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Artifizielle Störungen

Heimliche Selbstbeschädigung

Factitious disorders

Covert self-injury

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Zusammenfassung

Etwa 1,3–1,8 % aller allgemeinmedizinischen Patienten leiden an artifiziellen Störungen. Bei zwei Drittel der Patienten wird die Erkrankung chronisch. Die Diagnose wird oft erst nach Monaten bis Jahren gestellt. Meist kommt es im Krankheitsverlauf zu schwerwiegenden Komplikationen mit körperlichen Folgeschäden, einschließlich Verstümmelungen wie z. B. Amputation einer Extremität. Diese Patienten verursachen sehr hohe Kosten. Noch immer sind viele Ärzte unzureichend über die spezifische Problematik dieser Störungsbilder informiert. Die Frühdiagnose ist aber besonders wichtig, um die Folgeschäden zu vermeiden. Die Diagnostik, Differenzialdiagnostik und schließlich auch die Therapie stellen den Arzt vor eine besondere Herausforderung und erfordern immer die interdisziplinäre Zusammenarbeit zwischen verschiedenen Fachrichtungen.

Abstract

Approximately 1.3–1.8 % of general medical patients suffer from factitious disorders. The disease is chronic in two thirds of these patients and the diagnosis is often made only after months or years. These disorders require utmost skill in recognition, diagnosis and treatment as inadequate treatment may result in severe complications including mutilation, such as amputation of extremities. These patients invoke very high costs. Many physicians are still not adequately aware of the specific problems. The early diagnosis of the disorder is of special importance to avoid subsequent damage for patients and physicians. The diagnostics, differential diagnostics and ultimately also therapy represent a special challenge for physicians and always necessitate an interdisciplinary medical approach.

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Literatur

  • Almeida J, da Silva JA, Xavier M, Gusmao R (2010) Munchausen syndrome mimicking psychiatric disease with concomitant genuine physical illness. BMJ Case Rep. DOI 10.1136/bcr.07.2010.3142

  • Boyd AS, Ritchie C, Likhari S (2013) Munchausen syndrome and Munchausen syndrome by proxy in dermatology. J Am Acad Dermatol 71:376–381

    Article  Google Scholar 

  • Caocci G, Pisu S, La Nasa G (2008) A simulated case of chronic myeloid leukemia: the growing risk of Munchausen’s syndrome by internet. Leuk Lymphoma 49(9):1826–1828

    Article  PubMed  Google Scholar 

  • Catalina ML, Gomez MV, De Cos A (2008) Prevalence of factitious disorder with psychological symptoms in hospitalized patients. Actas Esp Psiquiatr 36:345–349

    PubMed  Google Scholar 

  • Clarkin JF, Yeomans FE, Kernberg OF (2001) Übertragungsfokussierte Psychotherapie der Borderline-Persönlichkeit. In: Clarkin JF, Yeomans FE, Kernberg OF (Hrsg) Psychotherapie der Borderline-Persönlichkeit: Manual zur psychodynamischen Therapie. Schattauer, Stuttgart

  • Cunningham JM, Feldman MD (2011) Munchausen by internet: current perspectives and three new cases. Psychosomatics 52:185–189

    Article  PubMed  Google Scholar 

  • Del Casale A, Ferracuti S, Rapinesi C et al (2012) Factitious disorder comorbid with bipolar I disorder. A case report. Forensic Sci Int 219:e37–e40

    Article  Google Scholar 

  • DeWitt DE, Ward SA, Prabhu S, Warton B (2009) Patient privacy versus protecting the patient and the health system from harm: a case study. Med J Aust 191(4):213–216

    PubMed  Google Scholar 

  • American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5. Aufl., DSM-5. American Psychiatric Publishing, Washington DC

  • Dinter van TG, Welch BJ (2009) Diagnosis of Munchausen’s syndrome by an electronic health record search. Am J Med. 10.1016/j.amjmed.2009.03.035

  • Eckhardt-Henn A (2011) Artifizielle Störungen. In: Uexküll Psychosomatische Medizin, theoretische Modelle und klinische Praxis, 7. Aufl. Urban & Fischer, München, S 631–640

