Aleem & Ajarim 1995 - misusing health services (Munchausen syndrome)

AIm

To present a case study of Munchausen syndrome in a patients referred for a possible immune deficiency.

Sample

- 22 yr old female university student.

- Opportunity sampling (referred to their hospital with a possible immune deficiency).

Controls

Case study of an individual

Apparatus

Triangulation of data (family history, symptoms, observations, interviews).

Method

This was a retrospective case study therefore patients were not subjective to testing or measures.

Results - family history

- The women was described as intelligent.

- Father was a teacher who was friendly and supportive.

- She has 6 sisters and the 3rd child.

- Her mother had breast cancer.

- None of her family worked in the medical field.

Results - symptoms

- investigated at 17 yrs old for menstrual cycle issues.

- She then developed deep vein thrombosis, which was treated unsuccessfully with medication.

- She was admitted to hospital at 22 with painful swelling on her breast. She told doctors she had previous swellings over her abdominal area requiring surgical drainage, leaving scarring.

- It was discovered this procedure had taken place over 20 times at various hospitals.

- It was discovered she presented at the various hospitals with a range of complaints/illnesses.

- CT and ultrasound scans diagnosed hematoma and she underwent surgery, recovering well which showed no issue with her immune system.

- An abscess meant she required further surgical drainage. Cultures taken from this drainage.

- A variety of bacteria were found in the cultures.

- Soon after this, another abscess developed on her breast which was drained again.

Results - suspicions

- It was suspected her problem was factitious as there was no explanation for the abscesses and the bacterial growth.

- She was assessed by a psychiatrist where she acted in an extremely defensive way and showed superficial emotion as well as a great deal of stress.

- A diagnosis of Munchausen syndrome was made.

Results - evidence

- When the patient was not in her bed, a nurse found a syringe full of faecal matter.

- When the patient returned, another patient informed her what the nurse discovered.

- The patient became very angry and left the hospital against medical advice so no follow up was possible.

Strengths of the study

A strength of this case study is that it offers detailed insight into a rare disorder. By reflecting on the signs and symptoms that the patients displayed, it may help other practitioners to diagnose Munchausen syndrome. It is an appropriate research method to use for this disorder as it is a rare condition and it would be both practically difficult and have ethical issues if researchers were to try and use an experimental method.

Another strength of research into Munchausen syndrome is that it provides practitioners with a greater amount of info about the symptoms and reasons for it occurring. For example, Jaghab et al (2006) discussed a number of key symptoms that may be present in someone with Munchausen syndrome. This type of research has allowed for more reliable diagnosis of this rare syndrome, allowing patients to start treatment more quickly, thus reducing the likelihood of severe harm to themselves or others.

Weaknesses of the study

A weakness of using a single case study is that that patient may not have been typical of all individuals who have Munchausen syndrome making it difficult to generalise from the findings to other patients with this disorder. If practitioners use this case study as a template to which other potential cases are compared, they may miss something because the disorder presents differently for different people.

Another weakness of case studies is that the qualitative data is provided may be subject to interpretation by the researchers. For example, the researchers may have interpreted the information provided about the woman's first hospitalisation differently due to already knowing about the syringe that was discovered. Had they not known about this info she may have been viewed differently. This means that the info given from the case study may not be reliable as interpretation depends on the researchers past experience.

I&D - idiographic vs nomothetic (study)

As Munchausen syndrome is relatively rare, an idiographic approach is appropriate a there are so few cases that generalising from small samples in a more nomothetic manner may not be considered valid. A strength of this way of working is that researchers often provided rich in-depth info about the patient, which means that readers who are also practitioners are able to decide whether the findings may be applicable/transferable to their own clients. However, when working with patients with Munchausen's it is important that practitioners keep an open mind as the condition may manifest in different ways in different individuals. This again underlines why taking an idiographic approach is so important.

Theories

Munchausen's - where patients go to dramatic lengths to deceive doctors into believing that they have a serious medical condition, often requiring multiple surgeries. There is no obvious external reward other than attention and feelings of power.

Falsification - this takes a variety of forms such as exaggerating of genuine symptoms, false reports of neurological symptoms such as fainting, dizziness. could be through manipulating lab test results through adding blood to urine samples, or ingesting substances such as insulin.

Diagnosis - 3 main signs practitioners should be alert to include:

----> Lengthy medical records with multiple admissions to various different hospitals.

----> Willingness to submit to any medical procedure regardless of pain, discomfort or risk.

----> Inconsistencies between the patients history and medical observations.

Malingering - this is where a person pretends to be ill or exaggerates symptoms for obvious gain or incentive. This might be avoiding something negative, or to obtain something such as drugs for their own use or for resale, or disability benefits/financial compensation etc.