Talk:Factitious disorder imposed on self

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Jwaserman, Aamorra, Adrianda, Qmedbs, Afsd95 (article contribs).

question

I'm sorry for adding this to an established section, but I don't know how to start my own, and this really is just a question. What is is called when it is like MsbP, but the child really is ill/disabled, and the parents make sure the child always feels like an invalid, protects them from having a life away from them, and they really do it for the attention they receive? I've known someone like this, and after her child died, she became a nurse to take on the same "I'll take good care of you because you're so helpless" routine with patients. And now I see the same thing in a nurse taking care of someone I know who is trying to get better. Does MsbP always have to be about an otherwise healthy child, or can it be a disabled child or a patient in a hospital, even if that patient is an adult? Atwhatcost (talk) 03:41, 16 May 2016 (UTC)

Please ask at Help:Reference desk. Jytdog (talk) 20:42, 21 September 2017 (UTC)

Table

What is the meaning of the table in section Diagnosis? The left hand column seems to have a heading 'Common signs and symptoms', but what of the other columns?86.132.221.224 (talk) 20:03, 1 November 2017 (UTC)

Suggestions from Queen's Medical Students

Hello!

We are a group of first year medical students from Queen's University who are editing this page as part of a class assignment. We have compiled a list of suggestions to improve this article and would appreciate any community feedback before we proceed with these edits. Please find below a list of our suggestions:

1) In the diagnosis subsection, change: "A similar behavior called Munchausen syndrome by proxy has been documented in the parent or guardian of a child." To: "A similar illness, Factitious Disorder Imposed on Another (formerly Factitious Disorder by proxy), also exists. This entails a person (not necessarily a parent or guardian), presenting another individual as falsely sick.

2) In regards to the “diagnosis” section, since extensive research on factitious disorder is not available, a brief summary of disease types that have been mimicked and laboratory diagnostics used to differentiate these cases from true disease could be included using the following table: Immediately before the table, we propose to add the following sentence (after ... "or electrocardiography may also be employed,"), "A summary of more common and reported cases of factitious disorder (Munchausen syndrome), and the laboratory tests used to differentiate these from authentic disease is provided below:

Disease Mimicked	Method of Imitation	Laboratory/Diagnostic Confirmation
Bartter’s syndrome	Surreptitious intake of diruetics Self-induced vomiting	High performance liquid chromatography (HPLC) analysis of urine Urine chloride analysis
Catecholamine-secreting tumor	Injection of ephinephrine into urine or blood stream	Adjunct analysis of increased Chromogranin A
Cushing’s syndrome	Surreptitious steroid administration	HPLC to differentiate endogenous and exogenous steroids
Hyperthyroid	Surreptitious thyroxine administration	Blood tests for free T4 and thyroid stimulating hormone
Hypoglycaemia	Exogenous insulin or insulin secretagogues	Simultaneous blood analysis of insulin, C-peptide, proinsulin, and insulin secretagogues
Sodium imbalance	Intake large quantities of salt	Measure fractional sodium excretion to differentiate intentional salt overload from dehydration.
Chronic diarrhoea	Watered down stool samples Laxative abuse	Measure fecal osmolarity Urine analysis to screen for laxatives using gas chromatography or mass spectrometry
Induced vomiting	Although many alternatives possible, ipecacuanha ingestion	HPLC measurement of serum or urine for elevated creatine kinase, transaminases and ipecacuanha
Proteinuria	Egg protein injection into bladder, albumin (protein) addition to urine samples	Urine protein electrophoresis analysis
Haematuria	Blood introduction to urine samples, deliberate trauma to the urethra	Imaging to rule out insertion of a foreign body, monitor sample collection, analysis of red blood cell shape in samples

Note: comment below on placement of citationJenOttawa teaching (talk) 14:20, 15 November 2017 (UTC)

3) In Munchausen syndrome#Treatment and prognosis, add the following to the end of the first paragraph: “Due to the uncommon and underlying nature of this disorder, it is hard to study as participation in studies is difficult to maintain after suggestion of factitious disorder diagnosis. As such a prognosis is difficult to establish.”

