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Turk Psikiyatri Derg 2020 ;31(2):137-142

Factitious disorder imposed on another (FDIA-DSM-5), formerly known as Munchausen Syndrome by Proxy (MSP) is a form of child abuse. A case can be recognised by only keeping the relevant diagnoses in mind. There are many cases of FDIA diversified by the contributions of both the caregiver and the child. Read More

Forensic Sci Med Pathol 2020 Jun 11. Epub 2020 Jun 11.

Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

Factitious disorders (FD) like Munchausen syndrome are well known to most physicians, yet the corresponding ICD-10 diagnosis F68.1 remains severely under-assigned and often misdiagnosed. To approach this problem, we conducted a nationwide inquiry for Germany and Norway as well as a comparison between these two countries regarding the incidence of diagnosis of FD. Read More

South Med J 2020 Apr;113(4):198-200

From the University of Louisville School of Medicine, Louisville, Kentucky.

Munchausen syndrome is a factitious disorder that is difficult to diagnose and treat. This article clarifies points for clinical recognition and management of patients with this condition. Patients with this condition often are dramatic and provide false and/or exaggerated symptoms or information. Read More

J Pak Med Assoc 2020 Jan;70(1):168-170

Department of Otolaryngology, Patel Hospital, Karachi, Pakistan.

Munchausen syndrome is a rare psychiatric illness that includes mimicking a group of medical conditions, in which a person repeatedly harms him or herself or falsely misinterprets any medical condition when he or she is not actually sick, in order to achieve health care attention. Underdiagnosis of this syndrome leads to irrelevant use of medical assets. Here, we document an interesting and rare case of a young girl presented in the outpatient department of the Otolaryngology department of Patel Hospital with episodes of bleeding from her ear, which is a rare presentation of Munchausen syndrome. Read More

J Infus Nurs 2020 Jan/Feb;43(1):39-46

Forrest General Home Care and Hospice, Hattiesburg, Mississippi. Janet P. McMillan, DSN, APRN, PMHNP-BC, ACHPN, CNE, is certified as both a psychiatric nurse practitioner and an advanced hospice and palliative care nurse. She draws her experience from her extensive nursing career, which began in 1982. For the past 20 years, Dr McMillan has worked in the home health and hospice fields providing care to patients with mental health needs.

Factitious disorder, formerly known as Munchausen syndrome, is a type of mental illness in which patients fabricate symptoms to gain attention or sympathy. When considering a patient with factitious disorder as a candidate for infusion therapy, the clinician must be aware of the challenges associated with providing an invasive treatment to high-risk patients while promoting safety. Read More

Open Med (Wars) 2019 7;14:792-796. Epub 2019 Nov 7.

Cardiology Department, Wroclaw Medical University, 50-367 Wroclaw, Poland.

Münchausen syndrome can be characterized by simulated illness, pathological lying and wandering from place to place (the patient typically presents to numerous hospitals). Individuals with elevated blood pressure due to non-adherence to medication have the so-called pseudo-resistant hypertension. A 45-year-old woman was admitted to hospital on an emergency basis because of a hypertensive crisis. Read More

Br J Nurs 2019 Nov;28(20):1288-1290

Staff Nurse, Paediatric Critical Care, Royal Manchester Children's Hospital.

J Clin Psychol Med Settings 2019 Oct 10. Epub 2019 Oct 10.

Quincy College, Quincy, MA, USA.

Medical child abuse, sometimes referred to as Munchausen Syndrome by Proxy or childhood factitious disorder, poses significant diagnostic, intervention, and ethical issues for medical and mental health practitioners alike. Psychologists working in pediatric hospitals and medical clinics should remain mindful of the health and ethical risks posed by these conditions, which are challenging to detect and treat. The surreptitious nature of the conditions and hazards they pose require an integrated medical, psychological, and child protective response. Read More

Dermatol Surg 2019 Oct 1. Epub 2019 Oct 1.

Department of Plastic Reconstructive and Aesthetic Surgery, Adiyaman University Education and Research Hospital, Adiyaman, Turkey.

J Family Med Prim Care 2019 Aug 28;8(8):2741-2743. Epub 2019 Aug 28.

Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA.

Patients with severe coagulopathy related to vitamin K deficient proteins can be associated with surreptitious ingestion of vitamin K antagonists. Our patient presented acutely with extensive ecchymosis, gingival bleeding and hematuria. Her initial PT and PTT were prolonged and INR was >12. Read More

J Med Case Rep 2019 Sep 12;13(1):287. Epub 2019 Sep 12.

Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.

Background: Rapid diagnosis and appropriate treatment of Munchausen syndrome is important not only for the patient but also for health care workers because a delay in diagnosis can worsen patients' clinical outcomes, and result in a substantial medical cost.

Case Presentation: A young and previously healthy 24-year-old Japanese woman, a nurse, presented with complaints of refractory abscess on her left upper limb for 3 months. A physical examination on admission revealed low-grade fever and a subcutaneous abscess in her left forearm. Read More

Clin Case Rep 2019 Aug 20;7(8):1473-1477. Epub 2019 Jun 20.

Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy.

This case contributes to raising awareness and understanding of the complex clinical presentations of Munchausen syndrome (MS). Education of staff to the seriousness and genuineness of this disorder should be implemented, especially in hospital units, in order to detect such complex clinical situations quickly and accurately, preventing iatrogenic risks. Read More

Cardiol Young 2019 Sep 5;29(9):1217-1218. Epub 2019 Aug 5.

Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.

A 14-year-old girl suddenly developed ventricular tachycardia and severe chest pain during hospitalisation for trauma surgery. CT revealed a needle in the pericardium. Careful interview elicited that she had inserted the needle by herself, and Munchausen syndrome was diagnosed. Read More

Indian Dermatol Online J 2019 Jul-Aug;10(4):496-497

Department of Psychiatry, Aster Medcity, Kochi, Kerala, India.

Am J Emerg Med 2019 09 30;37(9):1806.e1-1806.e2. Epub 2019 May 30.

UNLV School of Medicine, Department of Emergency Medicine, United States of America. Electronic address:

We report a case of 'delusional parasitosis by proxy'. A sixyear old child was brought to the emergency department by a mother with concerns that her son had a skin and scalp infestation. Despite the absence of any clinical findings being found on exam, the mother remained disproportionately concerned. Read More

Clin Dermatol 2019 May - Jun;37(3):268-277. Epub 2019 Jan 11.

Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

The self-induced dermatoses represent about 2% of dermatology patient visits, and include the recurrent body-focused repetitive behaviors (BFRB) (skin-picking or excoriation disorder, trichotillomania, onychophagia and onychotillomania), dermatitis artefacta, and features of other psychiatric disorders, for example, secondary to excessive grooming in body dysmorphic disorder, skin picking in delusional infestation, or secondary to self-harm in depressive disease. Among the BFRBs, onychophagia and onychotillomania are most likely to be associated with lesions that mimic other dermatologic conditions (eg, nail psoriasis, lichen planus, vasculitis, onychomycosis, melanoma). Dermatitis artefacta (DA) describes lesions that are self-inflicted with the intention of assuming a sick role in the absence of obvious external rewards. Read More

Case Rep Gastroenterol 2019 Jan-Apr;13(1):173-177. Epub 2019 Apr 9.

Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan.

Munchausen syndrome is a rare type of mental disorder in which the patient fakes illness to gain attention and sympathy. Patients may lie about symptoms, make themselves appear sick, or make themselves purposely unwell. We describe a case of repeated enterocutaneous fistula in Munchausen syndrome. Read More

Med Leg J 2019 Jun 20;87(2):73-76. Epub 2019 May 20.

Delusional health beliefs can be difficult and costly for practitioners to diagnose and manage. Patients often deny that mental distress is the cause of their illness, when it may be the most significant factor. Such patients can be relentless in their pursuit of a physical cause and go from doctor to doctor to find one who agrees with them, using up significant NHS resources. Read More

Int J Pediatr Otorhinolaryngol 2019 Aug 25;123:75-78. Epub 2019 Apr 25.

Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA.

