Munchausen by internet and false perinatal crises.

BACKGROUND: In representative cases of Munchausen by internet (MBI), an individual (or "poser") goes online to falsely report or exaggerate illnesses or life crises. The principal goal, as in factitious disorder imposed on self or another, is to garner emotional satisfaction. We provide the first evidence that MBI can target a specific type of health care provider-in this case, birthing doulas. METHODS: We describe 5 cases in which individuals have utilized social media platforms to report factitious perinatal illnesses and crises, including neonatal death, in real time. Current health headlines, such as those involving the COVID-19 pandemic, can be relevant to the ruses. Posers can engage in deceptions with several health care professionals concurrently or serially, and may portray multiple people ("sock puppets") at the same time. RESULTS: MBI has consequences that can be highly disruptive. In the cases highlighted in this report, many hours of support were given to individuals who had fabricated their pregnancies, infants, and perinatal complications. The doulas experienced feelings ranging from resignation to anger and betrayal. CONCLUSIONS: Health care professionals of all types who offer services online should be vigilant to the risks of potential MBI.

Munchausen Syndrome.

Munchausen syndrome is a factitious disorder that is difficult to diagnose and treat. This article clarifies points for clinical recognition and management of patients with this condition. Patients with this condition often are dramatic and provide false and/or exaggerated symptoms or information. They solicit attention from physicians, going doctor-to-doctor, having repeated diagnostic tests, procedures, hospitalizations, and evidence little improvement. Adherence to treatment plans is generally suboptimal and the patients frequently leave the hospital against medical advice. A compassionate, multidisciplinary approach to treatment is advised. It often includes conjoint clinical communication between the primary care physician and a psychiatrist. Open, supportive discussion with the patient about his or her condition is important. Long-term psychotherapy and follow-up are recommended.

"Impossible" patients in oncology: Two unusual cases.

OBJECTIVE: Cancer patients can present with impossible behavior, which can jeopardize their treatment and challenge healthcare professionals' teamwork. METHOD: Report of two unusual psychiatric cases, including Munchausen and Peter Pan syndromes, which occurred in a comprehensive cancer center.ResultGuidelines in medical and surgical wards are suggested to address such situations regarding oncologic compliance.Significance of resultsMultidisciplinary collaboration between medical and surgical teams and the psycho-oncologic department is highly recommended.

Factitious disorder (Munchausen's syndrome) in oncology: case report and literature review.

BACKGROUND: Factitious disorder is where patients repeatedly seek medical care for feigned illnesses in the absence of obvious external rewards; 'Munchausen's syndrome' is the historical name for this disorder. METHOD: We report on a case that was presented to a tertiary oncology center as a suspected rare bone cancer. RESULTS AND CONCLUSIONS: Psychosocial clinicians working in oncology settings should be aware of the complexities of diagnosing factitious disorder in cancer settings where empathy is prominent and suspicion unusual. Moreover, comorbidity can cloud the diagnosis (in this case substance abuse), and, even when accurately diagnosed, there are no evidence-based management approaches to offer to the patient. What seems to linger most after the patient is discharged, usually in a huff, are strong counter-transference feelings and substantial medical bills. Copyright © 2015 John Wiley & Sons, Ltd.

'Munchausen syndrome': a forgotten diagnosis in the spine.

PURPOSE: To present the case of a patient with Munchausen's syndrome who underwent multiple surgeries in the spine before the diagnosis was made and, therefore, to highlight the importance of this obscure condition that can result in unnecessary surgical treatment. METHODS: A 44-year-old businesswoman presented with multiple episodes of low back pain and weakness in both lower limbs over past 11 years. Past history consisted of multiple hospitalizations, and three surgeries on her lumbar spine at different hospitals, with dramatic improvement in symptoms being reported each time after surgery. Clinical examination showed inconsistent and nonspecific neurological findings. Imaging studies like X-rays, magnetic resonance imaging, and all neurophysiological studies were within normal limits. RESULTS: Multi-disciplinary evaluation by a team of orthopedicians, neurologist and psychiatrist and rehabilitation specialists diagnosed it as 'Munchausen syndrome'. Only one report of this fictitious disease in spine was found in review of literature (Association AP, Diagnostic and statistical manual of mental disorders: DSM-IV-TR(®), 2003). CONCLUSIONS: A history of multiple surgical interventions at multiple hospitals, often followed by dramatic improvement and then relapse, should trigger a suspicion of Munchausen syndrome, particularly in the scenario of normal imaging studies. Diagnosing this rare condition in spine is key to avoid unnecessary surgery.

