An algorithm for the diagnosis of Münchausen’s syndrome in eating disorders

Objective To present an algorithm for the diagnosis of Munchausen’s syndrome (MS) in patients with eating disorders (ED). Method Case reports and review of the literature using PubMed. Results Two cases diagnosed with anorexia nervosa (AN): one later diagnosed with MS and one with Munchausen’s syndrome by proxy (MSBP) are presented. We then present an algorithm to aid in the diagnosis of MS and MSBP in patients with eating disorders. Discussion EDs can be distinguished from MS by their distinctive psychopathological traits, including fear of weight gain, eating and shape concerns, and food restraint. However, the diagnosis of concurrent ED and MS can be difficult because patients with both disorders may manifest similar abnormal behaviours: self-injurious behaviour, manipulation, splitting, physical complaints, multiple admissions, non-compliance, and giving false information. We present an algorithm as an aid to the diagnosis of concurrent MS and ED.