A forensic case of Munchausen's syndrome

Self-Embedding Behavior in Adults: A Report of Two Cases and a Systematic Review

Self-embedding behavior (SEB) is the repeated insertion of sharp objects, such as needles or pins, into the soft tissues of abdomen, limbs, and other body parts. In this study, two cases of SEB were reported and the scientific worldwide literature reviewed. Thirty-two cases of SEB were identified through systematic searches in the main bibliographic databases. Mean age was 35 years (SD = 8.97). Just over two-thirds of the patients were female. Although the number of embedded objects could be as high as 200, major clinical and surgical complications were uncommon and mortality was null. Patients with SEB presented three major diagnoses: psychotic (25%), personality (21.9%), and factitious (28.1%) disorders. The practice of SEB largely went undetected as the patients themselves did not bring it to the attention of family members or physicians and usually denied they have engaged in SEB. A high level of suspicion is required to avoid a missed diagnosis.

Made up by makeup--A case report about an exceptional kind of self-inflicted "injuries"

BACKGROUND

Self-inflicted injuries are a known, but challenging topic in the healthcare sector and the judicial system. Therefore, differentiation of these injuries from a third-party-interference is crucial in the field of forensic medicine. However, self-painted injuries with makeup, which entail misleading of medical staff and the administration of justice, have apparently not been described in the literature so far.

CASE

A case of a rare kind of victim role staging in a 26-year-old Caucasian woman in the field of forensic medicine is presented. She supposedly had been robbed and harmed by two unknown men. The forensic examination revealed subjective symptoms and objective findings, such as skin discolorations appearing as fresh bruises. However, a closer look revealed makeup. After removal, no injuries were seen.

CONCLUSIONS

Awareness of the existence of exceptional cases of victim role staging is essential in the daily routine of healthcare, judicial and forensic professionals. Therefore, a questioning attitude within the physical examination as well as proper assessment of objective findings is crucial. Furthermore, the importance of an interdisciplinary approach of possible factitious disorders is demonstrated. The sensitization may exclude a third-party-interference, prevent damages to the health care system, avoid misleading of the administration of justice, and, therefore, reduce socioeconomic costs. Moreover, the recognition may enable adequate interventions and provide patients with professional help.

Munchausen's Syndrome in Plastic Surgery: An Interdisciplinary Challenge

Munchausen's syndrome is a rare psychiatric disease. We report a case in which we have collaborated with the psychiatrist for the diagnosis and also propose a diagnostic flowchart.