DECEMBER 2020 |Â NEWSLETTER #1
FACTITIOUS DISORDERS
BY PSYCHOLOGY ENTHUSIASTS' CIRCLE
Nocebo Effect 01 Somatoform Disorder 04 Cyberchondria - COVID-19 08 Medical Students Syndrome 12 Doctor shopping 17 Munchausen Syndrome by proxy on child abuse
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NOCEBO EFFECT By Jasmine Chan Optimism and pessimism are not merely attitudes. Self-fulfilling prophecies are not at all uncommon. Personal expectations could lead the body to fabricate factitious sensory perceptions that should not be present otherwise, and these conditions are so notorious they are even given names—the placebo and nocebo effects.
1# RETTELSWEN Causes of the Nocebo effect Negative expectations are associated with the production of neurotransmitters that increase one’s sensitivity to pain and other symptoms. What creates negative expectations on treatments could cause the nocebo effect. 1. Personal perceptions and anxiety Healthcare beliefs about the effects of certain drugs, perceived sensitivity to adverse effects and severity of one’s conditions, and level of anxiety could affect perceptions on treatments.
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For instance, some are doubtful about the side effects of statins, a drug that lowers cholesterol and the risk of heart attacks and strokes. A study at Hammersmith Hospital asked 60 patients, who had come off statins due to side effects, to take no pills, dummy pills, and actual statins over a period of time. Compared to taking statins, the patients rated the symptoms to be on average half as bad when taking no pills, but the scores were similar when they took dummy pills they thought were statins. 2. Healthcare experiences Healthcare professionals need to inform patients about their conditions and details of their treatments, yet patients are more likely to experience adverse effects discussed with them. They are also more prone to experiencing negative side effects if they have had negative healthcare experiences previously.
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3. Media coverage Much health information is broadcasted by traditional media, or available online. Social media, online forums, and the opinions of friends and family could shape perceptions about treatments. In 2007, negative media coverage in New Zealand about the changes in formulation of Eltroxin tablets was followed by a significant increase in reports of adverse reactions caused by them. However, only the manufacturer and appearance of the pills were changed, not its active component. The nocebo effect also extends beyond the context of healthcare experiences. News was spread about a “wind turbine syndrome� by anti-wind farm campaigners in Australia in 2010, and reports about symptoms were found to be concentrated in regions with a history of antiwind farm campaigning. Experiments also found out that people were more likely to report an increase of symptoms when assigned to watch news about the harms of wind farms.
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The nocebo effect and COVID-19
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Data about nocebo effects amidst the pandemic is not yet available, though they are suspected to be present. The unexpectedness of the pandemic, negative mass media coverage, lack of information and treatments, and perceived high level of contagion risk could cause people to develop a negative outlook on the situation. Quarantine measures and social distancing have also induced negative emotions such as confusion, anxiety and anger. It is possible that symptoms are amplified due to these factors. The more extreme case of “voodoo death�, which prolonged stress and fear could paralyse vital functions and lead to death, is also probable. However, the severity of nocebo effects could vary from region to region due to culture. For example, preliminary research found out that old German men were less afraid of the coronavirus than younger men. People of different cultures could also perceive news about the virus and cope with it differently.
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Strategies that mitigate nocebo effect. Although some studies show that negative side-effects of treatments are lower when patients are not told about them, it is still important we fully understand our health risks before treatments. Governments could set up means of emotional support to help reshape risk perception in the possibility of large-scale nocebo effects such as the current pandemic. On the individual level, we could limit negative media consumption, and be vigilant of our own thoughts and feelings to make reasonable expectations.
