Cases reported "Self Mutilation"

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1/3. Ocular munchausen syndrome resulting in bilateral blindness.

    PURPOSE: munchausen syndrome is a factitious disorder in which patients knowingly harm themselves for subconscious psychological reasons in order to be hospitalized. Recognition of this psychopathology is important, to prevent potentially severe eye damage. Ocular munchausen syndrome is uncommon. The authors describe an elderly woman with recurrent, probably self-induced, ocular trauma leading to bilateral blindness. The authors are unaware of any previously reported cases of munchausen syndrome resulting in bilateral blindness and occurring in old age. CASE REPORT: A 73-year-old woman was first seen in 1991 with a closed-globe injury to the right eye, apparently following a household fall. physical examination showed no sign of extraocular trauma. Right visual acuity was 20/30 after 2 months. She was readmitted in May 2003 with left globe rupture, allegedly following a domestic fall. No extraocular trauma was found. She developed ocular phthisis 6 months postoperatively. The patient was admitted again in February 2004 with right globe rupture, following another alleged domestic fall. physical examination showed no sign of extraocular trauma. Right visual acuity was 20/400 2 months postoperatively. Psychiatric evaluation revealed munchausen syndrome. psychotherapy was prescribed, but refused by her family. CONCLUSIONS: diagnosis of munchausen syndrome is difficult to make in the ophthalmic department. Munchausen patients have little or no ability to control their self-destructive behavior. A sympathetic and supportive approach is therefore required and these patients should be urgently referred to a psychiatrist with experience in factitious disorders. Even with psychotherapy, which is often refused, the prognosis remains poor.
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ranking = 1
keywords = factitious disorder
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2/3. Self-inflicted tongue ulcer: an unusual form of factitious disorder.

    factitious disorders in the buccal cavity are infrequent. A 9-year-old boy with a 5-year history of an artefact ulcer of the tongue is described. Psychiatric evaluation revealed an altered personality structure with a background of psychotic traits. Complete remission was observed with psychiatric management.
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ranking = 2
keywords = factitious disorder
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3/3. Exfoliative cheilitis--a factitious disorder?

    Exfoliative cheilitis is an uncommon lip lesion usually of great concern to the patient and quite refractory to treatment. The available literature was surveyed, and 3 cases have been described to illustrate various aspects of the condition. The difficulty of treating such lesions has been discussed, and a proposition put forward that the lesions are of a factitious nature.
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ranking = 2
keywords = factitious disorder
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