What are the 3 types of Munchausens?
Munchausens Syndrome
Munchausens Syndrome by Proxy
Munchausen’s Syndrome by Internet (CyberMunch)
Define:
- Munchausens
- Malingering
- Factitious disorder
Munchausens
-a person exaggerates or creates sx of illnesses in themselves to gain investigation, tx, attention, sympathy, and comfort from medical personnel.
Malingering
-Feigning illness has an external incentive (avoiding work, obtaining money)
Factitious disorder
-has no other incentive than to be a pt and experience the sick role
What is the difference between Munchausen and hypochondriacs?
Munchausen- pts know they are not sick
Hypochondriacs- believe they actually have the disease
Munchausens
- Etiology
- Sx
Etiology
-Theories suggest that a hx of abuse or neglect as a child, or a hx of frequent illnesses requiring hospitalization
Sx
- dramatic but inconsistent/discrepant medical hx
- unclear sx that are not controllable and that become more severe or change once treatment has begun
- predictable relapses following
- extensive knowledge of hospitals and medical terminology, textbook descriptions of illnesses
- multiple surgical scars
- new or additional sx following negative test results
- presence of sx only when the pt is alone or not being observed.
Munchausens by Proxy
- what is this?
- common presentation
- signs and sx
- characteristics of perpetrator
What:
fabricating of inducing illness in a child by the parent or primary caregiver in order to get attention. Illness does not occur when the child and caregiver are separated.
form of child abuse
- illness that is unexplained, unusual, prolonged, and resistant to tx
- problem only originates in the presence of the perpetrator and resolves when the child and perpetrator are separated
- the perpetrator seems less concerned about the childs illness than the clinicians who are providing care.
Signs and Sx:
- bleeding from various sites
- seizures
- CNS depression
- Apnea
Perpetrator Characteristics:
- biological mother
- usually 20-30YO
- seem to be loving and caring when around medical staff
- ALL have some sort of marital conflict
- 50% have medical training
Munchausens:
-examples of ways to be admitted to the hospital
self-induced infections
surreptitious ingestion of medicines, vitamins, minerals
Self-induced injury
Phlebotomy
Thermometer manipulation or substitution of thermometer
simulation of the clinical manifestations of specific dz or syndromes
Munchausens Syndrome By Proxy:
- common presentations
- dx
- tx
- GI bleed or UTI
- Vomiting or relfux
- Diarrhea
- Apnea
- Hypoglycemia
Dx:
-complete history
Tx:
- child protection team; abuse specialists or prediatrician
- law enforcement
- child protective and social services
CyberMunch
-what is this?
-
What: joins support groups on the internet and then falsify stories about themselves so that others will show sympathy and talk to them about their “misfortunes”
