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Factitious disorder

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Factitious disorder

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Factitious disorder

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Munchausen syndrome is a factitious disorder in which the patient (consciously/unconsciously) fabricates symptoms to gain attention.

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USMLE® Step 2 style questions USMLE

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A 6-year-old boy is brought to the emergency department after a sudden loss of consciousness. His medical history is relevant for attention deficit disorder, to which he currently takes methylphenidate. The mother, who is a nurse, mentions that the boy was jumping in a playground when he suddenly collapsed to the floor. Upon hospital admission, initial laboratory evaluation revealed no abnormalities, except for low blood glucose. After glucose administration, the child recovers completely. Exhaustive studies are requested to evaluate his hypoglycemia all of which are negative. When you inform the mother that his discharge is going to be soon, she expresses anger, telling you that she will take her child to another hospital. Next morning, the patient's blood glucose is 50 mg/dl (2.7 mmol/L). Physical examination shows dilated pupils and tachypnea. Which of the following is the most appropriate next step in management?

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Transcript

Content Reviewers:

Rishi Desai, MD, MPH

Factitious disorder, which is sometimes called Munchausen syndrome, is where an individual fabricates or exaggerates physical or psychological symptoms because they enjoy being in the “sick role”.

These symptoms are sometimes faked but may also be induced; for example, a person with factitious disorder might purposefully ingest something to induce vomiting.

Factitious disorder is listed in the DSM-5 as a somatic symptom disorder.

But unlike other disorders in that group, individuals don’t experience any symptoms, nor are they concerned that they will develop any symptoms.

Factitious disorder can happen as a single episode, but generally individuals have recurrent hospitalizations and are very knowledgeable about the symptoms they are trying to pass off as real.

Individuals with factitious disorder are generally motivated by the attention and sympathy that they receive when pretending to be sick.

These motivations are often subconscious, which is to say that individuals often don’t even realize why they fabricate their symptoms.

Importantly, individuals with this disorder are usually not faking their symptoms for money, time off of work, access to medications, or any other obvious external reward; if this were the case, it’d be a psychological condition known as malingering.

A related diagnosis is “factitious disorder imposed on another” which is also called factitious disorder by proxy or Munchausen syndrome by proxy.

In this form of the disorder, one person deliberately makes a second person ill without that person’s knowledge.