What Is Munchausen Syndrome?

Factitious Disorder Imposed on Self

Munchausen Syndrome
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Munchausen syndrome is considered to be a mental disorder. People who have Munchausen syndrome will usually act as if they have a true physical or mental issue even though they are really not sick. This behavior does not just happen one time. A person with Munchausen syndrome will often frequently and purposely act like he or she is sick.

Munchausen syndrome used to be its own disorder, but under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), it is now called factitious disorder imposed on self.

This is a mental disorder where individuals deliberately create, complain of, or exaggerate symptoms of an illness that does not really exist. Their main intention is to assume the sick role to have people care for them and be the center of attention.

Diagnosis Criteria for Munchausen Syndrome

Diagnosing Munchausen syndrome can be very hard because of all of the dishonesty associated with this disorder. Doctors must first rule out any possible physical and mental illnesses before considering a diagnosis of Munchausen syndrome. Additionally, in order to be diagnosed with Munchausen syndrome/factitious disorder imposed on self, the following four criteria must be met:

  • Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception
  • The individual presents himself or herself to others as ill, impaired, or injured
  • The deceptive behavior is evident even in the absence of obvious external rewards
  • The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder

Munchausen Syndrome Symptoms

The main symptom shown in a person affected by factious disorder imposed on self (AKA Munchausen syndrome) is deliberate causing, misrepresenting, and/or exaggerating of symptoms (physical or psychological) when the person is not actually sick.

They may suddenly leave a hospital and move to another area when it is discovered that they are not being truthful. People with Munchausen syndrome can be extremely manipulative since the main symptom of this disorder has to do with deception and dishonesty.

Additional symptoms may include:

  • Wanting others to view them as being sick or impaired
  • Falsifying medical records to specify an illness
  • Physically hurting themselves to cause an injury
  • Doing something to purposely injure themselves in order to cause an illness (for example, drinking a poisonous substance to have a violent stomach reaction)

Munchausen Syndrome Behavior

Because an individual affected by factitious disorder imposed on self will deliberately try to cause an illness or injury, the following are some examples of behavior you may see in somebody who may be diagnosed with this disorder:

  • Exaggeration of an actual injury that may lead to additional and unnecessary medical intervention
  • Complaining about neurological symptoms (such as seizures, dizziness, or blacking out), the presence of which is difficult to determine
  • Reporting being depressed and suicidal following an event (like a death of a child) even though there was no death and/or the person does not even have a child
  • Manipulating a laboratory test (for example, by adding blood to urine or ingesting a medication) to obtain a false abnormal result

Munchausen Syndrome vs. Munchausen Syndrome by Proxy

Both Munchausen syndrome and Munchausen syndrome by proxy are categorized as factitious disorders. There is one main difference between individuals with factitious disorder imposed on self and those affected by factitious disorder imposed on an other. That difference has to do with who the individual falsifies as being ill. With Munchausen syndrome, the person presents himself or herself to others as being sick, whereas with Munchausen syndrome by proxy, the person presents another individual to others as being ill or injured.

This “other” individual, who can be a child, another adult, or pet is considered to be a victim. So, a person affected by Munchausen syndrome by proxy may also be guilty of criminal behavior if his or her actions consist of abuse and/or maltreatment.

What Causes Munchausen Syndrome?

The exact cause of this disorder is not known. Due to the deception surrounding Munchausen syndrome, it is also not known exactly how many people are affected by it (but the number is expected to be very low). The onset of symptoms usually occurs in early adulthood, often after hospitalization for a medical condition. Unfortunately, this is a complex and poorly understood condition.

One main theory of what causes this mental disorder is a history of abuse, neglect, or abandonment as a child. A person may have unresolved parental issues because of this trauma. These issues may, in turn, cause the individual to fake being sick. People may do this because they:

  • Need to feel important and be the center of attention
  • Have a need to punish themselves by making themselves sick (because they feel unworthy)
  • Need to pass responsibility for their welfare and care on to other people

Another theory as to what causes Munchausen syndrome is if a person has a history of frequent or prolonged illnesses that required hospitalization (especially if this took place during childhood or adolescence). The rationale behind this theory is that individuals with Munchausen syndrome may associate their childhood memories with a sense of being taken care of. After becoming adults, they may try to achieve the same feelings of comfort and reassurance by pretending to be ill.

