Munchausen syndrome by proxy: a case report.

BACKGROUND: Inappropriately high levels of insulin secretion can cause the potentially fatal condition of persistent hyperinsulinemic hypoglycemia of infancy. Our paper focuses on another cause of severe hypoglycemia, which can be easily missed. CASE PRESENTATION: An 18-month-old Saudi female was referred to our hospital for further investigation and management of her recurrent hypoglycemic attacks as a case of persistent hyperinsulinemic hypoglycemia of infancy. During admission, we noticed multiple red flags from the history; the mother was insisting on a pancreatectomy, rather than going for a positron emission tomography scan, and most importantly, all hypoglycemic attacks occurred while the mother was around. Consequently, after further investigation, the case was diagnosed as a caregiver-fabricated illness, and the case was referred to the Child Protection Center. CONCLUSIONS: One must have a high index of suspicion to diagnose caregiver-fabricated illness. Physicians should be more attentive to prevent such a disease, which could eventually become lethal if left unnoticed.

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.

Preserving Immunity for Reporters of Medical Child Abuse.

All American jurisdictions have laws protecting children from abuse and neglect. Mandated reporters, including health professionals, whether their suspicions ultimately are substantiated or unfounded, are entitled to immunity when their reports are entered in good faith. When harm takes the form of medical child abuse (MCA, also known as Munchausen syndrome by proxy or factitious disorder imposed on another), its origin is ambiguous, at least initially. Questions arise as to whether the caregiver intended to deceive medical professionals and if the condition improved when the child was separated from the caregiver. Clinicians may have an obligation to report MCA in difficult-to-diagnose cases or those where parents press for hospitalizations and procedures. Substantiated cases may lead to removal of children from homes and criminal prosecution of parents. This can result in backlash against the reporter by the parents, with claims of malpractice, official misconduct, intentional harm, fraud or conspiracy to commit fraud, defamation (libel or slander), or all of the above. This article examines case law regarding alleged departures from good-faith reporting of MCA and explores potential limitations to immunity provided to mandated reporters. The findings include no significant instances in which the immunity shield for good-faith reporting was pierced.

Self-inflicted pathological cutaneous disorders. Part I.

Self-inflicted skin disorders are artefact diseases inflicted by the use of multiple different means, for various different purposes. They account for about 2% of dermatology patient visits and include disorders with a denied or hidden pathological behavior (factitious disorders) and disorders with a non-denied and non-hidden pathological behavior (compulsive disorders). In turn, factitious skin disorders are subdivided into two groups: factitious disorders without an external incentive and factitious disorders with external incentives. In addition to the general diagnostic criteria, the present work examines the clinical forms of diseases of the first group (including dermatitis artefacta, Munchausen Syndrome, Munchausen Syndrome by proxy, and Morgellons Syndrome). In this case, the subject suffers from psychological problems and generally aims to attract the attention of the people around him, and in particular of his general practitioner, or else is reacting to difficult or unfavorable environmental conditions by means of an involuntary somatization at the level of the skin. The second part of the work on self-inflicted skin disorders will comprise the factitious disorders with external incentives and the compulsive disorders.

Trastorno facticio en adultos: a propósito de un caso y revisión de literatura / Factitious disorder in adults: a case report and literature review

RESUMEN: El trastorno facticio consiste en falsificar, inducir o agravar las enfermedades para recibir atención médica, independientemente si están enfermas o no. El impacto que tiene esta patología va desde altos costos en salud asociado a la policonsulta, hospitalizaciones y tratamientos innecesarios; la funcionalidad y calidad de vida de estos pacientes, hasta el costo de vidas humanas. Este trastorno sigue siendo un desafío para los clínicos, puesto que no hay evidencia suficiente sobre la epidemiología, etiología, clínica y manejo dada su complejidad. En este artículo se presentará un caso clínico enfatizando en la evolución de la enfermedad, manejo inicial y posterior durante su hospitalización, junto con una actualización basada en la literatura, en torno al tratamiento de esta patología, con el fin de proponer intervenciones preventivas o protocolos que permitan evitar hospitalizaciones y tratamientos innecesarios. Luego se finalizará con la resolución del caso, pronóstico de esta enfermedad y una conclusión.

