Wednesday 19 December 2018

Ask Dr Jennifer: How do I deal with my hypochondriac mother?

Dr Jennifer Grant, a GP with the Beacon HealthCheck screening programme at Beacon Hospital.
Dr Jennifer Grant, a GP with the Beacon HealthCheck screening programme at Beacon Hospital.

Dear Doctor,

My mother is a hypochondriac. This is not something I say lightly; she actually becomes ill right at the moment where she isn't getting enough attention.

I first noticed this years ago when she suddenly became ill after I signed up for elective surgery. Now, she has a sibling who has been getting a lot of help because he had to go through a big operation and I can almost predict that an operation of some sort lies ahead for her.

Do doctors see this often, and if so, how is it that they can't nip it in the bud? I swear my mother has had unnecessary surgery over the years.

A: What you describe is highly suspicious for Munchausen syndrome, which is a form of factitious disorder and, unfortunately, all too common in modern medicine.

Munchausen syndrome is characterised by falsified general medical or psychiatric symptoms, resulting in unnecessary tests and treatments. Doctors are adept at spotting it, often within a few minutes of a consultation. One of the biggest clues lies with inconsistencies in the clinical history, physical examination and laboratory tests. Other clues include extensive clinical evaluation that is negative, a vague history in terms of clinical signs or symptoms, a long past medical or surgical history of conditions which are notoriously difficult to diagnose, and a poor response to standard treatments for the diseases in question.

You would think that if this condition is readily identifiable, then physicians could 'nip it in the bud', as you put it. However, it can be challenging for doctors when techniques are employed by a Munchausen syndrome patient to disrupt standard practice. For example, they may exploit the clinician's fear of missing a rare life-threatening disease or play into the clinician's fascination for solving a medical mystery.

No clinician will want to be remembered for missing an unusual presentation of a common disease, even if their suspicions are high for Munchausen syndrome.

In the absence of a clear diagnosis, but with persistent 'symptoms', the Munchausen patient will often seek additional diagnostic tests prompting more and more invasive procedures and therapeutic trials with medication.

A bit like your mother's case, the usual course of Munchausen syndrome appears to be one of intermittent episodes, and long-term recovery appears to be rare.

You could consider talking to your mother about factitious disorders and Munchausen syndrome and ask her to attend counselling as a form of treatment. Otherwise, brace yourself for more medical escapades.

Maybe in future, you can alert medical staff you come in contact with about your suspicions.

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