A SINGLE CASE REPORT OF RECURRENT SURGERY FOR CHRONIC BACK PAIN AND ITS IMPLICATION CONCERNING A DIAGNOSIS OF MUNCHAUSEN SYNDROME.

While undergoing treatment in the psychiatric depart- ment,4.C., a 40-year-old white male, who had arrived in the casualty department complaining of an uncontrol- lable anxiety attack and in a state of fluctuating con- sciousness, was found to be suffering from a psy- chopathological condition characterized by pathologi- cal lying, gambling, compulsive restlessness, a long clinical history of chronic back pain, with multiple inva- sive diagnostic investigations and repeated surgery for disc hernia with relative complications, culminating in the fitment of a fixed neurostimulator, a slowdischarge morphine pump and the patient being granted a full dis- ability pension. The continual increases in the doses of morphine suggested a tendency towards drug addic- tion. After providing a brief overview of lhe historical back- ground and current concepts relating to the relation- ship between factitious disorders, malingering and hysteria, the authors discuss the differential diagnosis of the case, suggesting a diagnosis of Mùnchausen syndrome (the hypothesis best supported by the clini- cal evidence). This diagnosis, although the subject of much academic debate, is, unfortunately, still not fre- quently encountered in the medical literature, with the result that even today it has a strong clinical, relational and social impact.