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References: Amanzio, M., Howick, J., Bartoli, M., Cipriani, G. E., & Kong, J. (2020). How Do Nocebo Phenomena Provide a Theoretical Framework for the COVID-19 Pandemic? Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2020.589884 bpacnz team. (2019, August 30). The nocebo effect: what is it, why is it important and how can it be reduced? The nocebo effect: what is it, why is it important and how can it be reduced? - bpacnz. https://bpac.org.nz/2019/nocebo.aspx Gallagher, J. (2020, November 15). Most statin problems caused by mysterious 'nocebo effect', study suggests. BBC News. https://www.bbc.com/news/health-54951648 Howick, J., & Ongaro, G. (2020, December 2). Coronavirus: could reading about the pandemic cause harm? The Conversation. https://theconversation.com/coronaviruscould-reading-about-the-pandemic-cause-harm-135585.
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SOMATOFORM DISORDER By Christine Pang What is Somatoform Disorder? Somatoform disorder (SFD), also known as somatic symptom disorder, is an illness of one’s somatic and psychological behaviour. Patients with this disorder tend to have a significant, or even intemperate focus on their physical symptoms.
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They are often overly sensitive towards normal bodily sensations, react with low tolerance to bodily discomfort, and interpret them very quickly as evidence of a serious disease. However, the physical symptoms that patients with SFD manifest cannot be fully explained by a general medical condition, nor other mental illnesses. Nonetheless, the physical symptoms that patients with SFD experience causes distress, regardless of whether their physical symptoms can be medically elucidated or not. The torment they undergo causes them to become more worried about their health, thus leading to the vicious cycle of frustration over one’s physical and mental health.
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Relationship between the influences of COVID-19 and Somatoform Disorder With the outbreak of the worldwide pandemic, the global public has entered an emergency of health. While tests of COVID-19, preventive measures, and vaccines are the major concerns of the general public, one’s somatic and psychological needs are often neglected under such agitated circumstances in which our daily lives are disrupted in all political, economic, and social aspects.
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An example would be from the US National Library of Medicine – National Institutes of Health. In a clinical case of a 16-year-old adolescent, he was presented with a history suggestive of COVID-19 infection and associated psychological distress. Physical symptoms like having a fever up to 38.7 °C lasting longer than 3 days, his heart rate being up to 130 beats per minute (bpm), and having breathing difficulties were delineated. Despite testing negative for the presence of COVID-19, his extreme and persisting health preoccupations required an inpatient admission to the Child and Adolescent Neuropsychiatric Unit. Based on his medical history and current presentation, he received a diagnosis of SFD.
06 Vulnerable individuals have been significantly affected by the pandemic. Those with SFD or other mental illnesses may experience severe psychological distress when they find themselves having symptoms of COVID-19, such as fever, coughing, fatigue, and other flu symptoms. Their pre-existing mental health vulnerabilities and their fear of catching the virus lead to increasing anxiety, somatic, and obsessive symptoms, thus exacerbating their underlying mental distress like depression and dysfunctional eating behaviour.
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Somatoform Disorder and Daily life Their pre-existing mental health vulnerabilities also cause them to face chronic problems that affect their daily life. At work, those with SFD may persistently take sick leaves, leading to unsatisfactory work performance and unemployment. Besides, their interpersonal relationships may be limited. Since most cultures would rather the “ill person” to “take a rest” during the period of convalescence by lessening social activities, patients with SFD may result in social withdrawal. They may also find the management of home difficult, like cleaning the house and cooking meals for their family members, as they lack the mental concentration and have perceived physical incapacitations. How to diagnose the Somatoform Disorder? The instruments available for diagnosing SFD differ according to their main diagnostic purpose of assessment. There is a broad agreement that mere self-description by patients themselves are not sufficient for making a diagnostic decision, as they often differ with the actual condition of the patient. Experts’ ratings are required to make a reliable and valid diagnosis. A number of approaches using structured interview guidelines or checklists have been developed for this purpose, like the Structured Clinical Interview for DSMIV(SCID) (6,7), and the Composite International Diagnostic Interview (CIDI). Both instruments cover most major mental disorders and include a separate section on SFDs. Within this section, the criteria for each individual SFD diagnosis can be evaluated.
