How do you deal with Munchhausen-type pts?

Nurses General Nursing

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We occasionally get pts that I swear have Munchhausen's. Sometimes I am little slow on the uptake, I tend to believe in people but dang! Sometimes, when it hits me, I just shake my head and wonder how they get that way and how do you figure out what is real and what isn't?

***see reply below***

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I agree that it's not your job to decide that. There are many conditions that don't show up on a test, but the person really does have something going on. Imagine how frustrating it must be for a patient who feels terribly ill, but all the tests in the world come back normal. It is frustrating. You know something is wrong with your body yet nobody can tell you what that is. You will honestly sit there and wish for something, anything to come back abnormal so they can put a name to your condition and finally treat it. Munchausen's is not normal. It is not normal for someone to purposely make themselves sick for attention. More likely, they just can't put a name to what is going on with this person yet.

I used to watch Mystery Diagnosis on tv and the one common phrase I would hear from each of those people was, they just wanted a diagnosis. I have seen what I think would be relatively easy things to diagnose take people over 5 years to get an answer on. One woman they showed, the minute I saw her on the screen I said she has Cushings. She did. It boggled my mind that I could clearly see what took her over 3 years to get a diagnosis on. For most of these people, it takes getting into the right doctor, who is going to take the time to really listen to what their patient is saying and not the standard 5anymore with lower reimbursements and more patients coming in. I know sometimes with me over the years, I have had to search out the right doctor who was going to work with me to get me where I needed to be. Nobody wants to feel ill, nobody wants to be in constant pain. That's why I say Munchausen's is not common. Most people want relief.

There really are people out there with it though. I had a pt that was vomiting up blood. Bright red blood. (Mind you she spent ALL her time at the hospital. Anyhow, we had a feeling something else was really going on because none of the vomiting episodes were ever witnessed and always happened after she came out of the bathroom. So I waited outside the bathroom door for her when she got up and heard the IV beep. I knocked and walked in and found her with her PICC line disconnected and her mouth around the PICC site sucking blood out of it quickly reconnected the fluid to the line and asked her why it was disconnected and what she was doing (playing stupid) she said it came undone and she had just vomited again. Her mouth was covered in blood and it was caked in her teeth. She honestly looked like a vampire...lol. I documented what I saw, contacted the dr and then he ordered a ph test of her emesis. It came back completely off and was comparable to the fluid she was receiving through the PICC LINE line. It was so obvious what the diagnosis was...but we had finally 'caught' her. It was truly sad because she didn't have anybody. No family, no friends. She came to the hospital for social activity. We eventually placed her in an AFC home so she didn't have as many episodes. It worked a bit. The saddest part was that she was only 26 years old.

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Specializes in ORTHO, PCU, ED.
I knocked and walked in and found her with her PICC line disconnected and her mouth around the PICC site sucking blood out of it....

WOW, that is desperate.

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Specializes in Hospice.

No, that's pathology. Do the best you can and try not to take the behavior personally. Harrass the medical team relentlessly for a psych consult. Does. your facility have a psych nurse liaison - maybe in the ED? Psych nurses have highly developed skills in dealing with behaviors like this. Figure out how to get their advice.

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Can't say I've ever had a Munchausen's patient, but back in the early 80s several of my co-workers and I were convinced we had a parent with Munchausen's by Proxy.

She got away with it for a few years, and then one time misjudged how long she could withhold her kid's seizure meds before rushing him to the ER to be "saved". (Her story was that he would periodically vomit them up. Never once did it while he was in hospital, however). He came in DOA.

Sad thing was, we had brought up the possibility of Munchausen's by Proxy several months earlier with his Pediatrician. He reamed us royally and pretty much told us to stop practicing Medicine without a license. Granted, the child really did have multiple illnesses and his symptoms were caused by mom deliberately withholding meds, but she fit the rest of the profile to a "T".

Thirty years later and I still think of that little boy. Both Munchausen's and Munchausen's by Proxy are difficult to deal with, and I'm not even really sure that intensive Psych intervention helps. From what I remember, there's a personality disorder component involved. And you can't cure a personality disorder.

