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AIDS
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Case Report: Munchausen’slAIDS Jay W. Baer, M.D. Assistant
Clinical Professor
of Psychiatry,
Department
Observers of patients with acquired immune-deficiency syndrome (AIDS) have reported a wide variety of psychiatric disturbances in this population, including depression, anxiety disorders, psychosis, and dementia [1,2]. In addition, physicians frequently witness emotional disturbances in physically healthy individuals yielded by the advent of the AIDS epidemic: hypochondriasis and mood and sexual functioning disturbances are frequent complaints of the worried well. I am writing to report a case of factitious medical illness presenting as Munchausen’s syndrome in which an individual fabricated an extensive treatment history for AIDS upon seeking evaluation of several physical complaints. The patient was a 28-year-old man who had recently moved across the country and presented at our hospital emergency room complaining of shortness of breath, severe headache, and fecal and urinary incontinence. He gave detailed history of treatment for two episodes of Pneumocystis curinii pneumonia and cyptococcal meningitis at a hospital in his state of origin and presented letters from another institution in that state documenting his AIDS diagnosis. Physical examination revealed only scattered expiratory wheezes. The extensive evaluation that ensued, which included head and abdominal CT scan, serial lumbar punctures, myelogram, arterial blood gases, and gallium scan, revealed no physiologic abnormalities. The patient’s headache and asthma responded to opiates and bronchodilators, respectively. Psychiatric consultation was requested when attempts to verify the patient’s history and glean information of his prior treatment revealed that he had not been diagnosed with AIDS, had not been treated for the General Hospital Psychiatry 9, 75-76. 1987 0 1987 Elsetier Science Publishing Co., Inc. 52 Vanderbilt Avenue, New York, NY 10017
of Psychiatry,
University
of California,
San Francisco
opportunistic infections he described, had forged his letters of introduction and had been evaluated in his state of origin for the physical complaints which he presented at our hospital. The medical staff felt tricked and exasperated. The patient conceded that he did not have AIDS, but was far from relieved, complaining bitterly of the inadequacy of his past and present physicians. He refused followup care for his asthma and emotional complaints. This patient met DSM-111 criteria for chronic factitious disorder with physical symptoms. The diagnosis of factitious disorder in patients concerned about AIDS should be made with caution, however, as many of these individuals have had confusing interactions with physicians. Some have been misdiagnosed as having or not having AIDS or AIDSrelated complex; many others, who receive accurate medical assessment, require repeated reassurance about their conditions. As our case demonstrates, factitious disorder with AIDS symptomatology has much in common with factitious disorder unrelated to AIDS. This includes migratory behavior, the raising of issues of trust and adequacy of care between doctor and patient, and intense countertransference anger in medical staff that requires intervention by the psychiatric consultant. It is noteworthy that the tremendous fear that AIDS engenders in our society does not preclude its incorporation into an individual’s psychopathology as a factitious disorder.
References 1. Dilley JW, Ochitill HN, Per1 M, et al: Findings in psychiatric consultations with patients with Acquired Im75 ISSN 0163-8343/87/$X50
J. W. Baer
munodeficiency 85, 1985
Syndrome.
Am J Psychiatry
142:82-
2. Jacobsen P, Perry SW: Organic mental syndromes possible in AIDS victims (letter). Am J Psychiatry 142:1389, 1985
76
Direct reprint requests to: Jay W. Baer, M.D. Department of Psychiatry, Ward 7 B San Francisco General Hospital San Francisco, CA 94110
Case Report: Munchausen’slAIDS Jay W. Baer, M.D. Assistant
Clinical Professor
of Psychiatry,
Department
Observers of patients with acquired immune-deficiency syndrome (AIDS) have reported a wide variety of psychiatric disturbances in this population, including depression, anxiety disorders, psychosis, and dementia [1,2]. In addition, physicians frequently witness emotional disturbances in physically healthy individuals yielded by the advent of the AIDS epidemic: hypochondriasis and mood and sexual functioning disturbances are frequent complaints of the worried well. I am writing to report a case of factitious medical illness presenting as Munchausen’s syndrome in which an individual fabricated an extensive treatment history for AIDS upon seeking evaluation of several physical complaints. The patient was a 28-year-old man who had recently moved across the country and presented at our hospital emergency room complaining of shortness of breath, severe headache, and fecal and urinary incontinence. He gave detailed history of treatment for two episodes of Pneumocystis curinii pneumonia and cyptococcal meningitis at a hospital in his state of origin and presented letters from another institution in that state documenting his AIDS diagnosis. Physical examination revealed only scattered expiratory wheezes. The extensive evaluation that ensued, which included head and abdominal CT scan, serial lumbar punctures, myelogram, arterial blood gases, and gallium scan, revealed no physiologic abnormalities. The patient’s headache and asthma responded to opiates and bronchodilators, respectively. Psychiatric consultation was requested when attempts to verify the patient’s history and glean information of his prior treatment revealed that he had not been diagnosed with AIDS, had not been treated for the General Hospital Psychiatry 9, 75-76. 1987 0 1987 Elsetier Science Publishing Co., Inc. 52 Vanderbilt Avenue, New York, NY 10017
of Psychiatry,
University
of California,
San Francisco
opportunistic infections he described, had forged his letters of introduction and had been evaluated in his state of origin for the physical complaints which he presented at our hospital. The medical staff felt tricked and exasperated. The patient conceded that he did not have AIDS, but was far from relieved, complaining bitterly of the inadequacy of his past and present physicians. He refused followup care for his asthma and emotional complaints. This patient met DSM-111 criteria for chronic factitious disorder with physical symptoms. The diagnosis of factitious disorder in patients concerned about AIDS should be made with caution, however, as many of these individuals have had confusing interactions with physicians. Some have been misdiagnosed as having or not having AIDS or AIDSrelated complex; many others, who receive accurate medical assessment, require repeated reassurance about their conditions. As our case demonstrates, factitious disorder with AIDS symptomatology has much in common with factitious disorder unrelated to AIDS. This includes migratory behavior, the raising of issues of trust and adequacy of care between doctor and patient, and intense countertransference anger in medical staff that requires intervention by the psychiatric consultant. It is noteworthy that the tremendous fear that AIDS engenders in our society does not preclude its incorporation into an individual’s psychopathology as a factitious disorder.
References 1. Dilley JW, Ochitill HN, Per1 M, et al: Findings in psychiatric consultations with patients with Acquired Im75 ISSN 0163-8343/87/$X50
J. W. Baer
munodeficiency 85, 1985
Syndrome.
Am J Psychiatry
142:82-
2. Jacobsen P, Perry SW: Organic mental syndromes possible in AIDS victims (letter). Am J Psychiatry 142:1389, 1985
76
Direct reprint requests to: Jay W. Baer, M.D. Department of Psychiatry, Ward 7 B San Francisco General Hospital San Francisco, CA 94110