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However, when conducting studies on larger communities and clinical populations, self-rating instruments can facilitate the identification of subgroups which are likely to be diagnosed with SFD. Although these instruments are not considered precise enough to make a final diagnostic decision about the presence of a specific SFD, such screening methods can help to identify potentially ‘negative cases’, hence making the diagnostic process more efficient and effective.
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Treatments of Somatoform Disorder Possible treatments include Cognitive Behavioural Therapy (CBT), medication, in particular tricyclic antidepressants, and applying for consultation to the primary care physician. Out of all the options, CBT, a gradual process that helps one to take incremental steps towards a behavioural change, has been concluded as the best established treatment for SFD. CBT can help to examine and adapt one’s beliefs and expectations about health and physical symptoms, as well as figuring out ways to cope with physical and psychological distress by finding the underlying causes, so as to improve one’s daily functioning at work and in social situations.
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References: Colizzi, M., Bortoletto, R., Silvestri, M., Mondini, F., Puttini, E., Cainelli, C., … Zoccante, L. (2020). Medically unexplained symptoms in the times of COVID-19 pandemic: A case-report. Brain Behav Immun Health, 5, 100073. https://doi.org/10.1016/j.bbih.2020.100073
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Hiller, W., & Janca, A. (2003). Assessment of somatoform disorders: a review of strategies and instruments. Acta Neuropsychiatrica, 15, 167–179 Sumathipala, A. (2007). What is the Evidence for the Efficacy of Treatments for Somatoform Disorders? A Critical Review of Previous Intervention Studies. Psychosomatic Medicine, 69(9), 889–900. https://doi.org/10.1097/psy.0b013e31815b5cf6
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CYBERCHONDRIA COVID-19 By Cherie Lau Have you ever fallen ill and, instead of consulting a doctor, turned to Google for a diagnosis? Did serious diseases turn up, such as brain tumours, heart disease, and multiple sclerosis? Were you alarmed, or even anxious? If so, you may have suffered from cyberchondria. As COVID-19 continues to spread worldwide, many are frantically searching for answers to their seemingly innocuous symptoms on the Web. This practice, however, may lead to unfounded health anxiety, heavily disrupting daily life.
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The term "cyberchondria" was first coined by Microsoft researchers in 2008, being defined as "the unfounded escalation of concerns about common symptomatology, based on the review of search results and literature on the Web" (White & Horvitz, 2008), although the article's focus was on unlikely or rare disorders, rather than a pandemic. Cyberchondria can be conceptualized as belonging to the broader category of health anxiety or hypochondriasis, but limited to anxiety brought about by the Web. Sufferers' common, harmless symptoms, such as coughing due to seasonal allergies, may be escalated to worries about rare, severe illnesses, such as throat cancer, due to how search engines and medical websites list potential diagnoses — with the most serious diseases being the most eye-catching and alarming.
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The issue of cyberchondria is particularly pertinent in 2020, since the use of the Internet as a medical source of information has risen in most cultures alongside rising rates of Internet access. The current COVID-19 pandemic, and the cultural fear associated with it due to coverage of COVIDrelated information by mass media, may also compel people to search for answers online. In a cultural context, cyberchondria is most likely to occur in cultures that have widespread Internet access, providing a wealth of immediate medical information on the Web; as well as having lower availability of healthcare, such as the U.S., where it is costly for the average citizen, whom may decide to self-diagnose through medical websites instead. Currently, studies conducted on cyberchondria cover a diverse range of countries and cultures, such as the UK (Tyrer, 2020), Romania (Maftei & Holman, 2020), Australia (Newby & McElroy, 2020), and Germany (Jungmann & Witthöft, 2020), showing that it is a significant cross-cultural issue. There are several demographic risk factors positively associated with cyberchondria amongst the COVID-19 pandemic, as identified by a study conducted by Alexandru Ioan Cuza University - namely "neuroticism, age, and being female" (Maftei & Holman, 2020). Neuroticism "reflects the tendency to experience negative emotions, cognitions, and maladaptive behaviors” (Bajcar & Babiak, 2020) — as such, people higher in neuroticism are more likely to experience irrational and unfounded anxiety, and thus likely to perform more searches concerning symptoms. Advanced age makes people more prone to experiencing cyberchondria, as mass media often propagates the fact that the elderly are most vulnerable towards COVID-19. The study makes no mention of why females are more likely to suffer from cyberchondria, however.
