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PubMed2003

A case of factitious disorder presenting as alcohol dependence.

Factitious disorders involve the feigning of physical or psychological symptoms in order to assume the patient role. Pseudologia fantastica, which involves the pathological creation of fabrications about one's background, is an associated feature of factitious disorders. Substance abuse disorders are also associated with factitious disorders. However, the manifestation of factitious complaints as substance abuse has yet to be reported in the literature. This case study describes a patient referred to a residential substance abuse treatment program who was discovered to have factitious alcohol dependence and prominent pseudologia fantastica.

Adult↗
PubMed1986

[Factitious disease. Observations on 44 cases at a medical clinic and recommendation for a subclassification].

From 1971 to 1985, 44 cases of self-induced factitious disorders were observed in the Medical Department of a University Hospital. The diseases were often severe, one patient even died. The various symptoms and diseases presented by the patients, the methods of producing them, and the diagnostic and therapeutic aspects of these cases are described. Patients were analysed with regard to age, sex, profession, psychosocial adaptation, number and duration of hospitalisations, presentation of complaints, behaviour on the ward, relation to the doctor, self-destructive tendencies, readiness to suffer and possible motivations. According to the criteria of the DSM-III, seven patients were malingerers (DSM-III: V 65.20) and 37 had a "chronic factitious disorder with physical symptoms" (DSM-III: 301.51). However, the findings in the patients of the latter group strongly suggest that they form an extremely heterogeneous population. Therefore we propose a subclassification of the DSM-III category 301.51 as follows: Type A. Muenchausen syndrome in the proper sense; dramatic deception of mainly acute illness; pseudologia fantastica; social maladaptation, chaotic life situations; many, mostly short hospitalisations; many interventions; at first well adapted, later hostile; mostly men. Type B. Self-induced, mainly chronic illness; behaviour adequate, highly compliant; often little emotion, contrasting with the sometimes severe illness; socially adapted; history remarkably blank with regard to psychosocial stress; several often longlasting hospitalisations and many interventions; almost exclusively younger women from (para-)-medical professions. Type C. Willfull interference with the healing of wounds, cutaneous ulcers, abscesses or dermatological artefacts; history with marked personal losses or severe chronic medical problems; at first well adapted, later hostile, passive/aggressive; women prevail. A conversion syndrome (DSM-III: 300.11) was not observed. In contrast to malingering, the basis of the disorder in types A, B and C is unconscious in origin, thus similar to the conversion syndrome. Contrary to the latter, however, the production of physical symptoms is under voluntary control. The proposed subclassification represents a hypothesis for testing which might facilitate the analysis of the basic personality disorder, so far lacking. The investigation of the psychopathology of these patients and their treatment is difficult if not impossible because most refuse psychiatric exploration and therapy. Consequently follow-up studies and data on the prognosis are rare.

Adolescent↗
PubMed1986

Falsifications in the psychiatric history: a differential diagnosis.

Several types of falsification may be encountered in the clinical setting, including lies, pseudologia fantastica, delusions and confabulations. I will review these phenomena in the psychopathology literature and propose five criteria to facilitate classification of a falsification. I will then present case histories that illustrate the relationship between the type of falsification and the clinical psychiatric diagnosis.

Adult↗
PubMed1993

False statements and the differential diagnosis of abuse allegations.

OBJECTIVE: Because child psychiatrists do not have a consistent way to classify the untruthful child and because there are no generally accepted definitions of the many ways in which false statements occur in allegations of abuse, the objective of this paper is to classify and define the various ways in which false statements occur in allegations of abuse. METHOD: The author reviewed 40 articles, chapters, and books that contained examples of false statements made by children or caregivers in the context of an abuse allegation. RESULTS: This paper clarifies the concepts of indoctrination, suggestion, fantasy, delusion, misinterpretation, miscommunication, innocent lying, deliberate lying, confabulation, pseudologia phantastica, overstimulation, group contagion, and perpetrator substitution. CONCLUSION: The correct classification of abuse allegations is important in both clinical and forensic child psychiatry. The definitions in this paper, which are based on clinical experience, should be studied through systematic research.

