ELSFVIER Neuropsychiatric Aspects in Munchausen’s Syndrome* Albert Diefenbacher, M.D. and Gerhard Heim, Ph.D. Abstract: The case of a 27-year-old woman with Munckaus- en’s syndrome is presented, in whom a history of cerebral palsy and pathological findings from electroencephalogram, cranial computed tomography, and neuropsychological assessment were prominent. It is argued that neuropsychiatric aspects may play a role in the development of Munchausen’s syndrome in a subgroup qf patients. 0 1997 Elsevier Science Inc. Introduction Factitious disorders with physical or psychological symptoms are characterized by intentional produc- tion or feigning of symptoms. The motivation is to assume the sick role. Symptoms, or physical signs, can be manifest in all organ systems. Patients’ acts seem to be deliberate, but-and this distinguishes them from malingering-they are compulsive, and performed in the absence of external incentives for the behavior [l]. A subgroup of chronic factitious disorders has been labelled Munchausen’s syn- drome, which, in addition, is characterized by mul- tiple hospital admissions due to general medical conditions and pseudologia phantastica [1,2]. Psychodynamically oriented explanations are paramount in the treatment of Munchausen’s syn- drome, and broken home situations, and physical or sexual abuse during childhood have been pro- posed to be of importance in the development of the disorder. Personality disorders from the so- called dramatic cluster B of the DSM-III-R-classifi- * Parts of this paper were presented as a poster at the Annual Meeting of the American Psychosomatic Society, Charleston, SC, March 1993 (abstract published in Psychosomatic Medicine 55 [1993], p. 118). Free University of Berlin, Department of Psychiatry, Berlin, Germany. Address reprint requests to: Dr. A. Diefenbacher, l.Allgemein- psychiatrische Abteilung, Ev.Krankenhaus Kiinigin Elisabeth Herzberge, Herzbergstr.79, D-10365 Berlin, Germany. General Hospital Psychiatry 19,281-285,1997 0 1997 Elsevier Science Inc. All rights reserved. 655 Avenue of the Americas, New York, NY 10010 cation-such as histrionic, narcissistic, borderline, or antisocial- have been described as comorbid conditions [3]. The possibility of contributing or- ganic cerebral dysfunctions has gained only minor attention. Pankratz and Lezak 141, in a series of 25 patients with the historical definition of Munchaus- en’s syndrome, found serious brain dystiction in about one-third of their sample. Pseudofogia phan- tastica, a prominent feature in Munchausen’s syn- drome, has been described in patients with trau- matic brain injury and other organic diseases [5-71. Furthermore, histories of developmental disorders, e.g., educational difficulty with subnormal intelli- gence [8] or dyslexia [9], have been mentioned in case reports of Munchausen patients. Given the above-mentioned relationship of the syndrome to comorbid personality disorders, a study of patients with personality disorders in the ‘dramatic cluster B’ of the DSM-III-R-classification is important [lo]. On neuropsychiatric cognitive screening evaluation, persons with dramatic per- sonality disorders made significantly more errors than control subjects, particularly in tests of plan- ning and sequencing cognitive functions, pointing to the probable co-occurence of biological factors in a subgroup of personality disorders also found in some Munchausen patients. We report a case that illustrates the biopsychoso- cial complexities of mechanisms that can lead to the development of a severe Munchausen’s syndrome. Case Report A 27-year-old woman was referred to our hospi- tal by court order from a pediatric surgical depart- ment where she persistently had demanded sur- gery for abdominal pain and pain in both legs. No medical reason could be found for either. The pa- 281 ISSN 0163~8343/97/$17.00 PII SO1 63-Si4,7(97)00022-4