Munchausen's or psudoseizures??

z's playa · Jun 6, 2005

Hmmmm...I'm sure that' s a tough call for everyone. I'm not a nurse so I'm only aware of the definition.

To me...from just reading your account of what she said right after her siezure at the bar..I'm tempted to lean towards her being an attention seeker if you will. But then again it may be coincidence. And legit. A very dangerous dx to make.

Anyone else have any ideas?

Z

PS Welcome to allnurses ! :balloons:

FrostedGlass · Jun 6, 2005

I can't make any diagnosis, but I can offer my thoughts on this.

People who have a factitious disorder tend to have many different "illnesses" requiring a lot of tests and so forth. It is unusual, but not impossible, for someone to pretend to have a chronic illness for such an extended period of time. I am guessing your friend may be in her 20s, so it's been maybe for around ten years now?

My guess is that she possibly have something psychological going on. She may not necessarily be faking the seizures, but it definitely sounds like she is using them to get attention, which really isn't healthy.

A couple of ideas, if this has been going on since she was at least 13, maybe she feels she has to keep up the "image." She may have had seizures before, and then just continued on with it. She may believe she is actually having the seizures because it's been going on for so long. It is hard to imagine someone who never had a seizure being able to convincingly fake one in front of medical professionals or otherwise.

Or, she could really have a mysterious seizure disorder, and she has gotten used to being "sick" in order to be loved and gain attention.

It would probably be really hard to do, but you may just want to ask her. No matter what it is, she is trying to get attention in an unhealthy way, and she'll end up with no friends if she keeps doing it.

RN_2_B_2006 · Jun 6, 2005

Do u guys think I should ignore her when she is talking about her illness, since she may be doing this to get attention? She's also told me that she has never had a seizure while she has been alone either, which I thought was also strange. I wanna help her but I don't really know how. Any clues on how I can try to get her to talk about it without actually asking if she is faking?

allnurses Guide · Jun 6, 2005

I had my second seizure shortly after taking a history from a laboring woman, who mentioned she had epilepsy. I told her I did too and we talked about our experiences. About 15 minutes later when I was helping the CRNA with an epidural, I had a seizure.

Sometimes things are just coincidence.

steph

Thunderwolf, MSN, RN · Jun 7, 2005

Personally, I wouldn't give it much attention. If she presents with a grand mal like seizure, is she post ictal?...if not, Hmmmmm. When she presents with a seizure like activity, tap her between the eyes with your finger...does she blink?...if yes, it may suggest a pseudoseizure. Again, regardless, many folks have seizures or seizure like activity, treat regardless, but make no big deal out of it, especially if she appears to obtain secondary gains...like attention or manipulation. There are better ways to get ones needs met. Since she has run the gamut and chronic course of tests and docs which do not support her claim BUT there is some question of secondary gains here, factitious disorder versus malingering needs better differentiated. Factitious disorders tend to have a intentional, dramatic flare to their presentations...which says, "look at me, I'm sick". Their are no secondary gains. The only gain is the gain of attention and care by another via being sick. Often, they have gone through a gamut of tests or docs, seeking treatment. When confronted about it, it is not uncommon to go AMA, deny allegations of falsehood, and go elsewhere for service. Your friend may fit here. Malingers produce symptoms in relation to external incentives...sort of convenient ways to get out of things...like "not tonight dear, I'm having a seizure". Once the external incentive is no longer an issue, guess what?...no symptom or illness. Hypochondriacal persons, another disorder, only go thru the gamut of tests and docs only because they truly believe and fear they have that illness due to misperceptions of their own body...the key word is "fear"--->being the motivator...it is NOT to assume a sick role or to get out of things. I hope this helps. Also, a thing to consider is if your friend has an underlying personality disorder which may complicate or exacerbate her condition/presentation. Something to think about.

CharlieRN · Jun 8, 2005

I like thunderwolf's answer but it may be more technical than you need. There is a good chance that your friend is getting a lot of her interpersonal needs met by being sick. As her friend, and not her healthcare provider, her illness is not your job. Keep that in mind. She is not your patient. Changing the subject when she wants to talk about how sick she is sounds like a fine idea. The subject bores you and you have nothing to offer her in the way of help. So don't talk about it.

If she presists, tell her that, nicely. I don't guarantee that she will not blow up at you, but if she does it is evidence that all she wants of you is a sounding board.

