Münchhausen syndrome F68.12

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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dermatitis autogenetica; dermatitis autogenica; Munchausen's neurosis; Pathomimicry

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Miege, 1893; Menninger, 1934; Asher, 1951

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  • Feigning a clinical picture with demonstrative, often dramatic descriptions of symptoms and false information about the anamnesis on the basis of a personality disorder. The syndrome must be distinguished from simulation (conscious intention to gain a recognizable advantage) and from hypochondria (suffering from an imaginary illness without self-harm). It is assumed that a lack of impulse control, reduced anxiety tolerance, externalisation of conflicts and lack of differentiated defence mechanisms to cope with problems can play a role in the disorder. Since the disease serves as a compensation for conflicts, the patient himself does not necessarily seek healing.
  • The skin as the border organ between man and the environment is often the target organ of self-injury, so that the dermatologist is confronted with the disease relatively often. It can be assumed that 0.05-0.5% of the total amount of the patient's body is attributable to Münchhausen syndrome. The type of self-harm can be caused by the application of chemicals, mechanical damage such as rubbing and scratching, thermal methods, ingestion of drugs such as thyroid homones or laxatives, introduction or injection of contaminated substances (e.g. into the bladder), application of allergens, etc. As a rule, irregular skin lesions with runners and regular base, absence of typical primary florescences, scars on the edge or other areas appear.

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The causes have not been clearly clarified. Psychodynamic, psychosocial and brain-organic factors are discussed. Addiction problems, dissociative states, borderline and antisocial personality disorders are not uncommon. Of pathogenetic significance are early childhood developments with indications of numerous traumatising real experiences, experiences of separation and loss, sexual and emotional abuse. Chronic diseases are often traceable in the family history. Cerebral dysfunctions predisposing to pseudologia phantastica may also be present.

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  • The dermatologist's task is to identify the artificial component of the skin change. This is the first step that can end the cycle of continuous diagnostics and the application of a wide variety of therapy attempts.
  • The patient's response to the self-harm is often difficult, but usually unavoidable in order to provide the patient with professional psychotherapeutic help. This step can lead to a breach of trust between patient and doctor, as the patient feels that his physical suffering is no longer taken seriously and understood by the doctor. S.a.u. Dermatitis artefacta, see artefacts below.

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  13. Tlacuilo-Parra JA et al (2000) Factitious disorders mimicking systemic lupus erythematosus. Clin Exp Rheumatol 18: 89-93


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Last updated on: 29.10.2020