4) We suggest moving the following sentences to Munchausen syndrome#Signs and symptoms or Munchausen syndrome#Diagnosis, rather than Munchausen syndrome#Treatment and prognosis:

“There are several symptoms that together point to Munchausen syndrome, including frequent hospitalizations, knowledge of several illnesses, frequently requesting medication such as pain killers, openness to extensive surgery, few or no visitors during hospitalizations, and exaggerated or fabricated stories about several medical problems. Munchausen syndrome should not be confused with hypochondria, as patients with Munchausen syndrome do not really believe they are sick; they only want to be sick, and thus fabricate the symptoms of an illness. It is also not the same as pretending to be sick for personal benefit such as being excused from work or school.[5]” → Munchausen syndrome#Signs and symptoms section

“There are several ways in which the patients fake their symptoms. Other than making up past medical histories and faking illnesses, patients might inflict harm on themselves such as taking laxatives or blood thinners, ingesting or injecting themselves with bacteria, cutting or burning themselves, and disrupting their healing process such as by reopening wounds.[citation needed] Many of these conditions do not have clearly observable or diagnostic symptoms and sometimes the syndrome will go undetected because patients will fabricate identities when visiting the hospital several times.” → Munchausen syndrome#Diagnosis section

We also suggest changing the following sentence in order to add an appropriate citation: “There are several ways in which the patients fake their symptoms. Other than making up past medical histories and faking illnesses, patients might inflict harm on themselves by consuming laxatives or other substances, self-inflicting injury to induce bleeding, and altering laboratory samples.”

5) I would like to change “Munchausen syndrome is a factitious disorder…” to “Munchausen syndrome, a term no longer in use, described a disorder wherein… Factitious disorder is now the term of choice by experts.”

I would also change “Munchausen syndrome fits within the subclass of factitious disorder” to “Munchausen syndrome was the original term used to describe a condition with predominantly…”

6) Modify the introduction of Munchausen syndrome by proxy to incorporate the new terminology of ‘factitious disorder’ and use language that reduces villainization of the perpetrator.

*Remove “Munchausen syndrome is related to Munchausen syndrome by proxy (MSbP/MSP), which refers to the abuse of another person, typically a child, in order to seek attention or sympathy for the abuser.”

*Insert:“Factitious disorder is related to Factitious Disorder Imposed on Another (formerly Munchausen syndrome by proxy), which refers to a caregiver producing illness in a person under their care, typically a child, in order to satisfy a psychological need for praise or sympathy for their devoted care.”

Many thanks to the Wikipedia community for your insights and feedback! :) Adrianda (talk) 16:54, 7 November 2017 (UTC)

COMMENTS: Citation creation did not use one of the standard templates, and #3 goes to the journal itself rather than to the abstract at PubMed, which is the norm. Citations ! and 4 are the same, unless 1 is for different page numbers. Bothe have "5th ed. ed." There is a separate Wikipedia article "Munchausen syndrome by proxy," so at your first mention of that term put it in brackets [[ ]] to create a Wikilink. Spelling: articles that were started with U.S. spelling conventions continue as such (same for those that started with UK/Canadian). Your proposed table for Diagnosis is an improvement over the existing table, which makes no sense. If replacing that table, the text at the beginning of the section needs to be amended. Also, for a table, the convention is to place the citation in the table rather than after. I am unsure of the value of your suggestion #3, but leave that to a physician reviewer. For your #4, citations needed. Item #5 raises an interesting point that may be left to the hands of an experienced editor, to wit, a proposal that the name of the article be changed, with a redirect created for people who search Wikipedia on Munchausen syndrome or Munchausen syndrome by proxy. If this path is taken, then the last sentence in History needs to be deleted. Looking forward to seeing this moved from Talk to the article. David notMD (talk) 12:03, 8 November 2017 (UTC)

Comment I agree with David notMD. This article uses the CS1-style citation templates (e.g. {{cite journal}}, {{cite book}}, {{cite web}}), so you must use the same style. Here's the first ref reformatted into a citation template for you:

• Kinns, H; Housley, D; Freedman, DB (2013). "Munchausen syndrome and factitious disorder: the role of the laboratory in its detection and diagnosis". Annals of Clinical Biochemistry. 50 (Pt 3): 194–203. doi:10.1177/0004563212473280. PMID 23592802.

