Self-provoked oral illness: When the mouth mirrors the soul.

BACKGROUND: Factitious disorder imposed on self (FDIS), also known as Munchausen's syndrome, is a psychological disorder characterized by falsification of physical or psychological symptoms without an obvious external incentive. Oral presentations of FDIS are infrequently reported, and diagnosis might be challenging because affected patients often have impressive skills in fabricating symptoms and deceiving healthcare professionals. AIM: To describe the diagnostic dilemma and management challenges in a female patient who presented with tooth ache and oral ulcers. CASE DESCRIPTION: A 53-year-old female presented with complex medical history, vague symptoms and confusing dental history regarding persistent toothache and generalized oral ulcers. She underwent extensive investigations and multiple dental and oral surgical procedures without reaching a confirmed diagnosis or achieving symptomatic improvement. Thorough review of her medical records revealed multiple admissions to various hospitals across the country and abroad for various reasons, and failed to find any laboratory, clinical, or radiographic evidence of her "claimed" symptoms. CONCLUSION: Oral healthcare professionals should suspect FDIS in patients presenting with vague and complex history that is not explained by clinical or radiographic findings. Consultation with psychiatric department and hospital administration might be needed to confirm diagnosis and plan appropriate management of the case.

A descriptive, retrospective case series of patients with factitious disorder imposed on self.

BACKGROUND: Despite cases of factitious disorder imposed on self being documented in the literature for decades, it appears to remain an under-identified and under-diagnosed problem. The present study aimed to explore factitious disorder imposed on self in a series of French patients. METHODS: Patients 18 years old and over with factitious disorder imposed on self were retrospectively included by two independent reviewers according to DSM-5 criteria in Rennes University Hospital for the period 1995 to 2019. Patients were identified from a clinical data warehouse. RESULTS: 49 patients with factitious disorder imposed on self were included. Among them, 36 (73.5%) were female. The average age at diagnosis was 38.4 years. The 16 patients with a health-related profession were all female. Direct evidence of falsification was found in 20.4% of cases. Falsification was mainly diagnosed on the basis of indirect arguments: history of factitious disorder diagnosed in another hospital (12.2%), extensive use of healthcare services (22.4%), investigations that were normal or inconclusive (69.4%), inconsistent or incomplete anamnesis and/or patient refusal to allow access to outside information sources (20.4%), atypical presentation (59.2%), evocative patient behaviour or comments (32.7%), and/or treatment failure (28.6%). Dermatology and neurology were the most frequently involved specialities (24.5%). Nine patients were hospitalized in intensive care. Some of them received invasive treatments, such as intubations, because of problems that were only reported or feigned. The diagnosis of factitious disorder imposed on self was discussed with the patient in 28 cases (57.1%). None of them admitted to making up the disorder intentionally. Two suicide attempts occurred within 3 months after the discussion of the diagnosis. No deaths were recorded. 44.9% of the patients returned to the same hospital at least once in relation to factitious disorder imposed on self. CONCLUSIONS: The present study reinforces data in favour of a predominance of females among patients with factitious disorder imposed on self. This diagnosis is difficult and is based on a range of arguments. While induced cases can be of low severity, cases that are only feigned can lead to extreme medical interventions, such as intubation.

Munchausen syndrome: report of a case and implications for dentists.

Munchausen syndrome (MunS), or factitious disorder imposed on self, is an exceedingly rare and immensely difficult syndrome to identify and manage and is considered a diagnosis of exclusion. Few reports exist in the dental literature to date, so the objective of this article is to describe a case of MunS in a 60-year-old woman who sought treatment for bilateral jaw pain and uncontrolled jaw movements. The patient's symptoms started 19 months previously, following placement of a 6-unit metal-ceramic bridge. Her pain started as a mild, intermittent ache that lasted for 30 minutes. However, gradually her symptoms became severe and constant. In addition, she started to experience episodes of uncontrolled jaw contractions that were associated with bilateral episodes of stabbing and shooting pain. Results from her comprehensive clinical assessment and investigations suggested that the patient had masticatory myalgia pain disorder and oromandibular dystonia. She experienced significant relief of symptoms with pharmacologic intervention. However, after an intermittent period of relief, she returned to the clinic with an inconsistent history, irregular clinical examination, and history of erratic behavior. The patient was referred to a psychiatrist, who eventually rendered a diagnosis of MunS. This article will also address considerations for the dental team, including how to identify cases of MunS, relevant courses of action, including appropriate referral, and the consequences of overdiagnosis of MunS.