Münchausen Syndrome

Frankly I am concerned about fantasy masquerading as reality.

I recently saw a very interesting show and I heard mentioned Münchausen Syndrome. Have you, the medical professionals been able to see this in any of your patients...ever? Just pure curiosity...Thank you all for responding

I have seen Munchausens syndrome several times in my practice. The particular patient ingested large amounts of nitrates over weeks and then abruptly stopped them precipitating anginal chest pain. In addition he had a long story of being a fighter pilot having just completed a twelve hour flight in a Phantom jet carrying an atomic bomb. Should have known right there it was made up. Since chest pain in a middle aged male is coronary pain until proven otherwise he received colossal doses of morphine. He insisted that the meds be given into a subclavian line for reasons which were unclear. After totally falling for it someone noticed his very long toenails which a military pilot wouldn't have. Did we feel stupid afterwards.

I HATE Munchausen patients.

Those assholes KNOW they aren't sick and just want attention.

Is Munchausen's syndrome not a personality disorder, a mental illness?

Surely these people are no less deserving of care and therapy to support their illness (their mental one rather than their imagined physical one) than any other patient?

^^^^ A hypochondriac truly believes they are sick. A person with Munchausen's knows they are acting. I don't have patience for that kind of crap. They just need a good slap in the face to be brought back to reality.

A person with Munchausen's is as aware they are acting out an illness as a driver going 100 miles per hour knows they are speeding.

As a nurse I understand mental illness, I understand that they are there and they happen and they often times are not something someone wants or can control. Key words there being "often times". There are more cases out there of Munchausen's than I care for.

Susie is exactly right. While Munchausen's is a mental illness these people are very well aware that they are not sick and there is nothing wrong with them. Often these people are highly intelligent, not to mention very crafty, sly, and extremely manipulative. Every move they make is planned out and meticulous. They have studied, read up on, planned out, thought out and whatever else so that they can continue with the behaviors without being caught. Munchausen's really is in laymen's terms, "extreme attention seeking behavior".

I have seen also a few cases of Munchausen's by proxy too. That means that the person is making someone else sick, for instance, a mother that poisons her baby, or suffocates it. In this case again it's attention seeking behavior on the worst level, but here the person wants to be the hero and wants to receive the praise for their heroic actions.

Oddly enough it's almost always women who have Munchausen's or Munchausen's by proxy, usually white, 25-35 years old, and often a medical professional of some kind or another.

While it sickens me to death, it is one of the things that I find medically the most interesting. I do love psych nursing a lot. I find the whole subject, every detail so fascinating, but the actual patients that have it drive me nuts and honestly, piss me off. I really do just want to give them a huge reality check.

Now when it comes to hypochondriacs, in my book there are two different kinds. You have the real ones who actually should and often do have a psych Dx of hypochondria and you have the ones that just think they do and or should. Someone with the real issue honestly believes they are sick, and usually have one thing after another after another, it's constant. These people also do their homework a lot of the time, in other words, if they think they have liver cancer they read up all about it then in their head they start developing the symptoms. In rare cases they can actually present with some of the real symptoms. Don't ask me how, I guess the mind is a powerful organ.

Then you have the people who really are not hypochondriacs by definition of Dx according to the DSM-5. But none the less these people are always whining about something or another. Their symptoms are always much worse than everyone elses, everything is exaggerated with them. These are the folks who come crying to you over a hang nail and tell everyone they got their finger caught in a door and it rolled all the skin back on their finger and now the bone is exposed. These are the type 2 hypo's. They unlike real type 1 hypos know they are not sick but they still want the attention like they are.

So long story short, all types of Munchausen's and the type 1 hypochondriac are mental illness', have a Dx accordingly and basically have their own chapters in the DSM-5. The second type of hypochondriac doesn't have a mental disorder, doesn't need a mental Dx, doesn't have a place or chapter in the DSM-5, but does need to be basically told to stop being a whiny-steiney you will be just fine.

Mashie

I'm a BIG fan of giving a smack in the face and telling someone to get real. (I guess that's part of why I love corporal S&M as much as I do.)

I just don't have the patience for fakers and I don't care what their reason or diagnosis is.

Once again, perception is NOT reality. Reality is reality.

I'm a BIG fan of giving a smack in the face and telling someone to get real.

So essentially you are a Maoist? As in 'all power comes from the barrel of a gun' or maybe from a slap in the face, for the more civilized among us? ... ha ha ha.

Once again, perception is NOT reality. Reality is reality.

What is reality?

It is math, physics? 2+2=4...

Other than that no 2 people see "reality" the same way.

What is reality?

It is math, physics? 2+2=4...

Other than that no 2 people see "reality" the same way.

Yes, exactly. Physics and 2+2=4

If a person doesn't see that THEY ARE SICK.

I'm not going to stand around and let anyone say their bullshit is real when it isn't

My feeling about Munchausens is that whatever the cause and reality it is a colossal waste of time and resources. When I've seen such patients I've been amazed. I've also been totally infuriated. It's not funny one bit when you've wasted three hours thinking a patient had unstable angina when it's all bullshit. Quite frankly, non medical people simply may not be able to see my frustration.

Yes, exactly. Physics and 2+2=4

If a person doesn't see that THEY ARE SICK.

I'm not going to stand around and let anyone say their bullshit is real when it isn't

Now, I care not a whit about hypochondriacs or Munchhausen's ...