ABSTRACT Factitious disorder consists of falsifying, inducing or aggravating illnesses in order to receive medical attention, regardless of whether they are ill or not. The impact of this pathology ranges from high health costs associated with polyconsultation, hospitalizations and unnecessary treatments, the functionality and quality of life of these patients, up to the cost of human lives. This disorder continues to be a challenge for clinicians, since there is insufficient evidence on the epidemiology, etiology, clinic and management given its complexity. In this article, a clinical case will be presented, emphasizing the evolution of the disease, initial and subsequent management during hospitalization, together with an update based on the literature, on the treatment of this pathology, in order to propose preventive interventions or protocols that allow avoiding hospitalizations and unnecessary treatments. Then it ends with the resolution of the case, prognosis of this disease and a conclusion.

Gaslighting in alleged assault ascertained as Munchausen syndrome transcending to malingering in highly counterintuitive self inflicted acid burns.

A factitious disorder leading to the self-infliction of highly counter-intuitive burns was diagnosed in a middle-aged female. The injuries were otherwise alleged to have been sustained by assault inflicted upon her by an unknown person. The case was diagnosed by medico-legal interpretation of injuries, in spite of a highly deceptive and concocted history by the patient and her husband. The entity was unique in being associated with magnificent primary, secondary and tertiary gains. The exploitation of the morbid sequel to malinger by the patient, and the involvement of the husband for the prolongation of the illness of his wife for financial gains as gaslighting was highly unusual. The self-infliction of injuries over hands is seen in factitious disorder. However, a combination of a guarded self-immersion of the hands and feet in a corrosive by an illiterate female, followed by malingering to earn livelihood is unprecedented in factitious disorders. The delayed presentation which required amputation of all the limbs to save the life of the patient is a glaring highlight of this case.

Insights into the clinical profile and comorbidities of factitious disorder in a multispeciality setting in southwest Nigeria: A cases series and review

Background: Factitious disorder (FD) is an under-recognized and under-diagnosed mental condition. Healthcare professionals often have challenges to diagnose and treating the disorder. As a result, needless and endless medical resources are recommended to assess and evaluate those affected. FD may present as a physical condition, a psychological disorder, or maybe both depending on the prominent symptoms. However, there is a strong correlation between having FD and psychiatric symptoms. Main Text: FD occurs in early adulthood, with a mean age of onset of 25 years in both genders, although with differing demographic features. The lifetime prevalence of FD imposed on oneself in clinical settings is 1.0%, 0.1% in the overall population (ranging between 0.007% and 8.0%) and occurs more in female health care professionals. FD may make up 0.6%­3.0% of psychiatric referrals, and it accounts for 3-5% of doctor-patient contacts. In actuality, 1-2% of hospital admissions and an average of 6-8% of all psychiatric admissions have been underreported. The study aimed to highlight the signs and symptoms of FD identified in a psychiatry department of a multispecialty center and to increase the awareness of health practitioners. A critical review of the literature was done with an emphasis on psychological symptoms. PubMed, Mendeley, and Google Scholar were thoroughly searched and full-text publications of journals from 2010-2021 were included. Conclusion: FD is a diagnostic puzzle that necessitates adequate, prompt medical attention as well as social support because of the potentially fatal consequence. A stronger patient-therapist relationship can strengthen the patient's conscious self-control to minimize the symptoms; therefore the healthcare provider has to be openminded. For the diagnostic enigma to be removed and for ease of treatment, additional research, increasing awareness among medical professionals and the general public, accurate evaluation, diagnosis, and psychotherapy should be encouraged. These case studies will contribute to the knowledge base of FD and improve the quality of care.

[Munchausen syndrome in a child].

A six-and-a-half-year-old girl with white secretions in her eyes for 2 weeks was treated in the Ophthalmology Department of the First Affiliated Hospital of Xi'an Jiaotong University after ineffective treatment in several hospitals. The patient refused to communicate with the doctor and receive detailed examination. Only conjunctival congestion was found in both eyes. According to the photos and specimens of white secretions from both eyes provided by the parents of the patient, the diagnosis was conjunctivitis and conjunctival foreign bodies. With the doctor's reminding, the parents did close observation and good communication. The child finally admitted that she had put tissue fragments into her eyes in order to attract the parents' attention. Munchausen syndrome was diagnosed by a psychiatrist. After symptomatic treatment and improvement of family environment, the patient's condition improved. (Chin J Ophthalmol, 2021, 57: 621-623).

