Sunday, February 1, 2015

Study group discussion: Histrionic personality disorder, Munchausen syndrome and MSBP

What's histrionic personality disorder?

I looked it up and found this on wiki:
A mnemonic that can be used to remember the characteristics of histrionic personality disorder is shortened as "PRAISE ME":
Provocative (or seductive) behavior
Relationships are considered more intimate than they actually are
Attention-seeking
Influenced easily
Speech (style) wants to impress; lacks detail
Emotional lability; shallowness
Make-up; physical appearance is used to draw attention to self
Exaggerated emotions; theatrical

Attention seeking in general.

Oh so how does this relate to mothers bringing their children in often for medical attention. Same thing?

Umm isn't that Munchausen syndrome by proxy? Different things.

Munchausen is more of medical attention seeking and histrionic looks like attention seeking in general.

If you're seeking medical attention for yourself, it's Manchausen syndrome and if you're trying to get attention to yourself by showing others are sick (mostly a child) it's Munchausen syndrome by proxy.

Oh ok. Thanks!

MSBP cases tend to involve faking medical symptoms, though. So mothers bringing in their children frequently for medical attention for real symptoms are probably helicopter parents (overly anxious and involved) but not necessarily MSBP.   Although if they exaggerate real symptoms that could be MSBP as well.

As for histrionic, it's not impossible that it would manifest as a parent bringing their child in for medical attention far more than is necessary, but as with all personality disorders, it's much more pervasive and would affect all other areas of their life and how they interact with the world, not just how often they bring their child in for medical attention.

Ah ok. Is Munchausen only specific to using another as a portal to attention. Or can this be self afflicted in order for the same degree of attention?

Munchausen by proxy is using other people's medical issues for attention. Usually children or the elderly or other dependents. Sometimes pets.

I had a patient who went to repeated doctors complaining that her child has joint pain, stiffness. Diagnostic procedures were done and all of them came out to be normal. They were suspecting MSBP in that case.

Munchausen syndrome (not by proxy) is when the person uses their own medical symptoms (often fake).

Ah ok. Now I see. So how does one start treatment for something like this?

Histrionic is in my opinion the most self defeating of the personality disorders with the exception of self defeating personality disorder, which isn't actually a recognized personality disorder anymore. Because people with histrionic need attention so much that they'll take on whatever role will get them the most attention  instead of being true to themselves.

Treatment for munchausen by proxy or not: Psychological treatment.  Helping them figure out how to get attention in healthier ways.  Interpersonal skills training.  Self esteem help so they don't need attention so much. Not giving them as much attention or sympathy might help, but it's mean and you need to be absolutely certain their faking it.

There was an episode in House MD on a patient with Munchausen syndrome. She induced hypoglycemia, seizures and took colchicine to mess up her blood profile.
She however had a medical condition that needed attention which made me realize that you can not dismiss every symptom in a patient with Munchausen without diagnostic procedures. It could be something serious. Interesting episode.

That's a huge issue with dealing with people with mental illnesses.   Doctors so often dismiss them because the mental illnesses can distort how they see things, but dismissing them means that you could miss out on something real and serious.

Would be truly unfortunately for a misdiagnosis that could potentially lead to death because the patient took antibiotics or of that nature.

Thanks for the information. Came accross the disorder while strolling the hospital. Answered so well.

Which did you come across?  Histrionic or MSBP?

Histrionic. While I walking through mental health. A group of docs were discussing personality disorders from the sound of it. That was one of which I over heard.

Ah. Personality disorders are tricky.  People aren't very likely to seek treatment, and they're not particularly easy to treat even when people seek help.  And they're complicated to diagnose because people often have symptoms from more than one, so trying to figure out which fits best is complicated.

Yeah that makes sense. I work in a military hospital so we alot of patients that will come back with not only physical but mental damage as well. The last patient I over saw had cellilitus, 2nd degree burns of the feet and would only speak to the females of the ward.
Mutisim something?

Selective mutism?

Yes!

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