[Non usual cases of hypoglycaemia--hypoglycaemia factitia]. / Neobvyklé prípady hypoglykémie--hypoglycaemia factitia.

Hypoglycaemia factitia means also in recent time serious diagnostic and therapeutic problem in medical clinical practice, whereby often repeating episodes of serious hypoglycaemia in patients with diabetes mellitus, but also in patients without diabetes mellitus could be very difficult do resolve. First unsuccessful diagnosis implicit from wrong chose of examination algorithm, can lead to unidentified surgical interventions as are laparotomy and pancreatectomy, respectively. Hypoglycaemia factitia is considered to be one of many manifestations of so called Münchhausen's syndrome for that is typical acting of diabetic patient with goal to intentionally making hypoglycaemia or within suicidal attempt of patient on the basis psychological disease with intention to attract attention of surrounding community to himself due to application of insulin or sulfonylurea drugs. Diagnostic and therapeutic process could be in the case of hypoglycaemia factitia extremely difficult as from time side, than from health and also from economical side and that why necessary to approach with maximum responsibility.

Munchausen syndrome and Munchausen syndrome by proxy in dermatology.

Patients with Munchausen syndrome purposefully injure themselves, often with the injection of foreign materials, to gain hospital admission and the attention associated with having a difficult-to-identify condition. Munchausen syndrome by proxy occurs when a child's caregiver, typically the mother, injures the child for the same reasons. Cases of Munchausen syndrome and Munchausen syndrome by proxy with primary cutaneous involvement appear to be rarely described in the literature suggesting either that diagnosis is not made readily or that it is, in fact, an uncommon disorder. At the center of both conditions is significant psychological pathology and treatment is difficult as many patients with Munchausen syndrome when confronted with these diagnostic possibilities simply leave the hospital. Little is known about the long-term outcome or prognosis of these patients.

[Chronic pain and artificial diseases]. / Chronischer Schmerz und artifizielle Erkrankungen.

A 34-year-old woman presented with a complex pain disorder and a previous diagnosis of the rare Gitelman syndrome but with a negative genetic test. The patient was admitted to a routine ward for treatment of the pain but was transferred to the intensive care unit after suffering severe hypokalemia and a narcoleptic attack. In the period of intensive care all blood parameters were stable but on release to the normal ward severe hypokalemia immediately reoccurred. With consent the patient's belongings were inspected and many diuretics and laxatives were found. The patient admitted to uncontrolled self-medication so that the diagnosis of Gitelman syndrome also appeared to be an artificial disorder.

[Lie, whacking lie and pseudologia phantastica--pathological lying in factitious disorder]. / Valhe, emävalhe ja pseudologia phantastica--patologinen valehtelu teeskentelyhäiriöissä.

Pseudologia phantastica refers to chronic pathological lying without a clear motive. It is a symptom in the factitious disorder in adults, Munchausen syndrome and an illness made up for or inflicted on a child. Child abuse is often involved. Patients making up or causing symptoms for themselves of their child may have been exposed to similar behavior as a child. Some of them have received care and attention only through an illness. Pseudologia phantastica may then in adulthood be directed to making up or causing illnesses for oneself or another person.

The tic in TikTok and (where) all systems go: Mass social media induced illness and Munchausen's by internet as explanatory models for social media associated abnormal illness behavior.

This paper explores the recent phenomenon of adolescents presenting en masse (both online and in clinical settings) with symptoms seemingly acquired from viewing illness-related content posted by social media influencers. The most frequently reproduced illnesses have included Dissociative Identity Disorder (DID) and Tourette Syndrome. It discusses evidence that the recent spate of new-onset, severe tics are a form of Mass Psychogenic Illness facilitated by social media networks (a phenomenon labeled Mass Social Media Induced Illness). It then suggests that many of those self-diagnosed with DID may be manifesting a similar, technologically-facilitated conversion phenomenon. It then explores another explanatory model: that these simulacra of DID and Tourette Syndrome may also arise via a mechanism more closely resembling social media facilitated Factitious Disorder. Similar presentations, of individuals falsifying cancer, have previously been labeled Munchausen's by Internet. It then proposes an overarching construct, Social Media Associated Abnormal Illness Behavior (SMAAIB), that is agnostic regarding phenomenology. Within this framework, it explores the ways in which de-commodifying attention, connection and care (measured once in appointments and admissions, now in 'likes' and 'shares') and obtaining a full picture of the patient's psychological, sociological and cultural grounding can offer deeper understanding and ultimately a path to wellness.