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: 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.

The girl who cried wolf: A literature review and case report of pediatric factitious disorder.

Pediatric presentations of factitious disorder (Munchausen syndrome) remain underdiagnosed and poorly understood compared to adult cases. The purpose of this study is to review the current literature on child and adolescent factitious disorder in order to better understand the differences between pediatric and adult presentations of this disorder. We also present the case of an adolescent girl with factitious disorder; her hospital course draws attention to the excessive healthcare expenditures and risk of iatrogenic complications associated with this diagnosis. We utilized MEDLINE and Google Scholar databases to conduct our review. Despite the limited number of high-quality studies analyzing pediatric presentations of factitious disorder, our review yielded several important findings. Studies suggest that the general acceptance of somatization as a common way for young people to manifest emotional stress may explain the under-diagnosis of this disorder in pediatric populations. Studies also highlighted differences in the clinical characteristics of factitious disorder when patients are stratified by age; most notably, younger patients are more willing to admit intentional falsifications when confronted and more likely to accept treatment, making them a potentially more effective target for intervention.

Secretan Syndrome: A Fluctuating Case of Factitious Lymphedema.

Secretan syndrome (SS) is a recurrent or chronic form of factitious lymphedema that usually affects the dorsal aspect of the hand and is accepted as a subtype of Munchausen syndrome. Secretan syndrome usually is induced by compression of the extremity by tourniquets, ligatures, cords, or similar equipment. This unconsciously motivated and consciously produced lymphedema is an expression of underlying psychiatric disease. Herein, we present a fluctuating case of SS involving the hand, with periods of severe lymphedema and those of complete amelioration, parallel to stressful and peaceful periods in the patient's personal life. We briefly review the current literature on SS to increase awareness among dermatologists, and we present information on the clinical portrait, diagnosis, and appropriate management of this peculiar and underreported disorder.

Factitious Disorder (Munchausen Syndrome) in Plastic Surgery: A Systematic Review of 42 Cases.

INTRODUCTION: Patients with factitious disorder (FD) or "Munchausen syndrome" intentionally fabricate or induce medical problems for psychological gratification. They may deceive plastic surgeons into performing multiple unnecessary procedures. We undertook the first systematic review of FD case reports in plastic surgery. Our aims were 2-fold: (1) describe the adverse outcomes associated with these cases and (2) identify strategies for their prevention by surgeons. METHODS: MEDLINE, EMBASE, and SCOPUS databases were searched. We included cases in which an adult with FD presented to a plastic surgeon. Our search returned a total of 42 eligible cases reported from North America (43%), Europe (37%), and Asia (20%). RESULTS: Seventy-six percent of patients were women, and 62% worked in health care. Sixty percent had a comorbid psychiatric disorder, the most common (50%) being depression. Ninety-three percent of our sample presented with self-induced lesions. The average delay in diagnosis of FD was 54 months, with 46% of patients receiving multiple surgical procedures in this time, including debridement (36%) and skin grafts (39%). Surgical wounds were frequently exploited by patients to remain in, or return to, hospital: 50% contaminated or manipulated their wounds to prevent healing. Thirty-six percent of cases resulted in significant long-term disability (24%) or disfigurement (12%). Ten percent of patients received an amputation. Outcomes were improved when patients were confronted by surgeons, however, and 62% were willing to see a psychiatrist. Surgeons were able to support recovery in 33% of cases-for example, by using occlusive wound dressings. CONCLUSIONS: Patients with FD who present to plastic surgeons are high risk: the majority require surgical intervention for severe self-injury, and many engage in harmful behaviors, such as "doctor-shopping." Early recognition of FD in plastic surgery is, therefore, crucial and may be achieved via careful examination of lesions for unusual morphology. Medical records may reveal extensive health care service use and negative investigations. Finally, plastic surgeons may play an important role in managing such patients. Management strategies include direct observation by nursing staff in the postoperative period and use of strict occlusive dressings to prevent access to surgical wounds.