Munchausen syndrome is an extreme type of factitious disorder. The case study by Aleem and Ajarim (1995) describes a patient with Munchausen syndrome, who first appeared to have an immune deficiency.

Mark scheme

Marking points from the official mark scheme (Oct/Nov 2020). The mark or mark type is shown in brackets.

1. Most likely answer (other appropriate responses to be credited):
2. Quote from study: 'Factitious disorders are characterized by physical or psychological symptoms that are intentionally produced or feigned in order to assume the sick role.
3. Marks: 1 mark for basic answer. 1 mark for elaboration/example
4. Definitive answers:
5. Quote from study: Essential features
6. Pathologic lying (pseudologia fantastica)
7. Peregrination (traveling or wandering)
8. Recurrent, feigned or simulated illness
9. Supporting features
10. Borderline and/or antisocial personality traits; Deprivation in childhood; Equanimity for diagnostic procedures; Equanimity for treatments or operations; Evidence of self-induced physical signs; Knowledge of or experience in a medical field; Most likely to be male; Multiple hospitalizations; Multiple scars (usually abdominal); Police record; Unusual or dramatic presentation.
11. Marks: 1 mark for each correct answer x4.
12. Most likely answer:
13. Quote from study
14. Physical examination was consistent with bilateral femoral nerve palsy and investigations (ultrasound, computed tomographic [CT] scan) were suggestive of hematoma.
15. Anticoagulation was stopped and surgical evacuation was carried out and she recovered well except for residual partial left femoral nerve palsy.
16. She was also investigated for amenorrhea and it was suggested to be hypothalamic in origin
17. Physical examination during the current admission revealed an intelligent young female, afebrile, with normal pulse and blood pressure.
18. There were multiple scars over the abdominal wall and there was a tender, hot and indurated area (4 x 5 cm) over the lateral aspect of the right breast. There were two small tender lymph nodes palpable in the right axilla. The rest of the examination was normal.
19. Marks: 1 mark for identification; 1 mark for result/finding. Simple answer: 'blood pressure' (1 mark) ‘it was found to be normal' (1 mark)
20. Most likely answer (other appropriate responses to be credited):
21. A physical examination often uses 'scientific equipment' which gathers objective data. A clinical interview gathers subjective data about the experiences of the patient.
22. The physical examination cannot lie; a patient can.
23. A physical examination is done by the medically qualified person who knows what to look for. A clinical interview of the patient's experience may lead the interviewer/medical practitioner to draw incorrect conclusions.
24. Marks: 1 mark basic answer, 2 marks detailed answer/elaboration or use of example.
25. Most likely answer (other appropriate responses to be credited):
26. Advantages:
27. The essential features of factitious disorders are likely to apply to other people.
28. A case study is a detailed investigation into one 'thing', the factitious disorder.
29. Unique cases can be understood which adds to knowledge about the disorder.
30. If many case studies produce similar results, it is possible to generalise.
31. Disadvantages:
32. No standardised measurement can be taken for everyone with the disorder.
33. Various methodologies are often used: interviews, questionnaires, tests (psychometric, projective and physiological) which may not reveal anything / be useful.
34. Individual differences (or ‘everyone is unique') in disorders means that what is applied to one person cannot always be applied to others.
35. Conclusion: any appropriate conclusion drawn from the discussion that has been presented. 1 mark if appropriate. A conclusion is a 'decision reached by reasoning' and so a summary of points already made scores 0 marks.
36. Marks: Question requires discussion; always plural of each argument, and always requires conclusion. 1 mark for each advantage/disadvantage (however detailed) and related to the question up to 4 max. 2 marks max for two strengths/weaknesses unrelated to the question. 1 mark for conclusion.