Munchausen syndrome

ミュンヒハウゼン症候群

WordNet

1. a pattern of symptoms indicative of some disease
2. a complex of concurrent things; "every word has a syndrome of meanings"

PrepTutorEJDIC

1. (疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/04/20 11:48:29」(JST)

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For feigned illness, see Malingering.

Factitious disorders
Classification and external resources
ICD-10	F68.1
ICD-9	301.51
DiseasesDB	8459 33167
eMedicine	med/3543 emerg/322 emerg/830
MeSH	D009110

Münchausen syndrome is a psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention or sympathy to themselves. It is also sometimes known as hospital addiction syndrome, thick chart syndrome, or hospital hopper syndrome. True Münchausen syndrome fits within the subclass of factitious disorder with predominantly physical signs and symptoms, but in addition they also have a history of recurrent hospitalization, travelling, and dramatic, untrue, and extremely improbable tales of their past experiences. Nurses and doctors sometimes refer to them as frequent flyers, because they return to the hospital just as frequent flyers return to the airport. However, there is discussion to reclassify them as somatoform disorder in the DSM-5 as it is unclear whether or not people are conscious of drawing attention to themselves.

Münchausen syndrome is related to Münchausen syndrome by proxy (MSbP/MSP), which refers to the abuse of another person, typically a child, in order to seek attention or sympathy for the abuser. It is an obsessive want to create symptoms for the victim in order to obtain repeated medication or even operations.

Description

In Münchausen syndrome, the affected person exaggerates or creates symptoms of illnesses in themselves to gain investigation, treatment, attention, sympathy, and comfort from medical personnel. In some extreme cases, people suffering from Münchausen's syndrome are highly knowledgeable about the practice of medicine and are able to produce symptoms that result in lengthy and costly medical analysis, prolonged hospital stay and unnecessary operations. The role of "patient" is a familiar and comforting one, and it fills a psychological need in people with Münchausen's. This disorder is distinct from hypochondriasis and other somatoform disorders in that those with the latter do not intentionally produce their somatic symptoms.

Risk factors for developing Münchausen syndrome include childhood traumas, growing up with parents/caretakers who were emotionally unavailable due to illness or emotional problems, a serious illness as a child, failed aspirations to work in the medical field, personality disorders, and a low self-esteem. Münchausen syndrome is more common in men and seen in young or middle-aged adults. Those with a history of working in healthcare are also at greater risk of developing it.

Arrhythmogenic Münchausen syndrome describes individuals who simulate or stimulate cardiac arrhythmias to gain medical attention. The syndrome differs from malingering, in which a patient fabricates symptoms for an apparent purpose, such as financial compensation, absence from work, or access to drugs.

A similar behavior called Münchausen syndrome by proxy has been documented in the parent or guardian of a child. The adult ensures that his or her child will experience some medical affliction, therefore compelling the child to suffer treatment for a significant portion of their youth in hospitals. Furthermore, a disease may actually be initiated in the child by the parent or guardian. This condition is considered distinct from Münchausen syndrome. In fact, there is growing consensus in the pediatric community that this disorder should be renamed "medical abuse" to highlight the real harm caused by the deception and to make it less likely that a perpetrator can use a psychiatric defense when real harm is done. Parents who perpetrate this abuse are often affected by concomitant psychiatric problems like depression, spouse abuse, psychopathy, or psychosis. In rare cases, multiple children in one family may be affected either directly as victims or as witnesses who are threatened to keep them silent.

Origin of the name

The syndrome name derives from Baron Münchhausen (Karl Friedrich Hieronymus Freiherr von Münchhausen, 1720–1797), a German nobleman, who purportedly told many fantastic and impossible stories about himself, which Rudolf Raspe later published as The Surprising Adventures of Baron Münchhausen.

In 1951, Richard Asher was the first to describe a pattern of self-harm, wherein individuals fabricated histories, signs, and symptoms of illness. Remembering Baron Münchhausen, Asher named this condition Münchausen's Syndrome in his article in The Lancet in February 1951, quoted in his obituary in the British Medical Journal:

"Here is described a common syndrome which most doctors have seen, but about which little has been written. Like the famous Baron von Munchausen, the persons affected have always travelled widely; and their stories, like those attributed to him, are both dramatic and untruthful. Accordingly the syndrome is respectfully dedicated to the Baron, and named after him."

