[Factitious diseases and Münchausen's syndrome]

Factitious diseases in which the symptoms are simulated or created intentionally are very varied: functional manifestations, haemorrhages, anaemia, pyrexia, metabolic disturbances (hypoglycaemia, hypokalaemia, hyperthyroidism, etc.), skin lesions and others. Different symptomatic associations are possible. The Munchausen syndrome which is mainly seen in anglo-saxon countries, is characterised by a long history of factitious symptoms in subjects with psychological profiles which are difficult to define because of the very behaviour of the patients themselves. Besides this syndrome, many psychological disorders have been described in patients presenting with factitious symptoms. One particular form is the creation of factitious diseases in children by their parents. The diagnosis of factitious disease is always difficult and confirmatory proof cannot always be obtained apart from certain cases in which laboratory tests show the presence of drugs in the plasma or urine. Psychotherapy which appears to be essential for these patients is generally very difficult to achieve.