‘Factitious’ illness or ‘Munchausen by proxy’

Abstract

The use of the term 'Munchausen by proxy '1 derives from the description of a form of adult illness behaviour, also known as 'hospital addiction', in which the patient presents to emergency departments of hospitals over a wide geographical area, named after the fabulous and extravagant adventures of the Baron von Munchausen. 2 Adult patients who exhibit this behaviour present with care- and attentionseeking behaviour and complaints of physical disease relating to any system of the body. Illness may be simulated in a range of bizarre ways and in the production of actual physical signs or symptoms these patients risk potentially serious or dangerous investigations or surgery. In most, serious personality disorder is present and the risk-taking behavior escalates, becoming entrenched and incorrigible. With the developments in the past few years of liaison psychiatry (the link between general medicine and psychiatry) it has become evident that the production of simulated, presumed or fabricated 'factitious' illness can occur with reference to any system of the body - endocrine, gynaecological, haematological, neurological and urological forms of factitious illness all exist. For example, I have documented a case of factitious (fabricated) ante-partum haemorrhage in a mother almost at term where the sudden appearance of an alarming quantity of blood (later shown to come from a self-inflicted cut in a varicose vein) led to an unnecessary emergency Caesarian section. Obstetric staff, whose basic training assumes genuine symptoms in mother and baby, are not surprisingly incensed at such risk-taking and deceptive behaviour and react negatively, yet many midwives are aware that, tired and miserable towards the end of a