—British Medical Journal, R.A.J. Asher, M.D., F.R.C.P.

Originally, this term was used for all factitious disorders. Now, however, there is considered to be a wide range of factitious disorders, and the diagnosis of "Münchausen syndrome" is reserved for the most severe form, where the simulation of disease is the central activity of the affected person's life.

Treatment and prognosis

Medical professionals or doctors suspecting Münchausen's in a patient should first rule out the possibility that the patient has an early stage disease that is not yet clinically detectable. Providers need to acknowledge that there is uncertainty in treating suspected Münchausen patients so that real diseases are not under-treated. Then they should take a careful patient history and seek medical records, to look for early deprivation, childhood abuse, or mental illness. If a patient is at risk to himself or herself, inpatient psychiatric hospitalization should be initiated.

Medical providers or doctors should consider working with mental health specialists to help treat the underlying mood or disorder as well as to avoid countertransference. Therapeutic and medical treatment should center on the underlying psychiatric disorder: a mood disorder, an anxiety disorder, or borderline personality disorder. The patient's prognosis depends upon the category under which the underlying disorder falls; depression and anxiety, for example, generally respond well to medication and/or cognitive behavioral therapy, whereas borderline personality disorder, like all personality disorders, is presumed to be pervasive and more stable over time, thus offers the worst or best prognosis.

Patients may have multiple scars on abdomen due to repeated "emergency" operations.

There are several symptoms that together point to Münchausen syndrome. Some are frequent hospitalizations, knowledge of several illnesses, frequently requesting medication such as pain killers, openness to extensive surgery, little to no visitors during hospitalizations, exaggerated or fabricated stories about several medical problems, and more. Münchausen syndrome should not be confused with hypochondria as patients do not believe they are sick, they want to be sick. It is also not the same as pretending to be sick for personal benefit such as being excused from work or school.

There are several ways in which the patients fake their symptoms. Other than making up past medical histories and faking illnesses patients might inflict harm on themselves such as taking laxatives or blood thinners, ingesting or injecting themselves with bacteria, cutting or burning themselves, and disrupting their healing process such as reopening wounds. Many of these conditions do not have clearly observable or diagnostic symptoms and sometimes the syndrome will go undetected because patients will fabricate identities when visiting the hospital several times. Münchausen syndrome has several complications as these patients will go to great lengths to fake their illness. Severe health problems, serious injuries, loss of limbs or organs, and even death are possible complications.

See also

• Münchausen syndrome by proxy, also known as Fabricated or induced illness
• Münchausen by Internet
• Victim playing
• Attention seeking
• Histrionic personality disorder
• Mythomania
• Psychosomatic illness
• Sickened, an auto-biography by Julie Gregory

Notes

References

• Feldman, Marc (2004). Playing sick?: untangling the web of Münchausen syndrome, Münchausen by proxy, malingering & factitious disorder. Philadelphia: Brunner-Routledge. ISBN 0-415-94934-3. 
• Fisher JA (2006). "Playing patient, playing doctor: Münchausen syndrome, clinical S/M, and ruptures of medical power". The Journal of medical humanities 27 (3): 135–49. doi:10.1007/s10912-006-9014-9. PMID 16817003. 
• Fisher JA (2006). "Investigating the Barons: narrative and nomenclature in Münchausen syndrome". Perspect. Biol. Med. 49 (2): 250–62. doi:10.1353/pbm.2006.0024. PMID 16702708. 
• Friedel,Robert O., MD Borderline Personality Disorder Demystified, Pg 9-10, Münchausen syndrome, Münchausen syndrome by Proxy. ISBN 1-56924-456-1
• Davidson, G. et al. (2008). Abnormal Psychology - 3rd Canadian Edition. Mississauga: John Wiley & Sons Canada, Ltd. p. 412. ISBN 978-0-470-84072-6. 
• Prasad, Ashoka; Oswald, A. G. "Munchausen's syndrome:an annotation"
• Staff, Mayo Clinic. "Munchausen Syndrome." Mayo Clinic. Mayo Foundation for Medical Education and Research, 13 May 2011. Web. 11 Apr. 2013

