Psiquiatria - Faculdade de Medicina - UFMG

Munchausen's syndrome: a case beginning in early childhood and that changed from acute abdominal to neurological type
Whether our patient has begun as a Munchausen by proxy can
neither be proven nor excluded. In eitheir case producing the
symptoms of severe illness has become a stable, lifelong persisting
pattern of behaviour.
The problems of classifying such cases arises from the degree
of voluntary control of the behaviour the patient is assumed to
have. For an individual case, this can rarely be decided, because
the sense of voluntary control is subjective and can only be
inferred by the outside observer. In our case, there is evidence of
much voluntary control, as for example his wandering from doctor
to doctor to prevent detection, or giving false diagnoses, or
exaggerating and feigning the history of his symptoms. The actual
change from acute abdominal to neurological type appeared
when his wife had assumed his wellknown abdominal pain to be
feigned. He was obviously mainly motivated by avoiding something
unpleasant and possibly by attracting attention and care.
His behaviour in this situation was, however, certainly more complex
than that of a pure malingerer. Unconscious mechanisms are
undoubtedly involved, but they are not, by definition, consciously
produced. From this point of view it has been argued9 that
even in cases of Munchausen's syndrome, the patient may be
under the control of psychodynamic forces of which he is not
fully conscious. It seems, indeed, that our patient has intentionally
produced his symptoms, but with increasing pressure of the situation
interacting with diagnostic emergency measures, he was
no longer able to control his behaviour. From this point of view,
it seems that physicians contributed to his actual psychodynamic
situation.
Resumo
Um caso raro da síndrome de Munchausen com início na infância é
descrito. O diagnóstico da síndrome de Munchausen foi realizado na
42 Casos Clin Psiquiat 1999; 1(1):40-42
idade de 29 anos, após os sintomas terem mudado de abdominais
agudos para neurológicos, com simulada perda de consciência inicialmente
atribuída a encefalite. Insight na psicopatologia deste paciente
é obtido através de sua biografia, de avaliação de um psicoterapêuta,
que o tratou alguns anos antes, e de seu perfil observado em alguns
testes psicológicos.
Palavras-chave: Transtorno Factício; Doença Auto-induzida;
Síndrome de Munchausen
References
1. Enoch MD, Trethowan WH. Uncommon psychiatric syndromes.
Bristol:Wright, 1979.
2. Ford CV. The somatizing disorders. Amsterdam:
Elsevier,1983.
3. Diagnostic and statistical manual of mental disorders. 4th ed.
Washington, DC: American Psychiatric Association,
1994:471-5.
4. Asher R. Munchausen's syndrome. Lancet 1951; I:339-46.
5. Poeck K. Psychogene Verhaltensweisen und Symptome. In:
Hopf HC, Poeck K, Schliack H. eds. Neurologie in Praxis und
Klinik. vol. III. Stuttgart: Thieme, 1986:8.
6. Graham JR. The MMPI: a practical guide. New York:
Oxford University, 1977:65-66
7. Lee DA. Munchausen syndrome in proxy by twins. Arch Dis
Child 1979; 54:646-7.
8. Meadow R. Munchausen syndrome by proxy. The hinterland
of child abuse. Lancet 1977; II:343-5.
9. Scully RE, Mark EJ, NcNeely BO. Case Records of The
Massachusetts General Hospital. N Engl J Med 1984;
311:336-8.