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Regardless of demographics, the psychological phenomenon of judgement biases causes people to base the likelihood of online diagnoses on the order in which they are ranked in search engines, as well as the perceived severity and rarity of listed health problems (White & Horvitz, 2008), thus worsening cyberchondria for subsequent Web users as search engine optimization increasingly prioritizes more concerning diagnoses. The paper considers two biases: baserate neglect and the availability bias, both causing cyberchondriacs to be biased towards the worst-case scenario — in the case of COVID-19, the most serious complications, or even death.
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Although it is not abnormal to worry about being infected by COVID-19, as well as searching for information online, while the pandemic is still ongoing, the line between normal worries and pathological health anxiety is crossed when the worry causes significant disruption to daily functioning. For example, when the anxiety prevents one from performing daily tasks normally, it may be cause for concern. Cyberchondria also has wider impacts on society, especially as it can burden already-overloaded healthcare systems when cyberchondriacs obsessively pursue medical diagnoses at hospitals and clinics. Due to the COVID-19 pandemic, conventional methods for treating health anxiety such as in-person psychological consultation may not be applicable. However, it has been found that internet-delivered cognitive-behavioural therapy (iCBT) improves cyberchondria (Newby & McElroy, 2020). The study considers pre-existing iCBT strategies for health anxiety, applying it to the treatment of cyberchondria during the COVID-19 pandemic. As Internet access is a prerequisite to suffering from cyberchondria, therapy offered through the Internet is a feasible and effective solution to cyberchondria.
11 In conclusion, the issue of cyberchondria and increased health anxiety has become especially important in light of the COVID-19 epidemic. Cyberchondriacs are not to be overlooked, despite the prevailing problem of patients actually infected with COVID-19. Psychological factors, such as biases, and cultural factors, such as traditional beliefs about health, must be taken into consideration to better treat cyberchondria and alleviate health anxiety. References Jungmann, S. M., & Witthöft, M. (2020). Health anxiety, cyberchondria, and coping in the current COVID-19 pandemic: Which factors are related to coronavirus anxiety? Journal of Anxiety Disorders, 73, 102239. https://doi.org/10.1016/j.janxdis.2020.102239
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Maftei, A., & Holman, A. C. (2020). Cyberchondria During the Coronavirus Pandemic: The Effects of Neuroticism and Optimism. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.567345 Newby, J. M., & McElroy, E. (2020). The impact of internetdelivered cognitive behavioural therapy for health anxiety on cyberchondria. Journal of Anxiety Disorders, 69, 102150. https://doi.org/10.1016/j.janxdis.2019.102150 White, R. W., & Horvitz, E. (2008, November). Cyberchondria: Studies of the Escalation of Medical Concerns in Web Search. Microsoft Research. https://www.microsoft.com/enus/research/publication/cyberchondria-studies-of-theescalation-of-medical-concerns-in-web-search/ Tyrer, P. (2020). COVID‐19 health anxiety. World Psychiatry, 19(3), 307–308. https://doi.org/10.1002/wps.20798 Bajcar, B., and Babiak, J. (2020). Neuroticism and cyberchondria: The mediating role of intolerance of uncertainty and defensive pessimism. Personal. Individ. Diff. 162:110006 https://doi.org/10.1016/j.paid.2020.110006
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MEDICAL STUDENT SYNDROME By Ivy Wong Do you dream of being a doctor? In SPCC, you can’t swing a cat without hitting someone who’s considered med school at some point in their life. We’ve all heard the horror stories: sleepless nights, mountains of lectures, struggling through projects and exams. But have you heard of ‘Medical Student Syndrome’? Sounds terrifying, doesn’t it? Well, it’s something like a combination of ‘self diagnosis’, ‘nosophobia’, and ‘hypochondriasis’. Don’t worry, these terms aren’t as intimidating as they sound. Let’s talk about Medical Student Syndrome!
