A simulated case of chronic myeloid leukemia: The growing risk of Munchausen's syndrome by internet

Caocci, Giovanni; Pisu, Salvatore; Nasa, Giorgio La

doi:10.1080/10428190802179889

Cited by 10 publications

(9 citation statements)

References 14 publications

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“…Legal sanctions have yielded some results in controlling the “acting out” of Munchausen’s syndrome, but the literature suggests that such measures are ineffective and can sometimes even reinforce bad behavior [63]. It is suggested that the best results within a physician-patient relationship can be achieved by approaching the dilemma from diverse angles [28]. …”

Section: Discussionmentioning

confidence: 99%

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Munchausen by Internet: Current Research and Future Directions

Pulman¹,

Taylor²

2012

J Med Internet Res

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BackgroundThe Internet has revolutionized the health world, enabling self-diagnosis and online support to take place irrespective of time or location. Alongside the positive aspects for an individual’s health from making use of the Internet, debate has intensified on how the increasing use of Web technology might have a negative impact on patients, caregivers, and practitioners. One such negative health-related behavior is Munchausen by Internet.ObjectiveMunchausen by Internet occurs when medically well individuals fake recognized illnesses in virtual environments, such as online support groups. This paper focuses on the aspect of Munchausen by Internet in which individuals actively seek to disrupt groups for their own satisfaction, which has not yet been associated with the wider phenomena of Internet trolls (users who post with the intention of annoying someone or disrupting an online environment).MethodsA wide-ranging review was conducted to investigate the causes and impacts of online identity deception and Munchausen by Internet drawing on academic research and case studies reported online and in the media.ResultsThe limited research relating to motivation, opportunity, detection, effects, and consequences of Munchausen by Internet is highlighted and it is formally linked to aspects of trolling. Case studies are used to illustrate the phenomenon. What is particularly worrying is the ease with which the deception can be carried out online, the difficulty in detection, and the damaging impact and potential danger to isolated victims.ConclusionsWe suggest ways to deal with Munchausen by Internet and provide advice for health group facilitators. We also propose that Munchausen by Internet and Munchausen by Internet trolling should be formally acknowledged in a revised version of the Diagnostic and Statistical Manual DSM-5. This will assist in effectively identifying and minimizing the growth of this behavior as more people seek reassurance and support about their health in the online environment. We also suggest directions for future research.

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Section: Discussionmentioning

confidence: 99%

“…Another case concerned a 44-year-old woman who said she had been diagnosed with chronic myeloid leukemia. Had the documents presented by her not aroused suspicion, she would have undergone a bone marrow aspirate and chemotherapy [28]. …”

Section: Introductionmentioning

confidence: 99%

Munchausen by Internet: Current Research and Future Directions

Pulman¹,

Taylor²

2012

J Med Internet Res

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“…15 Munchausen syndrome disrupts the normal physician-patient relationship, which is based on trust. 16,17 When unmasked, Munchausen patients react in ways ranging from ambivalence to hysteria and denial of fabricating their illness. Adults often are reluctant to see psychiatrists and leave the hospital against medical advice.…”

Section: Management Of Munchausen Syndromementioning

confidence: 99%

“…Adults often are reluctant to see psychiatrists and leave the hospital against medical advice. 5,6,8,12,16,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Children and adolescents, however, are more inclined to admit to their fabrications [38][39][40] and are more inclined to agree to psychiatric follow-up. [38][39][40] The recurring theme in this review points toward maintaining a high index of suspicion, but when should a clinician begin to suspect Munchausen syndrome?…”

Section: Management Of Munchausen Syndromementioning

confidence: 99%

Munchausen Syndrome: A Review of Patient Management

Wong¹,

Detweiler²

2016

Psychiatric Annals

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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.] M unchausen syndrome is the most severe and chronic form of factitious disorder imposed on the self, with predominantly physical signs and symptoms, pseudologia fantas-tica, 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

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“…One case each of simulated acute myelogenous leukemia, 1 chronic myelogenous leukemia, 7 and aplastic anemia after ingestion of oral busulfan 8 have earlier been reported in the literature, but in neither case were the stories so elaborate and treatment so extensive. Our case indeed seems unique in the context of allogeneic stem cell transplant.…”

mentioning

confidence: 99%