Our fifth case of the week demonstrates the value of a single case study to get insights into the process of diagnosing the Munchausen by proxy syndrome in an adult couple. The study presents one of the few published cases of a factitious disorder (i.e., a person pretending to have an illness, without a financial or other malingering motive). In this case, the disorder was transferred from an elderly nurse onto her 69-year old male partner. Before the diagnosis, the male patient had presented himself, always in presence of his female partner, with various and changing medical symptoms to different hospital units.
The author describes the emergence of the disorder (starting with a factious disorder in the woman to the transference of the disorder onto her male partner) as well as the different signals leading to the diagnosis. Comparisons with the Munchausen by proxy syndrome in parent-child relationships are made (e.g., educational status and profession of the woman, the presence of a psychogenic trauma in the woman, and the symbiotic relationship between the woman and the patient). However, the author also pays attention to the differences (e.g., the degree of compliance of the adult man and the absence of a close relationship between the woman and the medical staff) with how the disorder manifests itself in parent-child relationships.
The author describes the difficulties in the management of such a case, including the mirroring effects of the couple on the medical staff, the inclination of a medical team to refer the patient for further investigation, and the legal impossibility to separate the ‘caregiver’ from the ‘patient’. Possibilities for the future management of such cases are discussed.
The case is interesting as it provides an insight into the individual and relational features underlying the syndrome. As such, it also provides valuable tools for diagnosis and treatment.
Here you can find the link to the case in our Archive (registration is required):
The SCA team
Case of the Week , Munchausen by proxy , elderly couple , factitious disorder ,
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