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What is it? ‘Medical Student Syndrome’ is the name given to a condition frequently reported in medical students, usually when they start learning about diseases and diagnosis after the first year , hence the alternate names: ‘second year syndrome’, ‘third year syndrome’, ‘intern’s syndrome’, etc. In Psychology Today, it’s defined as ‘hypochondria-related disorders relating to the medical conditions they are studying educationally and/or vocationally’. In the same article, it cites Dr Baars’ book In The Theater Of Consciousness, which cheerfully denotes: ‘Medical students who study frightening diseases for the first time routinely develop vivid delusions of having the ‘disease of the week’ – whatever they are currently studying.’ Essentially, medical students often develop fears and delusions that they have contracted whatever disease they’re studying, fueled by the detailed descriptions and case studies from their lectures, notes, and textbooks. This then leads to excessive worrying, trips to the doctor, and an overwhelming sense of relief when they realise the truth, only for the cycle to begin again when the professor moves on to the next disease.
13 As a student blog from Imperial College UK describes with a charming anecdote about thyroid conditions, a student learns about a condition in a lecture, and is instantly struck with fear over the possibility that they themselves have this condition.
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After being taught about the presenting symptoms (feeling hot, palpitations, hyperactivity, anxiety, insomnia, fatigue, weight loss…) students begin to diagnose themselves with an overactive thyroid……“Gosh, I am glad I booked that GP appointment,” they remark, “an under-active thyroid explains all of my problems… I do get tired sometimes, and I occasionally need an extra jumper because of the cold, and I have gained a little weight.” Musing on the way home, they begin to consider that they might have symptoms of both an over and under-active thyroid. Perhaps they are the first person to have this they explore, perhaps they could write an article in a journal about it. The next day whilst studying the biochemistry of thyroid disease they begin to realise that perhaps their thyroid is normal (as it’s not possible to have both an over and under active gland at the same time). They sensibly cancel the GP appointment, only to regret it during the next lecture, when they self-diagnose diabetes. This hilarious story quite deftly illustrates the poor plight of medical students everywhere: Having learnt of a disease, they become hyper aware of every little sensation, every ache and pain and every tiny little thing gone wrong with their body. And thus, all of these add up to make it seem as if alas! They have contracted some terrible disease! Such self diagnosis is the main contributing factor to the overwhelming number of students who suffer from Medical Student’s Disease every year. But why? Why do they diagnose themselves so? Why?? As medical students, they study medicine. What a groundbreaking revelation! However, that also means that they are exposed to far more knowledge about various diseases and conditions than us plebeians are, and usually in far greater detail. Thus, they know far more about the ins and outs of the disease than we do. Knowing all these little details, as well as all these horrifying possible results, they develop a fear that the slight ache in their back could hint at a life-threatening disorder, thus incentivising them to get it checked out ASAP.
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In a way, Medical Students Syndrome overlaps with both nosophobia and hypochondriasis, although some academics disagree with the latter. Nosophobia is the extreme fear of developing a disease, usually a well known and potentially life threatening one. This leads to frequent health checkups, and a persistent feeling of worry even after these checks. See the resemblance to the Medical Student Syndrome described above? It differs from hypochondriasis in that it is specific to one particular condition, whilst hypochondriasis is a generalised fear of illnesses. As to where exactly Medical Student Syndrome falls here, I’ll let you decide.
