Page 24 - Delaware Medical Journal - May/June 2020
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CASE REPORT
symptoms as well and should also be considered in the differential diagnosis. This disorder now exists in DSM-5 in the spectrum and other psychotic disorders, as “delusional symptoms in the partner of an individual with delusional disorder.” However, this disorder cannot explain
the physical signs of scratches, cuts, and bruises the patient had that were reported by the family.
Alternatively, Munchausen syndrome by proxy may explain this particular case. According to the DSM-5, the diagnosis requires demonstrating that the individual is taking covert actions to misrepresent, simulate, or cause signs and symptoms
of illness or injury. These actions can include exaggeration, fabrication, simulation, and induction. In this case,
and clear line of deception. However, the patient’s mother may have been inducing false beliefs in the boy to gain sympathy and importance for herself. For example, she had been meeting with demonologists, doctors, and paranormal teams. This possibly gave her an opportunity to feel
CONTRIBUTORS
■ OMAR ALI SHAH, MD is a psychiatric resident at Delaware Psychiatric Center located in New Castle.
■ MARY E. DIAMOND, DO, MA, MPA is a board- certified child and adolescent psychiatrist
with the Department of Services for Children, Youth and their Families. She has also been a candidate for Adult and Child Psychoanalysis at the Psychoanalytic Center of Philadelphia.
■ GERARD GALLUCCI, MD, MHS is the Director of Residency Education for the Delaware Psychiatry Residency Program and Director
of Healthcare Integration for the Delaware Department of Health and Social Services.
important and gain attention. The patient had reported he had been scratched and hit by demons. There exists the possibility that the patient’s mother induced those injuries as well and told the patient it was a demon.
The patient’s mother was overly concerned about the boy during our meetings. The patient’s symptoms had
not been witnessed by hospital and clinic staff. They were reported by his mother. His reported seizures were not consistent with the neurologist’s diagnostic tests, including the EEG. The patient did not experience paranormal activities at the child center or during his hospitalizations. Although it seems very plausible that
the mother had been inducing her son’s
patient’s mother was deliberately inducing symptoms in the patient.
A more plausible explanation is that the family and patient truly believed they were experiencing paranormal activity. They strongly believed that the boy’s signs and symptoms were explained by this
REFERENCES
paranormal activity. This was ascertained by their self-reports and their seeking the support of priests, demonologists, and paranormal-activity investigative teams. The family had made plans to have the patient participate in an exorcism ritual. At times, the family felt it was necessary to keep the boy away from home to protect him from the angry entities. In fact, this need was met at the time, by bringing the boy to the crisis center. These behaviors and beliefs seem to support a situation consistent with folie à famille, although elements of Munchausen syndrome by proxy are also present.
CONCLUSION
diagnosing a patient who exhibits elements of Munchausen syndrome by proxy and folie à deux. The diagnosis
is further complicated when the patient and his mother attribute his condition to paranormal activities and the belief in these experiences is shared by a broader family network.
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