Page 23 - Delaware Medical Journal - May/June 2020
P. 23
CASE REPORT
RISK FACTORS FOR MUNCHAUSEN SYNDROME BY PROXY (FACTITIOUS DISORDER IMPOSED ON ANOTHER) AND FOLIE À DEUX OR FOLIE À FAMILLE (DELUSIONAL SYMPTOMS IN PARTNER OF INDIVIDUAL WITH DELUSIONAL DISORDER) IN THIS CASE:
The family were devout protestants. Some literature suggests religiosity is positively correlated with paranormal beliefs.
The patient continued to live in an environment that helped foster paranormal beliefs due to shared beliefs of other household members.
The patient had a history of emotional and physical abuse by his stepfather at the age of 9.
The patient had a history of sexual abuse. He reported being abused by staff at an inpatient psychiatric facility.
The patient was socially withdrawn. He was home-schooled since age 10 and thus had fewer interactions with same-age peers and other children and adults outside his family.
The patient refused treatment, including medication, because he believed his symptoms were due to paranormal activities and that he did not need treatment.
The patient had three psychiatric hospitalizations in the past year.
Family psychiatric history: Anxiety in mother and bipolar disorder in father.
about body image. The patient’s family endorsed the belief related to the paranormal activity and strongly believed related to these experiences in the home. They stated there were eye-witness accounts of the occurrences, received the support of priests, demonologists, and paranormal-activity investigative teams. They said they had video evidence of the paranormal activity.
A review of family history indicated that the patient’s mother had received
a diagnosis of anxiety disorder and the patient’s father had a possible history of bipolar disorder.
The patient resided with his family, including his mother, maternal grandmother, and three male siblings (ages 19, 11, 2).
The patient had a history of physical, sexual, and emotional abuse by the mother’s boyfriend.
The patient denied any history of substance abuse.
several episodes of head injury resulting in concussions, although neurological exams and imaging did not identify any brain injury.
During the course of the past year,
the patient was hospitalized on three occasions. Medication trials included the use of Abilify, Lexapro, Wellbutrin, and Seroquel.
At the time of admission, the patient was being treated with Vistaril for anxiety. His family and he refused more medications although his symptoms had been getting worse.
DISCUSSION
Shared psychotic disorder is mostly observed among people who live in close proximity and in close relationships.6 It is found in parent-offspring, sibling-sibling, or husband-wife relationships. Rarely,
all the family members share the same delusions, and this is called folie à famille.
diagnosing psychiatric illness in persons who believe they are experiencing paranormal activities. This was a 12-year- old boy who had several risk factors that made him vulnerable for having elements of Munchausen syndrome by proxy and folie à deux. Client characteristics are shown in the table above. The boy’s family described themselves as Protestant
Christians who lived in a small town near a metropolitan city. Several studies support a positive correlation between strong religious beliefs and paranormal beliefs.7-10 The family reported that the boy had anger outbursts, labile mood, and aggression directed at them recently because he was discouraged about being “possessed.” During the interview
at time of admission to hospital, the
boy denied any psychiatric symptoms and did not display characteristics of anxiety and/or depression. There was no history of psychosis or other psychiatric conditions that could possibly explain his experiences.
Perhaps, folie à deux, described as a shared psychotic disorder which appears in DSM-IV as a separate disorder,
could help explain some of the patient’s
Del Med J | May/June 2020 | Vol. 92 |
No. 3
119