External links

• Dr. Marc Feldman's Münchausen Syndrome, Malingering, Factitious Disorder, & Münchausen by Proxy Page - Page offering information on Münchausen and its many other names. Offers information on Dr. Feldman's books and his email address for interested parties.
• Article in Discover magazine, July 1993, by Abigail Zuger
• Sick note: Faking illness online - on "Münchausen by internet". The Guardian, 26 February 2011

UpToDate Contents

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• 1. 虚偽性精神障害とミュンヒハウゼン症候群 factitious disorder and munchausen syndrome
• 2. 代理によるミュンヒハウゼン症候群（医療上の児童虐待） munchausen syndrome by proxy medical child abuse
• 3. 虚偽性下痢症 factitious diarrhea
• 4. SIDSを含む乳児の予期せぬ死亡：初期マネージメント sudden unexpected infant death including sids initial management
• 5. 心因性不随意運動 psychogenic movement disorders

English Journal

• The evidential value of intra-alveolar haemosiderin-macrophages in cases of sudden infant death syndrome (SIDS).

• Kernbach-Wighton G, Albalooshi Y, Madea B.SourceInstitute of Legal Medicine, The University of Bonn, Stiftsplatz 12, D-53111 Bonn, Germany.
• Forensic science international.Forensic Sci Int.2012 Oct 10;222(1-3):27-32. Epub 2012 Jun 14.
• Intra-alveolar deposits of haemosiderin have repeatedly been brought into connection with some diagnostic value, such as markers for previous imposed suffocation, smothering due to Munchausen syndrome by proxy or sudden infant death syndrome (SIDS). This study is based on 104 SIDS cases and 14 contr
• PMID 22704554

• The role of nonperpetrating fathers in Munchausen syndrome by proxy: a review of the literature.

• Morrell B, Tilley DS.SourceTexas Woman's University, Denton, TX, USA.
• Journal of pediatric nursing.J Pediatr Nurs.2012 Aug;27(4):328-35. Epub 2011 May 14.
• Munchausen syndrome by proxy (MSBP) is a psychiatric condition and form of child abuse in which a caregiver, usually a mother, induces illness in a child to gain attention for herself. Because children that are abused by a MSBP perpetrator are likely to be hospitalized multiple times, it is importan
• PMID 22703679

Japanese Journal

• ミュンヒハウゼン症候群の1症例

• 境 徹也,澄川 耕二
• The journal of the Japan Society of Pain Clinicians = 日本ペインクリニック学会誌 17(1), 21-24, 2010-01-25
• 虚偽性障害は，身体的・心理的症状または徴候を意図的に作り出す疾患であり，特に身体的症状と徴候の優勢なものはミュンヒハウゼン症候群と呼ばれる．われわれは複合性局所疼痛症候群（CRPS）様症状をきたしたミュンヒハウゼン症候群患者を報告する．患者は47歳の男性であった．腰椎椎間板術後の腰下肢痛と歩行不能を訴え，車椅子で当科へ紹介受診となった．腰椎のMRIで，明らかな異常はなく，院外では普通に歩行していた …
• NAID 10026388995

• 代理によるミュンヒハウゼン症候群--児童虐待としての概念と対応について

• 梅澤 彩
• 摂南法学 (42・43), 229-250, 2010-12
• NAID 40018752116

Related Links

• Dr. Marc Feldman's Munchausen Syndrome Page

Welcome I am a psychiatrist, author, and expert. MUNCHAUSEN SYNDROME is the most severe and chronic form of my area of specialty, FACTITIOUS DISORDER. Munchausen syndrome, factitious disorder, and the other ...

• Dr. Marc Feldman's Munchausen Syndrome, Malingering ...

Order my newest book Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder Order a book I’ve co-edited on factitious disorder, Munchausen syndrome, and ...

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リンク元	「ミュンヒハウゼン症候群」「Munchausen症候群」
拡張検索	「Munchausen syndrome by proxy」
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Munchausen syndrome, Münchhausen syndrome

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Munchausen syndrome

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ミュンヒハウゼン症候群

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