And what did Dr. His Highness Hind End have to say when the lad died? You guys should have reported him for knowing mom was withholding his meds and, apparently, doing nothing about it and not involving Social Services or Child Protective Services.

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Specializes in Hospice.
And what did Dr. His Highness Hind End have to say when the lad died? You guys should have reported him for knowing mom was withholding his meds and, apparently, doing nothing about it and not involving Social Services or Child Protective Services.

This was in the early 80s. Today we would be falling over each other getting to the phone. Back then, sadly, not so much. He was also head of the department.

Mom was on a first name basis with the CEO, and always had a typewriter with her to send letters to him, newspapers, God, who knows. She was very obvious about it, too. She'd sit in the doorway of the kid's room.

She was also good at playing divide and conquer with the staff. You know, the old "You take so much better care of my son than anyone else." Said to just about all of us. In strictest confidence, of course. Most of us eventually saw through it, but she had one ally among the nurses who would threaten to get us in trouble for daring to think the whacko was...whacko.

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Specializes in Complex pedi to LTC/SA & now a manager.

Not sure as the daughter seemed to be a willing participant as she had to fake being paralyzed mom didn't do anything to her. Psychological abuse, scam/con artist, grifters probably a definite psychopathology in mom and child

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Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.
Not your job to figure out what is real and what isn't. You can only take information as presented to you, do your assessment, and plan care accordingly.

Regardless of how you feel, this is real to a patient.

If there's no end in sight to multiple complaints and issues, time to advocate for a care conference will all disciplines to best serve the needs of the patient.

If the patient can not function, perhaps they need a long term care solution. That is something you can discuss at the care conference.

Here's a little story from my experience. Patient who was admitted constantly, continued to--what we all thought--up the ante. New stuff constant. Long story short, they had a brain tumor and were dead 2 weeks later. Is this the norm? Not always. But never suspect that it is a pysch/all in one's head issue--it could be something else entirely.

So, remember, real to them is real to them. You can only advocate.

I respectively disagree. I would never treat a patient differently or appear to not believe them, but psychological issues are certainly our business in acute care. Appropriate documentation and referrals will be needed.

And look at the lady above that was sucking blood out of her PICC line. That definitely needed handled and documented for the patient's sake. A CLABSI could kill the patient. Hope the PICC was removed ASAP

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Specializes in ICU.
There really are people out there with it though. I had a pt that was vomiting up blood. Bright red blood. (Mind you she spent ALL her time at the hospital. Anyhow, we had a feeling something else was really going on because none of the vomiting episodes were ever witnessed and always happened after she came out of the bathroom. So I waited outside the bathroom door for her when she got up and heard the IV beep. I knocked and walked in and found her with her PICC line disconnected and her mouth around the PICC site sucking blood out of it quickly reconnected the fluid to the line and asked her why it was disconnected and what she was doing (playing stupid) she said it came undone and she had just vomited again. Her mouth was covered in blood and it was caked in her teeth. She honestly looked like a vampire...lol. I documented what I saw, contacted the dr and then he ordered a ph test of her emesis. It came back completely off and was comparable to the fluid she was receiving through the PICC LINE line. It was so obvious what the diagnosis was...but we had finally 'caught' her. It was truly sad because she didn't have anybody. No family, no friends. She came to the hospital for social activity. We eventually placed her in an AFC home so she didn't have as many episodes. It worked a bit. The saddest part was that she was only 26 years old.

I agree that people do have it, it's just rare. I also think that either a physician or psychiatrist need to diagnose it. That's my point. If I had witnessed what you did, I would promptly report it to the physician and let him deal with it. I also feel though that those type of people are rare and so you will run into those situations maybe two or three times in your nursing career. Someone being a hypochondriac is a different story and I'm sure nurses run into them more often. But someone making themselves sick on purpose to get attention and doing things like you described? That's not everyday. And those people are sick, mentally.

I wonder did the OP mean Munchausen's or being a hypochondriac? Once someone is given a particular diagnosis, especially a mental one, it follows them forever which is why someone should be careful when throwing those words around.

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