Munchausen by internet: current research and future directions.

BACKGROUND: The Internet has revolutionized the health world, enabling self-diagnosis and online support to take place irrespective of time or location. Alongside the positive aspects for an individual's health from making use of the Internet, debate has intensified on how the increasing use of Web technology might have a negative impact on patients, caregivers, and practitioners. One such negative health-related behavior is Munchausen by Internet. OBJECTIVE: Munchausen by Internet occurs when medically well individuals fake recognized illnesses in virtual environments, such as online support groups. This paper focuses on the aspect of Munchausen by Internet in which individuals actively seek to disrupt groups for their own satisfaction, which has not yet been associated with the wider phenomena of Internet trolls (users who post with the intention of annoying someone or disrupting an online environment). METHODS: A wide-ranging review was conducted to investigate the causes and impacts of online identity deception and Munchausen by Internet drawing on academic research and case studies reported online and in the media. RESULTS: The limited research relating to motivation, opportunity, detection, effects, and consequences of Munchausen by Internet is highlighted and it is formally linked to aspects of trolling. Case studies are used to illustrate the phenomenon. What is particularly worrying is the ease with which the deception can be carried out online, the difficulty in detection, and the damaging impact and potential danger to isolated victims. CONCLUSIONS: We suggest ways to deal with Munchausen by Internet and provide advice for health group facilitators. We also propose that Munchausen by Internet and Munchausen by Internet trolling should be formally acknowledged in a revised version of the Diagnostic and Statistical Manual DSM-5. This will assist in effectively identifying and minimizing the growth of this behavior as more people seek reassurance and support about their health in the online environment. We also suggest directions for future research.

Bilateral corneal perforations and autoproptosis as self-induced manifestations of ocular Munchausen's syndrome.

PURPOSE: To report a patient with bilateral corneal perforations and autoproptosis in a case of ocular Munchausen's syndrome. DESIGN: Case report. PARTICIPANT: A 26-year-old white male referred to the oculoplastics service with one month history of decreased vision bilaterally and painful right eye. Multiple eyelid scars and right corneal opacity were noted. The patient was previously seen at another institution for rapid loss of vision in both eyes. INTERVENTIONS: An orbit decompression among many procedures failed to controlled extreme pain and proptosis. MAIN OUTCOME MEASURES: Resolution of proptosis, stabilization of vision, pain resolution. RESULTS: Three weeks after enucleation of the right eye was offered, patient presented with spontaneous left ruptured globe. After multiple episodes of self-mutilation and infections, both eyes were exenterated. CONCLUSIONS: Munchausen syndrome can be seen with ophthalmic manifestations and should be considered in the differential diagnosis when ocular abnormalities cannot be explained after a thorough evaluation. Recognition of this psychiatric disease is not only important for correct medical diagnosis and treatment, but also essential in protecting the patients from unnecessary invasive and aggressive medical procedures.

[Depressive symptoms in pathomimia: comorbidity or psychiatric factitious disorder?]. / Symptômes dépressifs et pathomimie : comorbidité ou trouble psychiatrique factice ?

BACKGROUND: The factitious disorders, more commonly known as pathomimia, are mainly expressed as organic symptoms voluntarily induced by the patient. Patients suffering from these disorders do not seek to obtain immediate secondary benefits, contrary to simulation. They send the physician a challenge, sometimes by means of self-mutilation, or exposure to a vital risk. Their objective is to raise the interest and the mobilization of the medical community. The patient will develop intense relationships with the medical staff, technically mobilized as well as emotionally, as far as the factitious character of the disorder is uncovered. In some cases, factious disorders are conditions in which a person acts as if he or she has a psychiatric disorder, by deliberately exhibiting psychiatric symptoms. Most often described are factitious acute psychotic disorders, mourning, affective disorders and post-traumatic stress disorders. Psychiatric factitious disorders are difficult to diagnose, but they share common diagnosis criteria with other pathomimias. These subjects may suffer from pathomimia because of the occurrence of other psychiatric symptoms, such as pathological personalities, adaptation disorders, abuse and/or dependence on alcohol or other substances, or depressive disorders. This paper describes three clinical cases of pathomimia, diagnosed after hospitalization in a psychiatric unit for depressive symptoms, as a correlate to their factitious or authentic character. METHOD: Three case reports, describing patients with pathomimia hospitalized in a department of psychiatry for depressive disorders. RESULTS: The first case was a 57 year-old man considered as suffering from a bipolar disorder hospitalized for a depressive syndrome. The symptoms described and reported are those of a factitious disorder. The patient interrupted the medical care by asking to be discharged from the hospital. The second case was a young woman hospitalized following a suicide attempt. She has a history of multiple somatic and psychiatric factitious disorders. On admission she had depressive symptoms, more likely linked with a pathological personality, rather than with a major depressive episode. The third case presented a Munchausen syndrome. He was hospitalized for depressive symptoms. He had a comorbid major depressive episode. The prescription of antidepressants led to a significant clinical improvement. CONCLUSION: These three cases indicate that a real depressive syndrome may be observed with a patient suffering from pathomimia. Therefore, a neutral and complete psychiatric evaluation is necessary so as to not deprive these patients from the opportunity for an adapted treatment.

