Q. I work 1:1 with a child I suspect to have munchausens. She's 15, female, and obsessed with hospitals, mainly Psych wards. When escalated, she demands to be taken to the hospital, complains of sores or illness at least 5 times a week. She is doing much better now but I worry that she may revert back to these behaviors in the future. What would you recommend to prevent future problems and are there any specific treatments you'd recommend ongoing?

A. Of course, without evaluating the patient, I can't recommend specific treatments - but here are some ideas you might consider.

First, is there any identifiable comorbid Axis I or Axis II disorder that needs more vigorous treatment? For example, depression is often seen in this age group when Munchausen's Syndrome is diagnosed. If that were the case, medication and/or psychotherapy directed at that symptom could be helpful. Also, is there any evidence of Munchausen by proxy, or covert parental coaching of illness falsification? (see Libow JA, Child and adolescent illness falsification, Pediatrics 2000 Feb;105(2):336-42). If so, family therapy might be necessary.

I would also wonder about underlying Borderline Personality Disorder, which would generate other treatment possibilities (e.g., Dialectical Behavioral Therapy, and perhaps low-dose atypical antipsychotics, etc.). If you have not already obtained a consultation with someone specializing in adolescent psychiatry, I would certainly consider that option.

January, 2001

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