  • Eckhardt-Henn A, Hoffmann SO (1993) Depersonalisation und Selbstbeschädigung. Z Psychosom Med Psychoanal 39:284–306

    Google Scholar 

  • Eckhardt A (1988) Die Dynamik der Arzt-Patient-Beziehung bei der chronischen vorgetäuschten Störung. Psychother Med Psychol 38:352–358

    Google Scholar 

  • Feldman ID, Eisendraht SJ (1996) The spectrum of factitious disorders. American Psychiatric Press, Washington DC

  • Ferrara P, Vitelli O, Bottaro G et al (2012) Factitious disorders and Munchausen syndrome: the tip of the iceberg. J Child Health Care 17(4):366–374

    Article  Google Scholar 

  • Fliege H, Gramm A, Eckhardt-Henn A et al (2007) Frequency of ICD-10 factitious disorder: survey of senior hospital consultants and physicians in private practice. Psychosomatics 48(1):60–64

    Article  PubMed  Google Scholar 

  • Fonagy P, Jurist E, Gergely G, Target M (2002) Affect regulation, mentalization and the development of the self. Other Press, New York

  • Girolami A, Bertozzi I, Tassinato V et al (2014) Bleeding manifestations apparently unrelated to coagulation or other organic disorders: a tentative classification and diagnostic clues. Hematology 19(5):293–298

    Article  PubMed  Google Scholar 

  • Gregory RJ, Jindal S (2006) Factitious disorder on and in patient psychiatry ward. Am J Orthopsychiatry 76:31–36

    Article  PubMed  Google Scholar 

  • o A (2005) Internationale Klassifikation psychischer Störungen (ICD-10) Kapitel V (F), 5. Aufl. Huber, Bern

  • Kanaan RA, Wessely SC (2010) Factitious disorders in neurology: an analysis of reported cases. Psychosomatics 51(1):47–54

    Article  PubMed  Google Scholar 

  • Klaassen FA, Schober P, Schwarte LA et al (2008) Letters to the editor: fatal outcome of Munchausen’s syndrome. Resuscitation 78:99–100

    Google Scholar 

  • Kinns H, Housley D, Freedman DB (2013) Munchausen syndrome and factitious disorder: the role of the laboratory in its detection and diagnosis. Ann Clin Biochem 50:194–203

    Article  PubMed  Google Scholar 

  • Kucuker H, Demir T, Oral R (2010) Pediatric condition falsification (Munchausen by Proxy) as a continuum of maternal factitious disorder (Munchausen syndrome). Pediatr Diabetes 11:572–578

    Article  PubMed  Google Scholar 

  • Lin JL, Servat JJ, Bernardino CR et al (2012) Bilateral corneal perforations and autoproptosis as self-induced manifestation of ocular Munchhausen’s syndrome. Orbit 31(4):252–255

    Article  PubMed  Google Scholar 

  • Menninger K (1934) Polysurgery and polysurgical addiction. Psychoanal Quart 3:173–178

    Google Scholar 

  • Norcliffe-Kaufmann L, Gonzalez-Duarte A, Martinez J, Kaufmann H (2010) Tachyarrhythmias with elevated cardiac enzymes in Munchausen syndrome. Clin Auton Res 20:259–261

    Article  PubMed  Google Scholar 

  • O’Connor EA, Grunert BK, Matloub HS, Eldridge MP (2013) Factitious hand disorders: review of 29 years of multidisciplinary care. J Hand Surg Am 38:1590–1598

    Article  Google Scholar 

  • Pessina AC, Bisogni V, Fassina A, Rossi GP (2013) Munchhausen syndrome: a novel cause of drug-resistant hypertension. J Hypertens 31(7):1473

    Article  PubMed  Google Scholar 

  • Pulman A, Taylor J (2012) Munchausen by internet: current research and future directions. J Med Internet Res 14(4):e115. DOI 102196/imir.2011

    Article  PubMed Central  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. Annegret Eckhardt-Henn gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Eckhardt-Henn, A. Artifizielle Störungen. Psychotherapeut 60, 18–24 (2015). https://doi.org/10.1007/s00278-014-1091-z

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  • DOI: https://doi.org/10.1007/s00278-014-1091-z

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