Child↗
PubMed1996

Neurological syndromes in factitious disorder.

Factitious disorder is characterized by the intentional feigning of physical or psychological signs and symptoms. The best known type of factitious disorder, Munchausen syndrome, is marked by a chronic unremitting course with repeated hospitalizations. The purpose of this study was to assess the frequency, psychopathological phenomenology, and diagnostic classification according to DSM-III-R in patients with factitious disorder presenting as neurological syndromes. We prospectively included all patients who were hospitalized at our Department of Neurology, Freie Universität Berlin, during a 1-year period. Five of 1538 (.3%) patients were diagnosed as having factitious disorder with feigning of neurological syndromes. Four presented with the classic variant, Munchausen syndrome. All patients had similar, characteristic psychopathological features including self-discharge, aggressive behavior, pseudologia phantastica, and hospital wandering. In these cases the additional diagnosis of personality disorder was made according to DSM-III-R criteria. We concluded that factitious disorder presenting with neurological syndromes may be more prevalent than generally assumed. Our findings confirm the idea of frequent coincidence of factitious and personality disorders.

Adult↗
PubMed2006

The Aum Cult leader Asahara's mental deviation and its social relations.

This paper is a further discussion of the author's previous reports on the crimes committed by the Asahara-Aum Cult. First, the motivations of Asahara-Aum crimes, in particular those of murders, and their abnormality beyond the realm of criminology are ascertained. Second, psychopathology of the leader, Asahara, was considered, and it was assumed that Asahara was affected with the syndrome of pseudologia phantastica which was confirmed by his strange attitude during his trials. Third, the mental status of Asahara after the first trial was investigated, and some evidence was found that his mental status was so severe as to be 'unfit to plead' that psychiatric evaluation and treatment would be necessary. Fourth, the reasons for making people, in particular scientific elites, fascinated with Asahara and the Aum Cult were scrutinized and some clues were described. Finally, the problem that Aum has survived under the name of Aleph, how heavy capital punishment for Leader Asahara is appropriate, and that reparations for victims of Asahara-Aum crimes are urgent from the standpoint of social psychiatry, are discussed.

Antisocial Personality Disorder↗
PubMed1980

Munchausen syndrome and necrophilia.

Munchausen syndrome and necrophilia are uncommon disorders which do not appear to be related. It is suggested, however, that both of them center on "return to the womb" fantasies and may represent variants of each other. Specifically, the Munchausen patient's symptom triad (factitious illness, peregrination, pseudologia fantastica) is seen to reflect a wish for death and reunion with the maternal object.

Attitude to Death↗
PubMed1989

Clinical characteristics of the Munchausen syndrome. A review and 3 new case histories.

The term Munchausen syndrome was introduced by Asher in 1951 for the description of patients who tell fantastic stories and deliberately seek repeated hospitalizations at different hospitals for simulated or self-induced acute illnesses. The syndrome has been repeatedly criticized and several other eponyms have been suggested. In DSM-III-R the designation chronic factitious disorder is used synonymously with Munchausen syndrome. On the basis of 3 new case reports and a statistic processing of literature case histories, this paper suggests that when using the original criteria by Asher, the syndrome constitutes a subtype of chronic factitious disorders, specially characterized by factitious illness, peregrination, pseudologia fantastica and dramatic admission circumstances. Further, most of the criticism of the syndrome may be a result of the great variability in definitions and diagnostic criteria used by different authors. Other clinical characteristics of the patients as well as psychopathologic and psychodynamic considerations are briefly discussed.

Adult↗
PubMedDate not supplied

Factitious disorders: reformulating the DSM-IV criteria.

The author criticizes and reformulates the DSM-IV criteria in a clinically and nosologically sensitive way. Criterion A, the intentional production of physical or psychological signs or symptoms, emphasizes symptoms and cannot accommodate pseudologia fantastica, voluntary false confessions, and impersonations. Criterion B, the motivation is to assume the "sick role," has no empirical content and fulfills no diagnostic function. The two criteria need reformulating in terms of lies and self-harm, respectively. Criterion C causes misdiagnosis by pushing factitious disorders into the somatoform and malingering categories and should be abandoned. The author discusses the implications for the etiology of conversion disorders and the classification of factitious disorders.