I've also reformatted the table for you. It's important for visually-impaired visitors who use a screen reader that we mark up header cells properly and make sure that lists are marked up as semantic lists, not just bits of text with dots. Hope that helps. --RexxS (talk) 17:57, 11 November 2017 (UTC)

Thanks for your feedback RexxS and David notMD - really appreciated! HeatherMurray Queen's (talk) 22:06, 11 November 2017 (UTC)

References

Medscape reference

All of the Diagnosis section of this article is sourced to

• "Factitious Disorder Imposed on Another (Munchausen by proxy)". {{cite journal}}: Cite journal requires |journal= (help)

But that source relates entirely to Munchausen syndrome by proxy, (or factitious disorder imposed on another), a different condition. The conditions may well be similar, and possibly even related, but I see no evidence that the diagnosis of one condition is appropriate for the diagnosis of the other. Can somebody more expert in psychiatry than I (that's most folk) suggest appropriate sources to re-write that section? I can see

• "Factitious Disorder Imposed on Self (Munchausen's Syndrome)". {{cite journal}}: Cite journal requires |journal= (help)

might be usable, but I'd prefer something more scholarly if we're going to use it to source an entire section. --RexxS (talk) 22:29, 11 November 2017 (UTC)

Rename

Should we rename to the current name of "Factitious disorder imposed on self"? Munchausen's has not been the official term for a long long time. Doc James (talk · contribs · email) 00:34, 14 November 2017 (UTC)

Removed table

Hello Wikipedia Community! Thank you for your feedback on the edits we (Queen's med students) made. I am unsure of how history works, so I am posting the table that I removed from the article page here, so that if we decide we want to put it back it will be easy to do. I removed this table

Common signs and symptoms
Recurrent life-threatening events	Seizures	Bleeding	Poisoning
Hypoglycemia or hyperglycemia	Apnea	CNS Depression	Repeated infections
Diarrhea and vomiting	Rashes	Fevers

Adrianda (talk) 15:52, 15 November 2017 (UTC)

Thank you Adrianda. That's exactly right, as it gives other editors an immediate view of what was removed, along with the sourcing. Of course, that set of symptoms relate to Munchausen syndrome by proxy, so had no business being in this article in the first place!

I see from your prior edit summary that you think you're struggling with citation style. I think the citation you added in that edit is near-perfect, so don't worry about it. Simply do your best, and other editors will come along and fix any tiny discrepancies. For example, I've changed the separator for the page range from a hyphen (-) to an en dash (–), because that's our convention, but you shouldn't have to worry about it. That's how Wikipedia works. Cheers --RexxS (talk) 16:36, 15 November 2017 (UTC)

References

Updated suggestions from Queen's Medical Students

Hello Again!

Thank you to the Wikipedia community for your feedback! :D @RexxS:, your table reformatting is awesome! We would have had no idea how to figure that out. Also, thank you @David notMD: for the invaluable comments.

We have

• Fixed the DSM references (they are now the same reference)
• Posted the table to the article page, and added an introductory sentence with our citation listed
• @Doc James:, thank you for your comment. We completely agree, in fact we've been told that Munchausen syndrome is simply referred to as "factitious disorder" now, which has its own Wikipedia page. It's occurred to us that perhaps these pages should be unified, but feel this is a change that is too far out of scope for both our medical training and experience in editing Wikipedia. What are the community thoughts?
• We have also changed a sentence and added a citation for our fourth recommendation
• We'll aim to add the other changes on the article page ASAP

Thank you again for making this such a great learning experience.

