Surgical Addiction

[ASDIC]

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I am wondering if there are patients who have this type of addiction and what would you do to treat them?

 

[OldPsychDoc]

I am wondering if there are patients who have this type of addiction and what would you do to treat them?

Send them to live in exile in Bahrain?

http://news.yahoo.com/s/nm/20060125/people_nm/bahrain_jackson1_dc_1

 

[Anasazi23]

As psychiatry residents, we occasionally see the so-called mania operativa - those that seek out unnecessary surgeries. This, of course, must be differentiated from the similar but fundamentally different Munchausen's syndrome. The former often derives from obsessive personality characteristics, while the latter is more attuned to "playing the sick role" but taken to a highly pathological level.

There a few articles in the literature:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3718694&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7055773&query_hl=3&itool=pubmed_docsum

Treatment will vary greatly depending on careful examination and interview of the patient, but normally incorporates exile to Bahrain.

 

[MDgonnabe]

As psychiatry residents, we occasionally see the so-called mania operativa - those that seek out unnecessary surgeries. This, of course, must be differentiated from the similar but fundamentally different Munchausen's syndrome. The former often derives from obsessive personality characteristics, while the latter is more attuned to "playing the sick role" but taken to a highly pathological level.

interesting. i thought mania operativa was just another flavor of munchausen's. it sounds more like a somatic delusional disorder. any role for antipsychotics or ssri's due to the ocd component?

 

[Anasazi23]

The truth is that it depends entirely on the individual patient presentation. From a psychodynamic perspective, the motivation to seek surgeries can either be of a histrionic nature, that of "passive aggression" toward another in hopes of provoking guilt, and myriad other reasons.

The presentation may appear, as you say, as lying on the OCD spectrum, in which case, the treatment would be quite different...and different more still than that of a person exhibiting aneroid or other somatic delusions. Pharmacologically, the treatment options vary depending on the psychiatrists' assessment of the case, and the underlying drive of the pathological behavior. Again, it is invaluable to have medical school training when dealing with these folks, as they are unerringly somatic, will bombard you with complex disease state questions, and will "doctor shop" with the hopes of recruiting more and more sympathetic but misinformed surgeons to perform these procedures.

 

[NewRawTick]

How about body image dysmorphic disorder (is that even the right term) too? I was watching Oprah (yea, I know...) a few months ago and she had 2 guests, one male, one female. The male guest was ridiculously good looking and to him, saw "a monster" in the mirror. He would go to the dermatologist, complaining of acne (and he obviously didn't have it), and when the dermatologist said he was fine, he would try to damage his skin so that the dermatologist would prescribe him something for his acne. He couldn't hold a steady job because he would be too self-conscious about his looks to interact with anyone. THEN, the female guest was 26, and already had about 28 cosmetic surgeries and had lips out to THERE and her nose had been chipped away so much for surgery that she had to stick Qtips up her nose from time to time to keep the airway open. She was also getting ready to get her 3rd or 4th breast augmentation as well. We talked about this briefly in our psychiatry unit, but I had no idea that it got that extreme.