Munchausen Syndrome: A Review of Patient Management

The management of Munchausen syndrome is fraught with complexities related to legality, ethics, and its inherent nature. An illustrative case of factitious aortic dissection is presented as well as a review of the literature for the management Munchausen syndrome, which includes strategies reported to be effective. Management of Munchausen syndrome requires a high index of suspicion, a good history, and thorough physical examination. Objective illnesses resulting from the factitious behavior should be treated, while avoiding unnecessary procedures. Early referral to a psychiatry team is critical as this may be an empathetic and face-saving approach for the patient. Regularly scheduled appointments, not dependent on the patient’s distress level, are associated with improved long-term prognosis. Patients with Munchausen syndrome can suffer considerable iatrogenic morbidity and mortality, and they place immense strain on the health care system. Physicians should be aware of the complexities of these cases, the management options, and the frequent need for psychiatry consultations [Psychiatr Ann. 2016;46(1):66-70.] Munchausen syndrome is the most severe and chronic form of factitious disorder imposed on the self, with predominantly physical signs and symptoms, pseudologia fantastica, and peregrination (frequent traveling from one medical center to another) that often lead to recurrent hospitalizations. It tends to have a refractory course. Munchausen syndrome is unique because it is a psychiatric disorder that most frequently presents as an apparently severe illness in the non-psychiatric setting. Even though Munchausen syndrome is studied by most clinicians in training, the first case often leaves them feeling blindsided by the patient, creating a fractured clinicianpatient rapport. Many clinicians remember their first Munchausen syndrome case as if they were seeing medicine through a distorted prism and struggle with residual conflicting thoughts, as the clinical and ethical implications can be challenging. Munchausen syndrome was first described by Dr. Richard Asher in his landmark 1951 article.1 He had named the Lilian Wong, MD, MPH, is a Pediatric Resident, Department of Pediatrics, Virginia Tech-Carilion School of Medicine. Mark B. Detweiler, MD, MS, is a Staff Psychiatrist, Salem Veterans Affairs Medical Center; and an Associate Professor, Department of Psychiatry and Behavioral Medicine, Virginia Tech-Carilion School of Medicine. Address correspondence to Mark B. Detweiler, MD, MS, Veterans Affairs Medical Center (116A7), 1970 Roanoke Boulevard, Salem, VA, 24153; email: [email protected]. Disclaimer: The report findings do not represent the views of the Department of Pediatrics, Virginia Tech-Carilion School of Medicine, the Department of Veterans Affairs, or the United