1. Munchausen Syndrome Alex Verloove 2 nd hour Psychology 05-08-12

2. What is it? The person acts like they have a mental or physical disorder, when in reality, they just want attention Named for Baron von Munchausen, an18th C German officer who was known for embellishing the stories of his life and experiences The most severe type of factitious (artificial) disorder Axis II

3. Symptoms Chest/stomach pain, fever, problems with identity or self-esteem, Unusually comfortable in hospital setting Dramatic but inconsistent medical history Excitement for medical procedures They might lie about or fake symptoms, hurt themselves to bring on symptoms, or alter diagnostic tests (such as contaminating a urine sample). There are many forms this disorder may take: feigning cancer, cardiac disease, skin disorders, infections, bleeding disorders, metabolic disorders, chronic diarrhea, and many more.

4. Causes Exact cause not known Biological and psychological factors Researchers also are studying the possible link with personality disorders, which are common in individuals with Munchausen syndrome.

5. Commodity No reliable statistics to tell how many people suffer from this disorder in the U.S. Dishonesty in representation Can occur in children, but most often affects young adults.

6. Diagnosing Difficult Doctors have to rule out all other physical/mental disorders Refer patient to a psychiatrist or psychologist; specially trained to diagnose and treat mental illnesses Psychiatrists and psychologists use a thorough medical history and physical, laboratory imagery, and psychological assessment tools to evaluate a person Observe patient’s attitude and behavior Personality concerns are prominent and can make it that much more confusing to sort out organic from factitious If symptoms are found in DSM-IV, doctor can finally complete the diagnosis

7. Treatment Ironically, the person often is unwilling to admit to and seek treatment for the syndrome itself ◦ Makes treatment very difficult Psychotherapy Cognitive-behavioral therapy No medicines to treat factitious disorders themselves. ◦ “Medicine might be used, however, to treat any related disorder—such as depression, anxiety, or a personality disorder. The use of medicines must be carefully monitored in people with factitious disorders due to the risk that the drugs might never be picked up from the pharmacy or might be used in a harmful way,” (Phillips, K. 2010).

8. Complications Death from hurting themselves/faking symptoms Might suffer from reactions or health problems associated with multiple tests, procedures, and treatments, and are at high risk for substance abuse and suicide attempts

9. Outlook Chronic disorder More realistic to manage disorder than to try to cure it Avoiding unnecessary, inappropriate admissions to the hospital, testing, or treatment is important

10. Essential Features Pathological lying Peregrination Recurrent, feigned or simulated illness

11. Associated Features Severe emotional difficulties History of Suicide Attempts and/or depression History of Multiple Medical Procedures Adjustment Disorder Substance Abuse Dysthymic Disorder Somatoform Disorder Borderline Personality Disorder

12. Differential Diagnosis Genuine Psychiatric Pathology Malingering ◦ real symptoms, doesn’t admit to the real cause/exaggerates them Somatoform disorders ◦ Physical complaints/symptoms, no organic cause

13. Diagnosing Criteria The patient intentionally produces or feigns physical or psychological signs or symptoms. The motivation for the behavior is to assume the sick role. External incentives for the behavior are absent.

14. Case Study “Ms. A” 51 year old woman Presented to special agency to help her cope with her deaf/blindness She reports having Usher syndrome; recessive disease, loss of vision and hearing

15. Case Study Goes for an examination, they give her a walker ◦ Claims she has multiple sclerosis, glaucoma, cardiac disease, hypertension, diabetes, sleep apnea, and history of traumatic brain injury Seems able to see and hear without difficulty ◦ Requested that sign language be used ◦ Says she used to work as a sign language interpreter, but her sign language was not proficient for even her own use Did not request assistance services for her blindness symptoms, although many were offered

16. Case Study More interviews and exams ◦ Says she lived with her husband for 23 years, but could not say where he worked or what he did ◦ Didn’t appear to have restricted visual fields Inconsistent responses to tests ◦ Given hearing aids ◦ Hearing tests showed no more than mild hearing loss in one ear ◦ Blamed this on the machine; “I am deaf” Limited outside records; “I don’t remember my doctors’ names”

17. Case Study Multiple tests ruled out diabetes, glaucoma, cardiac disease, blindness, sleep apnea and multiple sclerosis She does not have Usher Syndrome She then announced that she actually had Leber syndrome, a hereditary mitochondrial disorder with central nervous system manifestations that can include deaf/blindness. She clearly did not have this condition. She also reported that she would be transferring her care to another center for deaf people and would see a deaf therapist using American Sign Language. She did not return to the agency.

18. Works Cited Hamdonia, S. (2004, April 14). Fact or fantasy- the truth behind munchausen syndrome. Retrieved from http://serendip.brynmawr.edu/bb/neuro/neuro04/web2/shamdounia.html http://serendip.brynmawr.edu/bb/neuro/neuro04/web2/shamdounia.html Hamilton, J. (2011, June 7). Munchausen syndrome. Retrieved from http://emedicine.medscape.com/article/295127-overview. http://emedicine.medscape.com/article/295127-overview Phillips, K. (2010, December 14). Diseases and conditions. Retrieved from http://my.clevelandclinic.org/disorders/factitious_disorders/hic_munc hausen_syndrome.aspx http://my.clevelandclinic.org/disorders/factitious_disorders/hic_munc “Factitious disorder. “ (2012, April). Retrieved from http://www.psychnet-uk.com/x_new_site/DSM_IV/factitious_disorder.html