Munchausen syndrome by proxy (MSBP) is a condition diagnosed when a caregiver knowingly fabricates or inflicts illness on another for his/her own gain. Typical cases of MSBP detected by otolaryngologists involve facial trauma or otologic injury, while descriptions involving the nose are rare. Destructive nasal lesions have a broad differential diagnosis and may require visits to numerous specialists, placing strain on both the patient and the healthcare system. Read More

BMJ Case Rep 2019 Apr 29;12(4). Epub 2019 Apr 29.

Endocrinology and Metabolism, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India.

Thyrotoxicosis factitia, a disorder frequently seen in young or middle-aged women with psychological disorders, most commonly results from surreptitious ingestion of excess thyroid hormones. In most patients, diagnosis is relatively straightforward and depends on the demonstration of biochemical thyrotoxicosis, suppressed endogenous thyroid function and absence of clinical features of underlying thyroid disease. However, at times, confounding factors can make the diagnosis particularly challenging and necessitate the investigating physician to don the detective's cap to get to the root of the problem. Read More

Breast J 2019 05 13;25(3):526-527. Epub 2019 Apr 13.

Breast Cancer Center, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.

Behav Neurol 2019 3;2019:3891809. Epub 2019 Mar 3.

Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

Background: Systematic studies on factitious disorders and malingering in large populations are rare. To address this issue, we performed a nationwide epidemiological study in Norway on the incidence of these diagnoses in an unselected patient population. In particular, we tried to confirm the diagnoses and to estimate the contribution of Munchausen syndrome to the spectrum of factitious disorders. Read More

J Pediatr Adolesc Gynecol 2019 Jun 25;32(3):334-336. Epub 2019 Mar 25.

Section of Adolescent Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Electronic address:

Background: Medical child abuse (MCA) is challenging to diagnose. Although young children are often affected, adolescents can be victims through caregiver coercion. Presentation is highly variable. Read More

Geriatr Nurs 2019 Mar - Apr;40(2):214-216. Epub 2019 Mar 11.

Riddle Medical LLS, Tarrytown, NY, USA.

Clin Child Psychol Psychiatry 2019 Jul 9;24(3):494-502. Epub 2019 Jan 9.

Yale School of Medicine, USA.

Clinical practice guidelines for informing children they have been subjected to caregiver-fabricated illness are highly limited in the current literature. This article addresses this issue by offering an ethically informed, psychological approach to the disclosure of this form of abuse to school-aged children and adolescents who have been significantly harmed. A multidisciplinary, staged model of communication which illustrates that truthful communication with children and their families is a necessary component of the recovery process is proposed. Read More

Lupus 2019 Feb 7;28(2):249-252. Epub 2019 Jan 7.

1 Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.

Childhood-onset systemic lupus erythematosus (cSLE) is a chronic inflammatory multisystem autoimmune disease that requires multiple differential diagnoses. Munchausen by proxy syndrome (MBPS) is a form of child abuse, where a caregiver intentionally creates a medical history and induces or fabricates signs or disease in a patient. To our knowledge, there is no case report of MBPS mimicking cSLE diagnosis. Read More

Saudi J Ophthalmol 2018 Oct-Dec;32(4):353-354. Epub 2018 Sep 24.

Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

Munchausen's Syndrome is a factitious disorder in which patients manipulate physicians through misrepresented signs and symptoms. The authors describe an 18-year-old woman with self-induced inoculation of ant's particles inside her conjunctival fornices of both eyes. The crushed particles was confirmed to be crushed ant's particles. Read More

BMC Emerg Med 2018 12 11;18(1):53. Epub 2018 Dec 11.

Northeast Georgia Medical Center Barrow, 316 N Broad St, Winder, GA, 30680, USA.

Background: Factitious disorder causing hypoglycemia is a psychiatric condition in which patients deliberately use blood sugar lowering medications to cause severe symptoms for the purposes of hospitalization or other primary gains.