There may also be a link between personality and factitious disorder imposed on self. This is because personality disorders are common in people with Munchausen syndrome. This disorder may stem from the person’s inner need to be seen as sick or disabled. It could also be due to the person having an insecure sense of their own identity. Individuals affected by this disorder are willing to go through extreme measures, such as undergoing painful or risky tests or operations in an attempt to gain the sympathy and special attention given to people who are truly sick. So pretending to be sick allows them to assume an identity that elicits support and acceptance from others. Admission to the hospital also gives these individuals a clearly defined place in a social network.

What Is the Prognosis for People With Munchausen Syndrome?

Factitious disorder imposed on self is a habitual condition, so it can be very difficult to treat. People with this disorder will often deny that they are faking symptoms, so they usually refuse to seek out or follow treatment. Because of this, the prognosis tends to be poor. Munchausen syndrome is associated with severe emotional difficulties. Individuals are also at risk for health problems or death because of their purposeful actions of trying to hurt themselves. They can suffer additional harm from complications associated with multiple tests, procedures, and treatments. Finally, people diagnosed with Munchausen syndrome are at a higher risk for substance abuse and suicide attempts.

Munchausen Syndrome Warning Signs

If you are concerned that someone you know may be affected by Munchausen syndrome, there are some warning signs that you can look out for. The main sign is that the individual seems to always be complaining about and/or exaggerating symptoms of an illness.

Additional warning signs can include:

  • Presence of symptoms only when the person is alone or not being observed
  • Extensive knowledge of hospitals and/or medical terminology (including textbook descriptions of illnesses)
  • Extensive but inconsistent medical history
  • Complaints of new or more symptoms following negative test results
  • Problems with identity and self-esteem
  • The person is reluctant or unwilling to allow medical professionals to meet with or talk to family, friends, or past medical providers
  • Ambiguous symptoms that are not able to be controlled and become even more severe or change after beginning treatment
  • Willingness or eagerness to go to the hospital as well as undergo medical tests, operations, and procedures
  • History of obtaining treatment at several hospitals, clinics, and doctor offices (possibly in different cities or zip codes)

Munchausen Syndrome Treatment

Although individuals with Munchausen syndrome may actively obtain treatment for the numerous disorders they create, these individuals typically do not want to admit to and seek treatment for the actual syndrome. People affected with factitious disorder imposed on self deny they are faking or causing their own symptoms, so obtaining treatment tends to be dependent on somebody else suspecting that the person has this disorder, persuading the individual to receive treatment, and encouraging the person to stick to treatment goals.

The main treatment goal for Munchausen syndrome is to change the person's behavior and lessen the misuse/overuse of medical resources. Treatment usually consists of psychotherapy (mental health counseling). During treatment sessions, the therapist may try to challenge and change the thinking and behavior of the person (this is known as cognitive-behavioral therapy). Therapy sessions may also try to uncover and address any underlying psychological issues that may be causing the person's behavior. During treatment, it is more realistic to have the person work toward managing the syndrome as opposed to trying to cure it. So, a therapist may try to encourage these individuals to avoid dangerous medical procedures as well as unnecessary hospital admissions.

Medication is typically not used in the treatment of Munchausen syndrome. If the person is also suffering from anxiety or depression, a doctor may prescribe medication. If this is the case, it is important to closely monitor these individuals because of the higher likelihood of using these medications to purposely hurt themselves.

In addition to individual therapy, treatment may also include family therapy. Teaching family members how to properly respond to a person diagnosed with Munchausen syndrome can be helpful. The therapist can teach family members not to reward or reinforce the behavior of the person with the disorder. This may make lower the individuals’ need to appear sick since they may no longer be receiving the attention they are seeking.

Sources:

American Psychiatric Association. Diagnostic And Statistical Manual Of Mental Disorders (5Th Ed). 5th ed. Washington, DC: American Psychiatric Publishing, Incorporated, 2013.

Elwyn, TS. "Factitious Disorder Imposed On Self (Munchausen's Syndrome) Differential Diagnoses." Emedicine.medscape.com. 2016.

Feldman MD. Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder. New York: Brunner-Routledge, 2004.

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