But just to talk about reality as a concept.

You do know there was a time when people saw the reality of physics as the sun revolving around the Earth, as the stars being holes in the celestial orb of the heavens, when forces were conveyed by an invisible ether and so on. And these ideas of reality were defended to the death, literally. It cost people who dissented their lives by being condemned to death by fire in more cases than you can imagine. And those doing the condemning were completely convinced of the reality of their ideas.

And yet over time, those doing the condemning were proven wrong. So who is to say what the next reality will be in the fullness of time?

It's much easier to say - and to treat someone - if you proceed from the idea they are dysfunctional in present day society. It's a politer and more courteous way of expressing the same basic idea.

Think about the huge amount of insurance dollars they are using up also. That has to effect all of us. On top of this, the abuse of medical professionals time and caring is terrible.

I believe that some of these people believe EVERYTHING they read on the internet and imagine themselves having all the symptoms they read about and bother their primary care Docs with everything they read about.

One psych professor I had in college, for a course in abnormal psych said that "A psychotic thinks that 2+2 is 5 and is OK with that, but a neurotic KNOWS that 2+2 is 4, but CAN'T STAND it."

. . . I believe that some of these people believe EVERYTHING they read on the internet and imagine themselves having all the symptoms they read about and bother their primary care Docs with everything they read about.

THAT would actually be a form of mild hypochondria fueled by the power of suggestion. It also happens to some degree to nurses, medical and dental students when they read pathology texts, but they come to realize, they do NOT actually have what they are reading about and don't waste other people's time..

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My feeling about Munchausens is that whatever the cause and reality it is a colossal waste of time and resources. When I've seen such patients I've been amazed. I've also been totally infuriated. It's not funny one bit when you've wasted three hours thinking a patient had unstable angina when it's all bullshit. Quite frankly, non medical people simply may not be able to see my frustration.

VERY true. Some people are not worth giving the time of day.

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Admittedly, I am a tough love kind of person and have no tolerance for mental illness. I'm glad there are people who can stand to be with them and treat them because it sure isn't me.

What may interest non medical people is the number of annoying patients we see. We have drug seekers and must keep a list of them. We have angry hostile patients who insult us. We have hypochondriacs and Munchausens who waste our time. We have little enough time to take care of those who really need it. This is the reality of emergency medicine today.

And what do you think it is like for the Canadians? For reasons unknown to real people, the USA is bent on copying their aggravating system. US hospitals and clinics close to the Northern most are getting a third of their work load from paying Canadians, and even subsidized Canadians.

Oh the things I could say here, lol.

Liquidsky, you are right on the money with every single thing you said in this thread. Jimmy, Susie, and Izrd as well.

I absolutely love reading about, learning about and studying psych stuff. However, as much as I enjoy learning about and even seeing these cases, I really honestly HATE dealing with these kinds of patients. They do absolutely drive me totally crazy, pun intended.

I am someone who has to be grounded in reality. I guess because of the kind of nursing I do and have done for so long I just have gotten into certain patterns, ways I do things, everything mostly with my kind of nursing is often life threatening. As a nurse who specializes in vent/trach patients my entire day and patient care really revolves around the ABC's of medicine which is Airway, Breathing, and Circulation. Without all three of those being managed correctly my patient dies. It's pretty much that simple. So me spending time on crazy patients whether it be a little bit or a lot usually means that someone else in my care at the moment is being jeopardized.

I have noticed that because I often have to work this way, meaning that things in my type of nursing are basically black and white that it has boiled over into my personal life as well. I have to be basically a no nonsense nurse. Everything I do is planned out, I have a list that I make at the start of my shift that I try my best to follow, and I stay on track. When I ask a patient if they are having trouble breathing I get a yes or no answer. If a wound vac isn't suctioning correctly I know immediately. In my kind of nursing I guess there isn't a lot of wiggle room for wishy-washy things or people. When I see an issue or a problem I have to take care of it almost always in the moment or one of my patients could die.

As I said this type of thinking has spilled over in my personal life as well and I have found that the older I get the less and less tolerance I have for people who can't answer a question directly. Psych patients never answer a question directly. Nothing with them is black and white ever. When I ask my husband if he needs gas money most of the time he tells me, "I don't know, maybe". That is what I am talking about that drive me crazy. So I tell him this exact thing, "you either do or you don't, which is it? It's a direct question with a yes or no answer." Poor guy, lol.

If I wasn't a critical care vent/trach nurse where I had to many lives in the balance every single second I might be able to relax a bit and deal with the crazies, but after so long almost 15 years now. It's muscle memory and is all I know anymore. The beauty of nursing or any facet of medicine is that there is a place for almost everyone. I do really love Alzheimer's, the elderly, vent trachs and critical care work, but I love learning about psych. Some nurses love labor and delivery or love pediatrics. I am not a fan of children in a medical setting at all, and usually hate their parents, and the first time I held a dead baby I would end up in a psych ward myself. So I greatly appreciate the medical professionals who enjoy that type of work because I just can't do it.

Mashie

Although psychiatry is appealing in the abstract, the reality of dealing with a major problem like schizophrenia is daunting. That said, a shrink I know just told me get their weight and calculate how much anti psychotic medicine to give them. Plenty of time to talk to them later.

When it comes to the crazies taking care of them is quite simple, lots of Thorazine and nice leather medical restraints. Once they are restrained both physically and chemically then talking becomes a lot easier, lol.

Mashie