Sincerely, Adrianda (talk) 16:02, 15 November 2017 (UTC)

Okay so we have "Factitious disorder" of which there are two types "imposed on self" and "by proxy". This is the first one of those. Have adjusted the naming to match. Doc James (talk · contribs · email) 18:03, 15 November 2017 (UTC)

Now, all THAT is what I call meeting Wikipedia's "BE BOLD" advice. David notMD (talk) 18:16, 15 November 2017 (UTC)

I did citation clean-up on the citations that were already in the article. I left Munchausen by Internet with that existing title, but added a link in the lead to direct to this now factitious disorder imposed on self. David notMD (talk) 12:44, 17 November 2017 (UTC)

@RexxS: I left a note on your Talk for my reasons for citation changes. David notMD (talk) 15:37, 17 November 2017 (UTC)

@David notMD: I left a note on your talk page giving my reasons for reverting you. I'll reproduce it here so that the students and other editors can see the reasoning:

Hi David. I've just reverted two of your edits to Factitious disorder imposed on self: [1], [2]. I know you're trying to improve the citations in that article, which are anything but consistent, but reducing the amount or granularity of information is not an improvement. It is easier for third-parties to scrape |first= and |last= than |vauthors=, so when somebody has taken the time to separate first and last names, please don't undo their good work. Similar considerations go for reducing given names to initials and abbreviating the full name of a journal. This isn't a paper encyclopedia and we don't have to save space by throwing away information.

I'm sorry you've been given bad advice at other articles. There is indeed value in making citations consistent, but in an article containing a mish-mash of styles, you could pick any style to made as the standard. In these cases you have to ask yourself, why would I level down to the least informative version, when I could level up to the most informative one? What advantage is there for the reader or re-user in throwing away information? --RexxS (talk) 15:53, 17 November 2017 (UTC)

Requested move 18 November 2017

Munchausen syndrome → Factitious disorder imposed on self – The applicable policy for naming of medical articles is Wikipedia:Manual of Style/Medicine-related articles, which is indicated at Wikipedia:Article titles as "It is supplemented by other more specific guidelines (see the box to the right). Unusually, the consensus for medical articles does not defer to WP:COMMONNAME, but is given at WP:NCMED as follows:

• "The article title should be the scientific or recognised medical name that is most commonly used in recent, high-quality, English-language medical sources, rather than a lay term (unscientific or slang name) or a historical eponym that has been superseded."
• "Some examples of international standards include: Diseases—The World Health Organization, International Statistical Classification of Diseases and Related Health Problems (ICD-10) or the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)"

The ICD-10 classification is "Intentional production or feigning of symptoms or disabilities, either physical or psychological [factitious disorder]" - see http://apps.who.int/classifications/icd10/browse/2016/en#/F68.1 and the DSM-5 classification is "Factitious Disorder DSM-5 300.19 (F68.10). The latest article at Medscape is titled "Factitious Disorder Imposed on Self (Munchausen's Syndrome)", reflecting the modern name, which is now preferred to "Munchausen's syndrome". You can see other examples of this updating in the recent references in the article. I know this doesn't sit well with what we do in other fields, but in medical articles, using the modern, scientific name is uncontroversial.

The longer title is necessary because of the existing article Factitious disorder imposed on another (which is the target of the redirect Munchausen syndrome by proxy). --RexxS (talk) 16:22, 18 November 2017 (UTC)