Case Presentation: We report a case of factitious hypoglycemia in a 19-year-old foster care adolescent female who presented to the Emergency Department with recurrent hypoglycemic episodes, to the degree that the patient required large amounts of dextrose and further management by intensive care unit hospitalization. Further inquiry revealed that the patient intentionally injected herself with large doses of insulin for the purposes of seeking hospital admission. Read More

Indian Dermatol Online J 2018 Nov-Dec;9(6):435-437

Department of Psychaitry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

Munchausen syndrome by proxy (MSBP) is a rare psychiatric disorder of a caregiver (commonly mother) who induces injury or symptoms on victim because of his or her psychiatry illness. The victims are usually under 6 years of age who cannot complain regarding inflicted injury. Diagnosis is challenging to the physician. Read More

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018 Dec;61(12):1587-1602

Zentrum für Kinderheilkunde, Universität Bonn, Bonn, Deutschland.

Interviewing a child of a suspected abuse (physical abuse, sexual abuse, neglect, Munchausen-by-proxy syndrome) is subject to complex risks of suggestion and distortion. The use of a standardized interview protocol as part of the investigation can significantly increase the scope and validity of the child's report in different settings (for example, pediatrics, child welfare services, court).In this paper, the interview protocol provided by the National Institute of Child Health and Human Development (NICHD) in its revised and complete version is presented in German and made available for free clinical use in the Appendix. Read More

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018 Dec;61(12):1579-1586

Zentrum für Kinderheilkunde, Universität Bonn, Bonn, Deutschland.

Doctors and especially paediatricians in clinics and private practices are often the first professionals to be confronted with the suspicion of a child endangerment (sexual abuse, physical abuse, neglect, Munchausen-by-proxy syndrome). They thus play a key role in the early assessment and clarification of suspicion and setting the course for the further interdisciplinary procedure.The clinical investigation of a suspicion is a diagnostic and communicative challenge. Read More

Nurs Clin North Am 2018 09;53(3):375-384

University of Arizona, College of Nursing, 1305 N. Martin Avenue, Tucson, AZ 85721, USA.

Munchausen syndrome and Munchausen syndrome by proxy are complex diseases that are difficult to diagnose and treat. To assist in this process, an overview of diagnostic criteria with common characteristics and red flags are discussed, with case studies illustrating identification and diagnosis of these disorders. Treatment options are addressed within the context of each of these complex syndromes. Read More

J Pediatr Adolesc Gynecol 2018 Dec 7;31(6):637-639. Epub 2018 Jul 7.

Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.

Background: Medical child abuse is a challenging diagnosis to make, particularly in older children with unusual presenting symptoms.

Case: A 7-year-old child with complex medical history presented with anogenital bleeding of unknown origin. Extensive laboratory testing, imaging studies, and diagnostic procedures were negative for any etiology. Read More

Palliat Support Care 2019 02 27;17(1):119-121. Epub 2018 Jun 27.

Medical Oncology Department,Centre Oscar Lambret,Lille,59020,France.

Objective: Cancer patients can present with impossible behavior, which can jeopardize their treatment and challenge healthcare professionals' teamwork.

Method: Report of two unusual psychiatric cases, including Munchausen and Peter Pan syndromes, which occurred in a comprehensive cancer center.ResultGuidelines in medical and surgical wards are suggested to address such situations regarding oncologic compliance. Read More

Am J Case Rep 2018 Jun 27;19:752-756. Epub 2018 Jun 27.

Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, Netherlands.

BACKGROUND Pediatric condition falsification (PCF) is a rare form of child abuse in which a caregiver fabricates or induces illness in the child. The diagnosis is difficult and controversial and can easily include false positives. CASE REPORT A boy, 3. Read More

Clin Ter 2018 May-Jun;169(3):e129-e134

University of Padua, Department of Molecular Medicine.

Munchausen syndrome by proxy is a relatively rare behavioral disorder affecting a child's primary caregiver, typically the mother. Ethical dilemmas that physicians may face in such situations mainly concern the medical options for best protecting the child's welfare, that are important, in clinical pediatric practice, because critical conflicts might arise between health professionals and parents. In such cases, the physician's primary obligation is to protect the children involved, whose family environment may be essential to their wellbeing. Read More

J Fr Ophtalmol 2018 Jun 11;41(6):e285-e286. Epub 2018 Jun 11.

Institutions ophtalmology B, hôpital des spécialités, Rabat, Morocco.

