Munchausen SYndrome ("The Baron Strikes Again")

[mycrofft]

http://discovermagazine.com/1993/jul/thebaronstrikesa243

An article I filed from a 1993 "DISCOVER" magazine. Anyone have examples they want to share?

(Or, as the "Baron von Munchausen" character would say when challenged, "Vas you dere, Charlie? Hmmmm?".

[YOUTUBE]http://www.youtube.com/watch?v=l3FPleejIEg"]http://www.youtube.com/watch?v=l3FPleejIEg [/YOUTUBE]

 

[mycrofft]

dupe

 

[Aprz]

That's an interesting story (and kinda sad too) although I don't have any story I can contribute. :[

 

[mycrofft]

I suspect this story because it ends so poignantly (Mycrofft's Second Law of the Internet: 'The best stories are rarely true").

But on my ER learning rotation we had a woman using her roomate's airline stewardess* uniform and pin-on nametag (before picture ID's) come in, literally crying about flank pain, giving hx of renal stones, saying she had to make a flight very soon. She was able to produced (unwitnessed) urine with trace unhaemolyzed blood and underwent a KUB, then received her Demerol and Vistaril shot. WHen they came back to tell her the good news about the KUB being normal, she was gone. Followup with the real stewardess revealed the trouble, and the roomate had split.

Most field Munchausen's are less intricate, but we had a "Munchausen by proxy" once, a woman who would act as a babysitter for other people in base housing, then she could "rescue" her charges probably by smothering them first.

There was an infamous one years ago where a woman was poisoning her daughter even while in hospital, sent out word the family was cash-drained and the daughter was dying of some disease, and she and her husband reaped tens of thousands of dollars in sympathy cash with which they bought a swimming pool, a Harley-Davidson, etc. If I recall, it was detected when the kid vomited after a mom-visit and the contents were anomalous.

*Before "flight attendant" was in use too.

PS: The phrases "Munchausen Syndrome" and particularly "Munchausen by proxy", are under attack, as is "shaken baby syndrome", as being non-clinical labels applied too liberally.

 

[Veneficus]

PS: The phrases "Munchausen Syndrome" and particularly "Munchausen by proxy", are under attack, as is "shaken baby syndrome", as being non-clinical labels applied too liberally.

And with good reason.

All eponyms should die a painful death.

They are especially problematic when multiple languages all call it something different because of so many simultaneous discoveries or not knowing somebody else already described it.

Then they try to fix it by adding a hyphenated name.

Perfect example of ego winning out over smart in medicine.

 

[mycrofft]

Too bad, lost a perfectly good mnemonic due to language abuse. Agreed.

At least "Munchausen's" was not a ego-shrine for some obscure eighteenth century horse doctor.

 

[mycrofft]

IS there such a thing as Munchausen's?

So what's a good name for patient's who are sociopathic or mentally ill to the extent of alleging or actually causing illness and injury to themselves and others for medical attention, and sometimes drugs or other benefit? Are they a true syndrome or do we just see it that way because medical people are the one common tile in their little scrabble game?

Compare:
1. Mom poisons daughter to get money.
2. Babysitter smothers charges to resuscitate them for acclaim?
3. Woman claims to have AIDS to gain housing, food, attention, and status (old-hand at getting AIDS assistance to newer patients)?
4. Inmate simulates spinal injury to get trip out of facility to a medical setting and maybe get drugs, or escape.
5. Nurse does subcutaneous injections of feca;l material to spike FUO"s. (fevers of unknown origins).

All true cases and most not unique. Thoughts?

 

[bigbaldguy]

I smelled a little bovine in the story as well but still very interesting disorder.

On a related note, recently while doing my clinicals I did one clinical at one hospital and one at another and saw the same woman come in on both. Completely different complaint each time (not a drug seeker as neither was a pain related issue). Even the small talk she made was completely different. She chatted about being from a different city, widowed the first time I saw her but had her husband with her the second time. It was like meeting a completely different person but I'm positive it was the same woman. I was thinking she was just a compulsive liar but now I'm thinking it was more along the lines of Munchausen's.