• Oppose No way, Hosea. To get some idea of how often the proposed move is used, I searched on google n-gram (result: could not be found) and google (8,400ish vs 340,000). This confirms my personal experience and suspicion that Munchausen syndrome is much more commonly used. So oppose per WP:COMMONNAME. Issue can be revisited in 5-10 years when the proposed name gains more acceptance. --Tom (LT) (talk) 22:33, 19 November 2017 (UTC)
  • Yes, José. And Heart attack is a lot more commonly seen than Myocardial infarction, but that's the medical name for the condition, and that's where the article is. Did you bother to read the policy on article titles for medical topics at all? COMMONNAME is nothing more than a secondary consideration for those articles. --RexxS (talk) 23:38, 19 November 2017 (UTC)
    • C'mon, guys, we're all friends, and we should act like it. LT's entitled to his view about how to balance the competing considerations, just like each of the rest of us are. We don't absolutely follow the "official only" approach in every case. If we did, then we wouldn't have a Featured Article at Tourette syndrome.
      On a related point, does anyone know when the "new" name officially started being used? We commonly wait a few years after a name change, precisely for the reason that LT gives: the new names do not always gain acceptance, and there are commonly multiple possible "official" names. WhatamIdoing (talk) 18:56, 20 November 2017 (UTC)
      • So what's the point of having documented guidelines and policy if anybody can make up their own "competing consideration" and ignore the policy? If we followed WP:NCMED for Tourette syndrome, we'd find: (i) Combined vocal and multiple motor tic disorder [de la Tourette] (ICD-10); (ii) Tourette's disorder (ICD-9); Gilles de la Tourette syndrome (OMIM); (iii) Gilles de la Tourette syndrome (Diseases Database); (iv) Tourette syndrome (MedlinePlus); (v) Tourette Syndrome and Other Tic Disorders (Medscape). So, yes, we would have a Featured Article at "Tourette syndrome" – what title do you think we would have? --RexxS (talk) 23:59, 20 November 2017 (UTC)
        • I expect that the point behind accepting common sense considerations is the same point behind declaring WP:Ignore all rules to be a fundamental policy, and the same the reason that guidelines such as NCMED say "it is best treated with common sense, and occasional exceptions may apply" right at the top. We need to accept common sense and rationales for the occasional exception.
          In the instant case, I see these names in key sources: Intentional production or feigning of symptoms or disabilities, either physical or psychological [factitious disorder] (ICD-10, which additionally lists Munchausen syndrome as the second of three common alternative names), Chronic factitious illness with physical symptoms (ICD-9), Munchausen Syndrome (MeSH), and Munchausen syndrome aka/or Factitious disease aka/or Hospital addiction syndrome (Diseases database). That doesn't actually look like a strong case for declaring that your preferred name is actually "the scientific or recognised medical name that is most commonly used in recent, high-quality, English-language medical sources, rather than a lay term (unscientific or slang name) or a historical eponym that has been superseded". I see (a) no evidence here that your suggestion is the "recognised medical name" (every source I checked prefers a different one, but they do still recognize the old one), or that the eponym has actually been superseded in practice (see, e.g., Peter's comment about the new name not being popular, i.e., not having really superseded the old one yet). Which is kind of a pity, because my own WP:Use common sense argument was going to be in favor of your suggestion on the grounds that it would reduce confusion with respect to the "by proxy" version, which more people will have heard of. But you seem to have just argued against using common sense and in favor of a "law" that doesn't necessarily support your proposal. WhatamIdoing (talk) 08:00, 21 November 2017 (UTC)
          • No point in trying to shoot me: I'm just the messenger. This isn't a game of trying to assert my viewpoint over somebody else's, and I'm quite impressed by your line of reasoning in not necessarily accepting Factitious disorder imposed on self as the best choice to meet WP:NCMED. So there's nothing for it to be a pity about. In fact, if Tom had adduced that sort of argument instead of blindly spouting an irrelevant guideline, I'd have thanked him for it, and we wouldn't be having this argument.
            I'm still not seeing any reason whatsoever for throwing IAR at me, though. You demonstrate to everyone you're on shaky ground when you have to quote "occasional exceptions may apply", but can't generate any reason why those exceptions should apply in the case you're putting forward. The only problem with common sense is that it's not very common, and I think I prefer a Wikipedia where editors are expected to follow agreed policy and guidelines, rather than have the anarchy of everybody claiming that the "law" doesn't apply to them. YMMV. --RexxS (talk) 14:50, 21 November 2017 (UTC)
• support per RexxS rationale(invariably name changes occur, we should do this now...IMO)--Ozzie10aaaa (talk) 00:15, 20 November 2017 (UTC)
• Support This is the current name. Doc James (talk · contribs · email) 00:34, 20 November 2017 (UTC)
• Support. The correct name may not be particularly popular, but it does define the appropriate scope of the article better than a more frequently used but possibly poorly defined term. Other popular names are available as redirects, so the reader will be able to find the appropriate article without difficulty, and will be educated on arrival about the recognised terminology, as well as the other information available. · · · Peter (Southwood) ^(talk): 06:22, 20 November 2017 (UTC)
• Support I think changing the name of the article would be a step in the right direction. 'Factitious disorder imposed on self' is the current medical/psychiatric term, used in the DSM-5. We met with a psychiatrist and psychiatry resident to discuss our proposed edits to the Wikipedia page, and their main feedback was also regarding the change in terminology ('Munchausen syndrome' is no longer really used.) Jwaserman (talk) 15:50, 20 November 2017 (UTC)Jwaserman — Preceding unsigned comment added by Jwaserman (talk • contribs) 15:47, 20 November 2017 (UTC)
• Support A "common name" in one country may be completely unknown in another, and uninformative when translated. David notMD (talk) 16:45, 20 November 2017 (UTC)
• Support for rationals already presented above. This is a common name, and looking at newer litterature it has superseeded the older term. Carl Fredrik ^talk 15:31, 21 November 2017 (UTC)

