middle-aged adults, but it has been reported in patients of all ages (ie, childhood through advanced age).
- Pediatric Munchausen syndrome is a different disease from Munchausen syndrome by proxy (MSBP). MSBP is a syndrome in which an adult simulates or creates symptoms in a child to receive an ill-defined secondary gain from the child's hospitalization.
- MSBP is child abuse and must be dealt with when it is suspected. Because of the dangerous nature of the varied means used to create factitious symptoms, the mortality rate is significant; estimates range from 5-50%. MBSP is currently a topic of intense interest and research, given its potentially dire prognosis for the children who are its victims.
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