Diagnostic and Statistical Manual of Mental Disord↗
PubMed1979

Munchausen syndrome in a psychiatric setting: three case reports.

A primarily psychiatric presentation of Munchausen Syndrome has only rarely been reported and has been assumed to be unusual. Three patients presenting to psychiatric hospitals are discussed. These patients were found to demonstrate the salient features of Munchausen Syndrome: repeated simulation of illness requiring hospital admission, pseudologia phantastica, wanderlust and the use of aliases. It is our view that such presentations are not uncommon.

Adult↗
PubMedDate not supplied

[Munchausen syndrome].

The Munchausen Syndrome is characterized by the tireless and repeated attempts, carried out by the affected individual, to obtain hospitalization following an extremely credible and dramatic representation of physical symptoms. This condition was described at first by Asher in 1951; the author saw fit to link the syndrome to the name of the Baron of Munchausen, the character described by Raspe, famous for the tendency to tell lies concerning his invented adventurous life, thus highlighting what is the main element of the disease which is the tendency to lie to the doctors about one's health, filling one own's life with dramatic events (pseudologia fantastica). The purpose of this article is to offer a comprehensive review of some of the literature dedicated to the factitious disorders, with particular stress on the psychiatric and psychodynamic interpretations offered throughout the years.

Humans↗
PubMed1991

[Münchhausen syndrome].

Münchhausen's syndrome is characterized by fictitious illnesses associated with hospital peregrination, pseudologia fantastica with a mythomanic discourse that includes strongly structured medical elements, passivity and dependance at examinations, and aggressiveness. The whole picture is so typical that the syndrome can easily be recognized. Cases of Münchhausen's syndrome by proxy (Meadow's syndrome) have been reported during the last few years; the condition concerns children suffering from diseases which are entirely due to their parents and can be compared with the battered child syndrome. In terms of nosology, among pathomimias Münchhausen's syndrome figures as a borderline state. Since it is impossible to establish positive relations with these patients, treatment fails in almost every case.

Adolescent↗
PubMed1989

[A clinical study of generalized amnesia].

Six cases of generalized amnesia were reported. Generalized amnesia caused by phenomena of genuinely psychogenic origin is a rare psychological disorder and spontaneous recovery from amnesia in a comparatively short period of time is one of the characteristics of this disorder. Three of the cases in this report developed amnesia which was prolonged in comparison with previously reported cases. A comparison between these six cases and previously reported cases of amnesia elucidated the general characteristics of this disorder, differential diagnosis from other disorders, the development of a new identity during the amnestic period, amnesia as an alternative to suicide, factors related to prolonged amnesia, and its treatment. Although differential diagnosis from other disorders, especially from malingering, is sometimes difficult, the patient's attitude toward amnesia, the development of the clinical course of amnesia, the premorbid personal history, and interpersonal relationships should be carefully observed and evaluated in order to differentiate generalized amnesia from malingering. During the amnestic period it was observed that three of the cases believed that they had names of other persons, and two of them recalled personal histories completely different from their own. Previously, such phenomena have been mainly discussed from the view-point of pseudologia fantastica or malingering in Japan. The author discusses how a new identity could be developed in cases of generalized amnesia. According to Abeles, et al., generalized amnesia can sometimes serve as psychological suicide. The author emphasizes that the patient's suicidal risk should be evaluated carefully, even if he or she does not seem highly suicidal superficially. Excessive haste to recover from amnesia may heighten the suicidal risk or help develop a distorted personal identity. The principle for the treatment is to exclude an unnecessary therapeutic manipulation and maintain a consistent and comprehensive psychotherapy. The author also discusses factors with which the duration of amnesia can be evaluated in the initial treatment planning. The premorbid personality, the premorbid social adjustment, previous conflicts leading to amnesia, the whole clinical picture of amnesia, the whereabouts of the patient's family, and the suicidal ideation should all be taken into account.

Adult↗