JAMA Dermatol 2018 Jun;154(6):716

Texas Tech University Health Sciences Center, Lubbock.

Paediatr Int Child Health 2019 08 8;39(3):227-229. Epub 2018 Jun 8.

a Department of Pediatric Surgery , Children's Hospital Bechir Hamza , Tunis , Tunisia.

Fabricated and/or induced illness (previously known as Munchausen syndrome by proxy) is a form of child abuse in which the perpetrator induces, exaggerates or fabricates illness in his/her child. Two-month-old twins were referred to the paediatric surgery centre with trocar needles lodged in different organs. A radiograph undertaken in one of them because of acute respiratory distress demonstrated needles in the heart and diaphragm which were removed surgically. Read More

Curr Pharm Biotechnol 2018 ;19(2):99-112

Clinical Analysis Department, Hospital Universitari Son Llatzer, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain.

Background: Clinical and forensic toxicology can be defined as two disciplines involving the detection, identification and measurement of xenobiotics in biological and non-biological samples to assist in the diagnosis, treatment, prognosis and prevention of poisonings and to disclose causes and contributory causes of fatal intoxications, respectively.

Objective: This article explores the close connections between clinical and forensic toxicology in overlapping areas of interest.

Methods: An update has been carried out of the following seven areas of interest in analytical toxicology: doping control, Sudden Cardiac Death (SCD), brain death, Sudden Infant Death Syndrome (SIDS) and Munchausen Syndrome by Proxy (MSBP), prenatal exposure to drugs and Fetal Alcohol Syndrome (FAS), Drug-Facilitated Crimes (DFC) and intoxications by new psychoactive substances (NPS). Read More

Front Pediatr 2018 18;6:110. Epub 2018 Apr 18.

Section of Child and Adolescent Neuropsychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.

Factitious Disorder Imposed on Another (FDIA), also known as Munchausen Syndrome by Proxy (MSbP) is a very serious form of child abuse. The perpetrator, usually the mother, invents symptoms or causes real ones in order to make her child appear sick. Usually this is due to a maladaptive disorder or to an excessive of attention-seeking on her part. Read More

Soc Hist Med 2017 Aug 6;30(3):567-589. Epub 2016 Oct 6.

Concepts used by historians are as historical as the diagnoses or categories that are studied. The example of Munchausen syndrome (deceptive presentation of illness in order to adopt the 'sick role') is used to explore this. Like most psychiatric diagnoses, Munchausen syndrome is not thought applicable across time by social historians of medicine. Read More

Arch Dis Child 2019 02 4;104(2):110-114. Epub 2018 Apr 4.

Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.

Int J Environ Res Public Health 2018 03 29;15(4). Epub 2018 Mar 29.

Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06100 Perugia, Italy.

Background: In most of the cases regarding children, factitious disorders (FDs) are intentionally produced by parents. Less attention is paid to FDs in which a child or adolescent intentionally induces or falsifies the disease to attain a patient's role.

Case Presentation: A 13-year-old immigrated and adopted boy previously underwent an operation for renal joint syndrome and was affected by recurrent episodes of renal colic. Read More

Vertex 2017 Mar;28(132):145-151

Servicio de Salud Mental Instituto de Investigaciones Médicas "A. Lanari", Facultad de Medicina, UBA.

We present a detailed case report that shows a woman patient who has Factitious Disorder manifested by the coexistence both of: A) typical/direct Munchausen and B) Munchausen by proxy or indirect: being the frst one (A) about the own person and the second one (B) about other people (most cases about their own young children). Furthermore, in the reported case we observed that the patient shown the particularity of having positive biological markers for Myasthenia Gravis (serology markers), and having inconsistent clinical manifestations that are typically observed in the exacerbation phase when she still continued in remission phase. In our own bibliographic research we couldn`t fnd anything about this case of "Mixed Munchausen Syndrome with organic comorbidity". Read More

Vestn Otorinolaringol 2018;83(1):72-74

L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152.

The authors describe a rare clinical case of psychogenic hearing loss in a female patient presenting Munchausen's syndrome with special reference to the objective and subjective methods designed to evaluate the hearing ability and used for diagnostics of this condition. Read More