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How seriously should we take it? People tend not to take Medical Student’s Syndrome very seriously. The doctors who check over medical students have most likely had this brief panicky period themselves, and know that usually, usually, ’tis just the student’s overactive imagination and worry. However, a few special cases do arise here and there. In a 2013 article by Dr Barron Lerner, he details how although MSS was generally met with eye-rolls and halfsarcastic quips, two of his classmates turned out to be seriously sick. Cam, who had been experiencing symptoms for quite some time, was met with a doctor who was ‘a little dismissive’, but was confirmed to have myasthenia gravis, a neuromuscular disorder that causes weakness throughout the body, especially the eyes and eyelids. To this day, Cam experiences periodic “low level eye weakness,” but it does not interfere with his ability to work as an infectious diseases specialist. Another student, Mike, had a story with a twist. Unaware that he was ill, a blood-cell count test in class alerted both him and the professor to his iron-deficiency anemia, caused by blood loss, most likely from his intestines. Unable to detect the source of the loss, he finished the semester without a diagnosis, and later found that the source was a cancerous mass in his abdomen. Luckily, it was removed and he survived to become a general internist.
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While there may only be one or two of these “actual diagnosed students” in every cohort, their problems could have been detected and solved earlier if they had been taken more seriously. One or two every cohort is no small number in a cohort of a few hundred students each year. However, with the issue of Medical Student Syndrome still being quite present, is it ethical to have physicians perform every test possible when a student complains of feeling ill?
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Yes. The answer is yes. As from the example from the blog above, most students come to their senses and make the logical conclusion that no, they’re overthinking it, and they’re fine. Those who visit the doctors are either seriously worried, in which case the doctor’s visit will probably bring them great psychological relief, or they’re seriously feeling unwell. Although MSS is a real phenomenon in med schools, why shouldn’t doctors take the time to really listen to students when they complain of feeling poorly? Impact: In the age of the internet, information is readily accessible at our fingertips. Websites like the famously hilarious WebMD will overdiagnose you at the click of a button, allowing you to believe that your headache really means cancer, or that the bruise on your elbow means cancer, or the diarrhea you’ve been having means cancer, or… well, you get the idea. With how widespread information is nowadays, it’s quite easy for people to, not unlike medical students, develop a persistent fear of having a specific disease. (refer to article on Cyberchondria) But how does Medical Student Syndrome specifically impact us, the med students, and society as a whole?
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At its core, a doctor’s job is to diagnose a patient, prescribe them meds/treatment, and basically start them on their journey to recovery. It’s straightforward...ish. What a doctor can learn from their brief stint with MSS is this: an analytical eye, critical thinking, and empathy. After having once selfdiagnosed themselves with a myriad of problems, they’ll know that ah, yes, this headache is probably not cancer, as none of the other symptoms have presented! This lady probably doesn’t have that disease, because although she suffers a few symptoms, they’re common symptoms of aging, and she’s not at a genetic risk! Etcetera etcetera! Their experience with MSS lends them a new critical lens from which to view patients, allowing them to make better diagnoses. More important, empathy. Having gone through the worry and stress of possibly having a disease with MSS, these doctors are more able to empathise with the patient and their fears, to be able to comfort them and reassure them, and to deliver news, good or bad, in a more soothing manner. Empathy is one of the key features of being a doctor, as in order to care for a patient, you must connect with them emotionally as well as understand their sufferings.So what have I told you here? Medical Student Syndrome is a common condition seen in medical students all around the world. But maybe, just maybe, it can teach us all a valuable lesson, and change the world for the better.
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References: Griffiths, M. D. (2016, September 29). A Brief Look at Medical Student Syndrome. Psychology Today. https://www.psychologytoday.com/us/blog/inexcess/201609/brief-look-medical-student-syndrome.
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Lerner, B. H. (2013, September 5). When Med Students Get Medical Students' Disease. The New York Times. https://well.blogs.nytimes.com/2013/09/05/when-medstudents-get-medical-students-disease/ Raypole, C. (2019, May 21). Nosophobia, or Fear of Disease: Diagnosis, Treatment, More. Healthline. https://www.healthline.com/health/nosophobia Trenchard, L. (2016, August 20). Medical Student Syndrome. Student blogs. http://wwwf.imperial.ac.uk/blog/studentblogs/2016/08/20/medical-student-syndrome/.