And

While doing my basic clinicals I remember an elderly woman who was brought in who had this incredibly elaborate story about these incredibly interesting symptoms. I can remember how no one seemed to think it was the least bit interesting so I thought maybe she was a drug seeker but she wasn't really asking for any meds. One of the nurses told me "she's just lonely" which may have been part of the issue but even at the time I thought her story was awfully elaborate for someone who just wanted a day in the hospital. Wonder if this was something like Munchausen's as well.

 

[mycrofft]

But IS Munchausen's actually a syndrome?
Just because the people who make up the names are the common point in all these behaviors, does that make it a syndrome?
Or do you have lonely people, hysterics, delusionals, drug seekers/addicts, drug seekers/neurootic, polysurgery addicts, people who want to be part of the medical world, etc., but NOT really one syndrome?

 

[bigbaldguy]

But IS Munchausen's actually a syndrome?
Just because the people who make up the names are the common point in all these behaviors, does that make it a syndrome?
Or do you have lonely people, hysterics, delusionals, drug seekers/addicts, drug seekers/neurootic, polysurgery addicts, people who want to be part of the medical world, etc., but NOT really one syndrome?

The voices in my head say yes.

 

[Amberlamps916]

I wrote a paper on Munchausen syndrome/MSBP for medic school. It's always been an intriguing subject to me. Namely because I had a relative who got her pulled tooth infected on purpose and did various other ill advised things to get herself hospitalized because her affair with the dentist had ended. Good times.

 

[mycrofft]

I wrote a paper on Munchausen syndrome/MSBP for medic school. It's always been an intriguing subject to me. Namely because I had a relative who got her pulled tooth infected on purpose and did various other ill advised things to get herself hospitalized because her affair with the dentist had ended. Good times.

Did she exhibit other signs of mental illness? Never mind, too personal. Point is, just because she used the medical/dental professions (whitesuits) as her stooges, does it make it a syndrome, or an expresison of some other mechanism of illness, or an extreme transactional "game"?

 

[Achilles]

Is there a difference between hypochondriasis and Münchausen?

 

[Anjel]

Is there a difference between hypochondriasis and Münchausen?

I always thought with munchausen people actually tried to make them self sick or someone else that they cared for.

With hypochondriac they just think they are sick.

 

[VFlutter]

I always thought with munchausen people actually tried to make them self sick or someone else that they cared for.

With hypochondriac they just think they are sick.

Correct. With Munchausen the people purposely fake sickness to gain attention whereas hypochondraics truly believe they are sick and have anxiety related to anything perceived as a symptom.

 

[mycrofft]

Used to read or hear about "degrees of Munchausen":

I: Lie about being sick to gain medical attention for whatever.
II: Lie about another being ill or injured to gain medical attention for whatever.
III: Make oneself actually sick to gain medical attention.
iV: Make someone else sick or injured to gain medical attention for whatever.(AKA "Munchausen by proxy").

Hypochondriasis means you genuinely fear you or someone else is ill without or against medical diagnosis.

Psychosomatic illness was originally thought to be factitious or a sign of wanting attention/other benefit, but there are actual psychosomatic illnesses (stress related illnesses, some forms of classic PTSD due to chronic cortisol OD, etc) where the mind (or emotions) make the body sick.

Hysteric and other psychiatric conditions have the person actually believing, reporting, experiencing and sometimes exhibiting objective signs and symptoms of actual medical problems, but they often do not fall into a classic diagnosis; examples are self-reported blindness, paraplegia, dyspareunia, chronic gastrointestinal complaints, etc., often to subconsciously avoid frightening confrontations or situations

I will say "Munchausen", but I will be using it as shorthand for liars as a rule. Not a real medical term.