Factitious injury and related conditions

Some patients consciously or unconsciously generate their own symptoms or physical injuries. Excluding deliberate self-harm (acknowledged by the patient), the remaining presentations can be categorized as somatoform disorders, factitious disorders (including Munchausen’s syndrome and Munchausen’s syndrome by proxy), and malingering. The distinction between these disorders is important for the plastic surgeon who may have the first opportunity to diagnose them.

Munchausen’s syndrome

This literature review reviews Munchausen syndrome. The question of its nosological affi liation is considered, etiological theories and epidemiological indicators are presented. The options for the development of the clinical picture, the problems of therapy are described. A systematic literature search was conducted using the Scopus, Web of Science, MedLine, elibrary, and other databases.

Thyroid detectives: on the trail of Munchausen’s syndrome

Thyrotoxicosis factitia, a disorder frequently seen in young or middle-aged women with psychological disorders, most commonly results from surreptitious ingestion of excess thyroid hormones. In most patients, diagnosis is relatively straightforward and depends on the demonstration of biochemical thyrotoxicosis, suppressed endogenous thyroid function and absence of clinical features of underlying thyroid disease. However, at times, confounding factors can make the diagnosis particularly challenging and necessitate the investigating physician to don the detective’s cap to get to the root of the problem. We discuss a patient whose diagnosis was reached with ingenuity after considerable effort from four endocrinologists having a total experience of 37 years in their field.