Munchausen (Munchhausen) Syndrome

Features:

(1) peregrination – constantly shifting care from one physician or hospital to another

(2) pseudologia fantastica – extravagant and fantastic falsehoods about one's self

(3) The story is plausible on initial presentation but tends to break down on probing. The patient may be quite knowledgeable about the claimed condition.

(4) The reward is based on psychological gain with no obvious source of immediate financial or physical benefit.

(5) The patient usually strongly denies any falsehood if confronted.

Once the syndrome is suspected, often after ruling out conditions in the differential diagnosis or after encountering a irrefutable inconsistency, it may take some effort to document the mechanism for induced symptoms.

Management usually involves psychological intervention and can be challenging. Difficulties may be encountered with:

(1) maintaining contact with the patient, who often leaves once discovered out

(2) confronting the patient in a manner that is beneficial

(3) penetrating the resistance shown by the patient