Psychaprn · Jun 8, 2005

I've been friends with a person for 10 years. She has this seizure disorder that no one can figure out. Even when we were 13 years old I could sense that something just wasn't right. She has been to four or five different states to receive treatment. She gets so mad when the doctors tell her that they can't find anything wrong with her. Her symptoms have changed so much since she first started having seizures. She has told me that it was neurologic related, cardiac related, musculoskeletal related, and GI related. She had symptoms such as her legs hurting, headache, back pain, stomach ache, memory loss, numbness, chest pain, and many others. She's had tons of proceedures including a heart cath and multiple MRI's and EEG's and still no one has been able to diagnose her. She's even told me that doctors have suggested psychiatric treatment and she gets very very mad and offended. I NEVER would accuse anyone of faking something so serious but just some of the things she says makes me sort of suspicious and uncomfortable. She came to visit me and a bunch of us went out, including her ex-boyfriend that she is still crazy about. She went on and on all evening long about how she hadn't had a seizure in so long. Then, she started to seize in a bar. She was taken to the hospital and when I went in to see her the first thing she said was "Well, I guess (ex-boyfriend) knows how sick I really am now. Maybe he'll treat me a little better." I'd been very supportive of her until then. Now I just try to change the subject when she wants to talk about her illness (which is just about all of the time) and she gets very aggrivated with me. I don't know what to do. Is there anyway I can know she isn't really having a seizure? I just started researching Munchausen's today and I had never heard of it before. If she is truly faking it, is there anyway I can help her?

YOU DON'T MENTION IF IT'S GRAND MAL SZS. IS SHE ON MEDS FOR SZS.?IF IT IS , I THOUGHT INCONTINENCE WERE FEATURES. SHE COULD HAVE DEPRESSION WHICH COULD ACCOUNT FOR ALL HER SYMPTOMS OR A PERSONALITY DISORDER. I'D ADVISE SHE SEE APSYCHIATRIST FOR A THOROUGH WORK-UP. IF SHE REFUSES IT, SINCE IT'S THE ONE THING SHE HASN'T TRIED , I'D BE SUSPICIOUS ABOUT HER MOTIVATION AND PERCEIVED SECONDARY GAINS FROM BEING SICK. I'D ALSO TELL HER THAT IF SHE WON'T CONSIDER A PSYCHIATRIST YOU DON'T KNOW HOW TO HELP HER AND I'D DISCOURAGE HER TALKING ABOUT HER SEIZURES AND NOT GIVE THEM MUCH ATTENTION.

belfry · Jun 8, 2005

Well, by definition, Munchausen's by proxy is a problem of another person either making someone sick or fabricating sx to get the other person treated, in order to get attention for themselves. Usually a mother and a child. For example, a mother taking child to many different doctors about vague symptoms like failure to thrive, and after investigation it comes to light that the mother is perhaps poisoning the child (did you ever see Sixth Sense?).

That being said, it sounds like your friend might be pretty manipulative, if you get that "uh-oh" feeling then I suggest you heed it and put some distance between you and her. Sometimes your gut is your best diagnostician.

pebbles, BSN, RN · Jun 9, 2005

That being said, it sounds like your friend might be pretty manipulative, if you get that "uh-oh" feeling then I suggest you heed it and put some distance between you and her. Sometimes your gut is your best diagnostician.

I agree. It might not be important whether she is faking or having "genuine" seizures. The fact that her behaviour around the seizures and illness is manipulative sounds like a good reason to question the friendship. I guess it's still possible to be freinds with her in light of your doubts and feelings.... but being more aware of how she uses her "illness", and not allowing yourself to be manipulated by it is a tough row to hoe....

Angobnursern · Jun 9, 2005

I just have to say that there is probably an underlying cause of this even if she is faking it. She may not even be aware of it. I think seeing a psychiatrist couldn't hurt, even if she truely believes that the seizures are real, there must be a "stressor" that causes them to come on. I would suggest that she at least try seeing a psychiatrist especially if she feels that medical doctors are not doing anything for her.

kadokin, ASN, RN · Jun 17, 2005

I like thunderwolf's answer but it may be more technical than you need. There is a good chance that your friend is getting a lot of her interpersonal needs met by being sick. As her friend, and not her healthcare provider, her illness is not your job. Keep that in mind. She is not your patient. Changing the subject when she wants to talk about how sick she is sounds like a fine idea. The subject bores you and you have nothing to offer her in the way of help. So don't talk about it.
If she presists, tell her that, nicely. I don't guarantee that she will not blow up at you, but if she does it is evidence that all she wants of you is a sounding board.

Yes, exactly, what he said.