Additional Aspects

I would like to point out the following additional aspects to the article (1):

• Factitious disorders also exist in children and adolescents (2). Libow found eight years to be the lower age limit (3). Stein et al. describe a 10-year-old boy whose symptoms were first reported at the age of four (4). This was followed by eight episodes of painful macrohematuria with intensive diagnostics before it was discovered that he had inserted foreign bodies into his urethra.

• Recognizing a pseudologia phantastica, even one with no medical context and even if it is not pathognomonic as a symptom on its own, can make it easier to convert the differential diagnosis of Munchausen syndrome into a suspected diagnosis.

• Non-confrontational treatment of a patient despite a confirmed diagnosis can make work with relatives more difficult. The same applies to the final report: once a diagnosis has been confirmed, it should be communicated to the relatives and in the final report, thereby avoiding continuing any unnecessary doubts about the diagnosis as well as (if possible) any further, non-indicated interventions.

• If Munchausen syndrome is diagnosed, the treating team members can feel that the patient has deceived them, which can lead to disappointment and anger. These feelings need to be reflected upon, to allow for appropriate follow-up.