Retracted because I'm not sure what the implications for search traffic are. Googling "Myocardial infarction" gives Wikipedia at nr. 1, googling "Heart attack" gives our article at page 2. Carl Fredrik ^talk 15:33, 21 November 2017 (UTC)

User:CFCF in my experience Google figures things out fairly well and traffic is not affected. Doc James (talk · contribs · email) 16:12, 21 November 2017 (UTC)

@CFCF: That illustrates one of the problems with using Google to make judgements. Google delivers individualised results as far as it can, so I see the Wikipedia article Myocardial infarction as the number one Ghit for that term – as you do – but when I Google "heart attack", I see our article Myocardial infarction as Ghit number four, after the NHSUK, NHSUK Choices, and British Heart Foundation pages. No doubt editors across the pond won't see such Anglo-centric results. As far as I can tell, Google seems to treat search terms that are Wikipedia redirects like Heart attack almost as favourably as searches for the actual article name. We also need to remember that there is likely to be a lot more competition for lay and slang terms like "heart attack", because Demi Lovato hasn't recorded a track called "myocardial infarction".--RexxS (talk) 17:29, 21 November 2017 (UTC)

First of all, it is possible to turn off individualized results (as I have done), so the only thing they would be going off is location (which does not explain US & UK-centric links coming up above Wikipedia). Second, I think it matters more than we think — and we shouldn't just brush it off so lightly. Carl Fredrik ^talk 17:35, 21 November 2017 (UTC)

There's no point in turning off individualised results because most readers don't do that, so you can't draw any conclusions from those sort of experiments. Because we don't know the algorithms Google uses to determine result rankings, we can't explain any set of results, and it's pointless to try. I think it matters much less than you think, and I don't believe we should be trying to fit our article naming policies to suit Google. YMMV. --RexxS (talk) 18:41, 21 November 2017 (UTC)

User:CFCF last time we discussed this, we looked at the data and it did not support a concern. Can you provide evidence of concern? Maybe we could change the name and then reassess things in a few months.

Right now the article used the NEW name for part of the 15th and 18th and all of the 16th and 17th. Looking at the data and not seeing significant concern.[3]

That we are number one and two for heart attack and myocardial infarction means supports that naming has no significant effect. Doc James (talk · contribs · email) 06:15, 23 November 2017 (UTC)

• Support. For two reasons: 1) Psychiatry, psychology, and other mental health disciplines have used factitious disorder rather than Münchhausen syndrome for decades, e.g., in DSM-III (1980) "301.51 Chronic Factitious Disorder with Physical Symptoms ... This has also been called Münchhausen syndrome" (p. 288). Most authoritative sources, such as the previously mentioned DSM-5 and ICD-10, but also the draft version of ICD-11, UpToDate, the Merck Manual, the Cleveland Clinic, and the Mayo Clinic, to name a few examples, refer to factitious disorder, usually with a parenthetical mention of Münchhausen syndrome, e.g., the Cleveland Clinic, "(Formerly known as Munchausen syndrome)." Some journal articles still use Münchhausen syndrome, but, particularly in psych journals, one sees factitious disorder used, sometimes with Münchhausen syndrome in parentheses, with explanations such as this one from an article in Psycho-Oncology, "Background: Factitious disorder is where patients repeatedly seek medical care for feigned illnesses in the absence of obvious external rewards; ‘Munchausen’s syndrome’ is the historical name for this disorder." (It is a very interesting article btw - well-written, succinct, brief.) 2) Many authoritative sources refer to Münchhausen syndrome as a severe form of factitious disorder imposed on self, i.e., it is a subcategory of factitious disorder. This definition is not universal, which is a point that could be addressed in the Factitious disorder imposed on self article.   - Mark D Worthen PsyD (talk) 07:42, 22 November 2017 (UTC)