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DOCTOR SHOPPING By Heather Lo
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Factitious disorder is a serious mental disorder in which someone deceives others by appearing sick, by purposely getting sick or even by self-injury (Lo & Ma, 2020). The word “factitious” is derived from the Latin word “Facere”, meaning “to make”. Patients with factitious disorder may exaggerate their physical symptoms, provide fabricated medical history or reports. Patients with factitious disorder often engage in a behaviour called “doctor shopping”. This refers to the situation when a patient visits 15 or more doctors in order to seek different prescriptions without professional referral. One of the reasons why patients with factitious disorder engage in doctor shopping is that they want to play the role of a sick person. Because their medical history and symptoms are fake or made up by the patient, doctors are not able to find reasons to explain the patient’s symptoms. The patient keeps on finding different doctors to draw their attention to their health. By approaching different doctors (that is, doctor shopping), the patient can receive continuous care and can carry on playing the role of a sick person. That’s why and how factitious disorder promotes doctor shopping.
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The behaviour of doctor shopping can create a lot of serious impacts on patients with factitious disorder. The two main impacts are delay of treatment to factitious disorder and the risk of self-harm. Factitious disorder is not easily identified by doctors. Therefore, the doctor may be tricked by the patient and can only direct his treatment according to the symptoms the patient reported. This may also delay treatment for mental illness itself. Doctor shopping behaviour may also increase the risk of self-harm. Some patients may harm themselves to enhance the authenticity of the medical symptoms (for example, getting their leg hurt) in order to trick the doctor. In view of the above serious impacts, we should increase the awareness of this behaviour. Sources: Cleveland Clinic medical professional. (2020, November 19). Munchausen syndrome: Symptoms, Treatment & Definition. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9833munchausen-syndrome-factitious-disorder-imposed-on-self. Mayo Clinic Staff. (2019, December 14). Factitious disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/factitiousdisorder/symptoms-causes/syc-20356028.
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MUNCHAUSEN SYNDROME BY PROXY ON CHILD ABUSE By Tina Liu
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Talking about the term “child abuse”, I believe every one of us can recall some reported cases related to it. But have you ever considered that mental health issues is one of the major pushing factors behind child abuse? An example of this will be Munchausen syndrome by proxy. Before we move on to how it promotes child abuse, let me present to you what exactly Munchausen syndrome is. What is Munchausen syndrome by proxy? Munchausen syndrome by proxy (MSBP), or medical child abuse (MCA), refers to “an individual who falsifies or induces illness in another person to accrue emotional satisfaction”.
In cases of child abuse, children are the usual victims while the parents act as the perpetrators. Although the root causes of MCA are yet to be determined, doctors believed that the abuser was encouraged by the attention and care they got from having a sick child. Abusers will then intentionally lie about the child's symptoms, exaggerate a medical problem, or even do physical harm to the child to “obtain” symptoms. Unfortunately, child abuse caused by MCA is both hard to detect and cure, as the abusers themselves does not neccessarily see their behaviour as harmful.
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What are the potential complications of MCA on the victim? Children who are abused by caretakers with MCA can develop multiple illnesses or injuries, while some of these can be life-threatening. Under situations of being injured by their caretakers to produce a certain symptom, children can be subjected to painful and frightening medical procedures which they do not need. For example, a mother insisted that her children must be treated for hyperactivity disorder, although there is no evidence to make the diagnosis. In some extreme cases, the abuser may even starve or suffocate his or her child on purpose during hospitalization. As a result, children may experience depression and anxiety for many years after they grew up, hence developing MCA themselves as well.
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Rare and hard to detect, what can we do? 1. From the perspective of observers As it is very difficult for us to identify people with MCA and there is no way to predict who will develop MCA, whenever there are typical symptoms found on others (especially parents) such as insisting the child being sick, having a large history of visiting many different doctors or health care facilities, and unusual eagerness in having medical tests, the chances for them to have MCA is high. When encountering cases like this, prevent confrontation of the suspected caretakers directly but reach out for the help of professionals. There are various things that we can do, for example, reporting your concerns to a child welfare agency, or contacting Childhelp National Child abuse hotline, to help avoid another case of child abuse of MCA. 2. From the perspective of patients Once you found yourself developing the warning signs of MCA or are now suffering from other personality disorders badly such as borderline personality disorder, seek psychiatric counselling immediately before harming yourselves for others. Do not try to refuse the fact of having MCA or resist treatments, as there are many therapies which can effectively help you out. If you voice out for help at once and listen to doctors’ instructions, there will still be opportunities to cure MCA completely.
