Experience treating patients with Munchausen Syndrome

[AdelaideSole]

I just listened to this podcast episode about an individual living with Munchausen's and she talks about in her  Podcast  how it was a nurse that saved her life because she finally felt comfortable enough opening up to the nurse about her condition. It got me thinking as a new nurse, how do you build rapport with a patient who has suspected Munchausen's? I suspect I treated one a few months ago and I just remember the patient being very upset and hard to please.

[speedynurse, ADN, BSN, RN, EMT-P]

One thing I want to mention is that this is a very, very rare condition.

Autoimmune diseases, genetic diseases, and other conditions are on the rise - perhaps partially due to the American lifestyle (high stress, poor eating habits, long work hours, etc). and partially due to an increase in the availability of tests and science. If a patient is accused of Munchausen's, it can close the door on treatment for a very real condition.

The reason I say this is far too often, the medical community can and does fail patients....I had a patient whose son died of brain cancer because it was misdiagnosed as "anxiety and stress-related" when he needed an MRI early on. I have had patients discharged from the ER with chest pain, only to come back to the ER hours or days later with a STEMI....the list goes on and on...

[JBMmom, MSN, NP]

I only had one patient with an actual diagnosis in the years I've been in the hospital. It was when I was first transitioning from long-term care to the hospital and I was still on orientation with a preceptor. She told me it would be a good learning experience to deal with this patient who is hospitalized on average once a month for a variety of "conditions". This time I got in report that she injected feces into her PICC line and was septic. 

I felt kind of badly for her. I think she was hospitalized so frequently because she had no close friends or family, by her account, and so hospitalizations were her only social experiences. We spoke at length about stuff, she rang the call bell frequently. I think I had a lot of patience with her, although when she started complaining that she can't understand why she's so sick all the time. I did mention that there appeared to be contamination of her PICC line that lead to this admission and asked did she have any idea how it might have come to be contaminated, especially because it appeared to be fecal contamination. She never answered my question, she stopped chatting as much and I didn't really have to see her for the rest of my shift. I don't think that was rude, but I had to lay out what I knew and ask her for any more information. I don't know what happened to her, I've often wondered, she wasn't very old .

[FolksBtrippin, BSN, RN]

It's hard for a medical nurse to address the problem by building a rapport, because the attention you give as a medical nurse in the acute environment  reinforces the behavior. 

As a psych nurse, I deal with patients who hurt themselves for medical attention frequently. Not all of them  have muchausen syndrome.

The best way to handle it in my opinion is to give minimal attention for medical self injury while *at the same time*  give maximum attention for healthy behavior, and if none is present spend a lot of attention  encouraging healthy behavior and rewarding the patient with attention when  he or she identifies and/or practices healthy coping skills. 

 

[AdelaideSole]

44 minutes ago, FolksBtrippin said:

It's hard for a medical nurse to address the problem by building a rapport, because the attention you give as a medical nurse in the acute environment  reinforces the behavior. 

As a psych nurse, I deal with patients who hurt themselves for medical attention frequently. Not all of them  have muchausen syndrome.

The best way to handle it in my opinion is to give minimal attention for medical self injury while *at the same time*  give maximum attention for healthy behavior, and if none is present spend a lot of attention  encouraging healthy behavior and rewarding the patient with attention when  he or she identifies and/or practices healthy coping skills. 

 

what's interesting is in the podcast it is a psych nurse that she finally is able to open up to. I wonder if this is something psych nurses are more equipped to do then us on medical side.

[FolksBtrippin, BSN, RN]

13 hours ago, AdelaideSole said:

what's interesting is in the podcast it is a psych nurse that she finally is able to open up to. I wonder if this is something psych nurses are more equipped to do then us on medical side.

I don't think its impossible for medical nurses to help, just very tricky ?. Especially in the acute environment. 

 

[JBMmom, MSN, NP]

11 minutes ago, FolksBtrippin said:

I don't think its impossible for medical nurses to help, just very tricky ?. Especially in the acute environment. 

Very good point. It seems to be a very complicated issue with more psych involvement than acute medical. However, it's unlikely that in this day and age of medical treatment that patient ever get the appropriate referrals to psych resources once the medical conditions have been treated. 

[FolksBtrippin, BSN, RN]

21 minutes ago, JBMmom said:

Very good point. It seems to be a very complicated issue with more psych involvement than acute medical. However, it's unlikely that in this day and age of medical treatment that patient ever get the appropriate referrals to psych resources once the medical conditions have been treated. 

Its even less likely that a patient with this disorder would show up for mental health treatment.

How can a medical nurse address factitious disorder while caring for a patient with self-inflicted illness? I feel like there are some answers. 

It might be appropriate to be gently confrontational. Eg... "It seems that fecal matter was put into your line on purpose."

Or more firmly confrontational 

"What did you hope would happen when you put fecal matter in your line?"

I think it is best to let the patient know that you know. Of course, she might just step up her game. I don't know. 

I think its a good topic. 

 

 

 

[vintagegal, BSN, DNP, RN, NP]

I think we often take our medical knowledge for granted. The public at large does not know a fraction on health conditions that nurses do. For example, you could have chest pain radiating to left arm and nausea and go to ER to be diagnosed with GERD. It’s really hard to judge the individual because they may truly feel it was an emergency, and sometimes it is. There are two forms of munchaussen, one is by proxy: this one involves projecting fictitious conditions on others such as the persons own child. This is extremely rare, however nurses should be alert for any signs of potential or actual child abuse and should report these suspicions accordingly.

[NutmeggeRN, BSN]

1 hour ago, vintagegal said:

I think we often take our medical knowledge for granted. The public at large does not know a fraction on health conditions that nurses do. For example, you could have chest pain radiating to left arm and nausea and go to ER to be diagnosed with GERD. It’s really hard to judge the individual because they may truly feel it was an emergency, and sometimes it is. There are two forms of munchaussen, one is by proxy: this one involves projecting fictitious conditions on others such as the persons own child. This is extremely rare, however nurses should be alert for any signs of potential or actual child abuse and should report these suspicions accordingly.

And there are those parents who thrive on the "excitement" of their kids  illness...

if it is a fever they have a rare infectious disease...POSSIBLY!!

if they have a pain in their gut, it is a TUMOR....POSSIBLY

?

[dream'n, BSN, RN]

I did have a patient when I worked in psych with extreme Factitious disorder/Munchausens.  The patient was very time-consuming and the disorder was frustrating to deal with.  They were a wonderful person, but absolutely exhausting. 

 

[speedynurse, ADN, BSN, RN, EMT-P]

22 hours ago, dream'n said:

I did have a patient when I worked in psych with extreme Factitious disorder/Munchausens.  The patient was very time-consuming and the disorder was frustrating to deal with.  They were a wonderful person, but absolutely exhausting. 

 

I have met one during my entire time in healthcare. It was bizarre and also involved fecal matter ? But that is literally the one and only case I have seen. The rest I believe were cases that were yet to be discovered - plenty of things we don’t find out in an ER or surgical field. That’s why there are other fields.....genetics, endocrinology, immunology, etc.