Persistent Delusional Disorder Presenting as Munchausen by Proxy - A Case Report

Delusion is a false, unshakable belief that is out of keeping with the patient’s social and cultural background (Patricia Casey et al, 2019). Persistent delusional disorder (PDD) is characterized by the development either of a single delusion or of a set of related delusions which are usually persistent and sometimes lifelong. Often they are persecutory, hypochondriacal, or grandiose, but they may be concerned with litigation or jealously, or express a conviction that the individual’s body is misshapen, or that others think that he or she smells or is homosexual (ICD-10 classification of Mental and Behavioural Disorders). Delusional disorder with delusions of infidelity has been called conjugal paranoia or Othello syndrome (Sadock & Sadock, 2015). Munchausen syndrome was first termed by Asher in 1951. Munchausen syndrome by proxy, essentially, is a form of child abuse in which a parent, usually the mother, or a caregiver repeatedly fabricates or actually inflicts injury or illness in a child for whom medical intervention is then sought, often in an emergency setting (Sadock & Sadock, 2015). This case report presents one such beautiful case, where a father with persistent delusional disorder repeatedly fabricates an illness in his daughter, and make multiple requests to medicate his daughter. The core component of the delusional belief was infidelity. Initially, it was difficult to find any psychopathology in the daughter, except for some maladaptive reaction formation to frequent altercations with the father. Subsequently, it was realized that the father had persistent delusional belief related to his daughter’s fidelity (which was not corroborated by the daughter or other relatives). Personality can play a role in the genesis of delusional states; abnormally suspicious personalities can react to difficulties with deepening ideas of persecution, or may slowly develop delusions of marital infidelity or bodily ill health. One basic difference between Schizophrenia and PDD, is that delusions in PDD are well systematized, with one basic delusion and remainder of the system being logically built on this error (Patricia Casey et al, 2019). Persistent delusional disorders lack other psychopathology like hallucinations seen in Schizophrenia. Keywords: Persistent Delusional Disorder, Munchausen by Proxy, Infidelity, Paranoia