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Controversies over Munchausen syndrome by proxy The concept of Munchausen syndrome by proxy was first described by an English paediatrician Roy Meadow in 1977, regarding it as “a form of child abuse played out in the medical setting�. However, as this term began to grow increasingly popular, Roy Meadow pointed out that some social workers and legal professionals had misunderstood or overused this concept, in an article published in 1995. In the report, he reviewed many problematic parenting behaviours that have been mistakenly considered as MSBP. His work was also preceded by two other articles which highlighted the diagnostic misunderstandings and MSBP look-alikes. As evidenced in these papers, the label of Munchausen syndrome by proxy or some warning signs of it could be easily misapplied in many situations. Even nowadays, the definition of Munchausen syndrome by proxy remained to be controversial and argued over courts. Mothers who were accused of having MSBP and mistreating their children had been encountering legal battles and forced into contentious struggles with legal professionals and child protection services, hence sometimes resulting in a false accusation. Conviction cases on innocent The lack of statute acknowledgment and controversial definitions of Munchausen Syndrome by proxy led to confusion or struggles in law enforcement and courts, resulting in cases of a false accusation of the innocent. In the year 1999, because of the biased evidence provided by Roy Meadow, a lawyer named Sally Clark was wrongly convicted of murdering her sons. Under the false figure given by Meadow, Clark was sent to jail. But the truth is only revealed after the Royal Statistical Society recalculated the true odds.
22 After the cause of death of the two children was found, Clark was released in January 2003. Unfortunately, she died from alcohol poisoning after suffering from catastrophic trauma of the experience. Apart from Sally Clark’s case, Meadow was also involved in several other cases resulting in innocent mothers being imprisoned. The mothers in those cases were wrongly convicted of murdering two or more of their children and had already been imprisoned for up to six years. Despite the seriousness of MSBC, experts have widely overestimated the dangerousness of MSBC mothers, and whipping up fears about MSBC mothers is typical. Most of the time, experts often exaggerate about some terrifying things that MSBP mothers have done to their children; while these stories are sufficient enough for a judge to order a child into protective custody, even without an assessment of the mother. And once in custody, it will be extremely difficult for the innocent mother to get back her child.
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Conclusion In conclusion, Munchausen syndrome by proxy is an extremely serious mental disorder and is a type of child abuse. We should not tolerate the behaviour of MSBP and reach out for help if we encounter such disorder, we are doing this not only to end the sufferings of the children, but also to give help to adults who have MSBP. Reference Feldman, M. (2020). Dr. Marc Feldman's Medical Deception Resources. Munchausen. https://www.munchausen.com/. Monroe, J. (2020, June 3). The Facts About Munchausen by Proxy Syndrome. Newport Academy. https://www.newportacademy.com/resources/mentalhealth/munchausen-by-proxy-syndrome/. Pietrangelo, A. (2017, July 9). Munchausen Syndrome by Proxy: Causes, Symptoms and Diagnosis. Healthline. https://www.healthline.com/health/munchausen-syndrome-by-proxy. Prankratz, L. (2006). Persistent Problems With the Munchausen Syndrome by Proxy Label. Journal of the American Academy of Psychiatry and the Law Online, 34(1), 90–95. Stirling, J., & the Committee on Child Abuse and Neglect. (2007). Beyond Munchausen Syndrome by Proxy: Identification and Treatment of Child Abuse in a Medical Setting. The American Academy of Pediatrics, 119(5), 1026–1030. https://doi.org/10.1542/peds.2007-0563