[Munchausen syndrome in an extreme form of factitious disorder].

Patients suffering from this disorder mimic symptoms of diseases and seek medical procedures and operations. We present a case of a patient who underwent a thorough investigation for unexplained persistent hypoglycemia. According to the algorithm approach to the non-diabetic patient, we measured insulin and c-peptide plasma levels while glucose levels were low and looked for sulphonylurea, blood and urine traces. Following the above, an endoscopic ultrasound demonstrated a small pancreatic lesion and an explorative laparotomy was performed to detect an insulinoma. This procedure was complicated by partial colectomy due to colonic gangrene. Following the patient's recovery, hypoglycemia recurred and the laboratory tests were repeated, revealing trace amounts of glipizide in her serum and urine. Studies which examined the prevalence of the phenomenon among cases of unexplained hypoglycemia, including patients who were operated for presumed insulinoma, were reviewed. No specific therapy for factitious disorder has been established. Management is based upon psychotherapy which is often not very effective. We recommend that one has to keep in mind that negative tests for sulphonylurea traces in serum and urine, do not contradict the diagnosis of factitious disorder, and it is recommended to repeat these tests several times.

Factitious disorders in neurology: an analysis of reported cases.

BACKGROUND: Factitious disorder (FD) is the deliberate production or simulation of symptoms in order to adopt the sick role. OBJECTIVE: The authors look at FD in the neurology setting. METHOD: The authors examined documented, published cases. RESULTS: FD cases in neurology are strikingly different from those in other specialties in terms of their demographics. Whereas the paradigm of FD in medicine as a whole is of the socially stable female healthcare worker, neurology continues to report largely the classic itinerant "Munchausen's" type. DISCUSSION: The authors explore two possible explanations for this: either that female healthcare workers with FD do not present neurologically, or that, if they do, they are diagnosed with conversion disorder.

Facticious disorders in dermatology.

Facticious Disorders are self inflicted skin lesions and includes the creation of physical or psychiatric symptoms in oneself or other reference persons. In dermatology frequently, there are mechanical injuries by pressures, friction, occlusion, biting, cutting, stabbing, thermal burns or self-inflicted infections with wound-healing impairment, abscesses, mutilations or damages by acids and other toxic to the skin. The current classification differentiates between four groups: 1. Dermatitis artefacta syndrome in the narrower sense as unconscious/dissociated self-injury, 2. Dermatitis paraartefacta syndrome: Disorders of impulse control, often as manipulation of an existing specific dermatosis (often semi-conscious, admitted - self-injury), 3. Malingering: consciously simulated injuries and diseases to obtain material gain, 4. special forms, such as the Gardner Diamond Syndrome, Münchhausen Syndrome and Münchhausen-by-Proxy Syndrome. This categorization is helpful in understanding the different pathogenic mechanisms and the psychodynamics involved, as well as in developing various therapeutic avenues and determining the prognosis.

The origins of factitious disorder.

Factitious disorder is the deliberate simulation of illness for the purpose of seeking the sick role. It is a 20th-century diagnosis, though the grounds for its introduction are uncertain. While previous authors have considered the social changes contributing to growth in the disorder, this article looks at some of the pressures on doctors that may have created the diagnostic need for a disorder between hysteria and malingering. The recent history of those disorders suggests that malingering would no longer be acceptable when applied to the potentially larger numbers involved in workers' compensation or in mass conscription. Equally, the absolution given to hysteria on the basis of the Freudian subconscious would survive only as long as that model retained credibility. Growing egalitarianism and changing doctor-patient relationships in the 20th century would no longer tolerate a sharp division between culpable malingering and exculpated hysteria, which may previously have been made on grounds of class or gender. They would contribute to the need for a mediating diagnosis, such as factitious disorder.