What Is Munchausen Syndrome? What Causes Munchausen Syndrome?

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Main Category: Psychology / Psychiatry
Also Included In: Mental Health
Article Date: 18 Oct 2009 - 11:00 PDT

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Munchausen syndrome (UK: Munchausen's syndrome) is the recurrent faking of catastrophic illnesses. It is a psychological disorder in which the individual keeps coming back for treatment for an acute and often serious illness which does not exist or has been deliberately induced - patients recurrently pretend they are seriously ill and ask for treatment.

Munchausen syndrome should be spelled with a double "H", as in Munchhausen. However, the misspelling with just one "H" has become so common that it is probably no longer considered as a spelling mistake, and most likely many people, including a significant number of health care professionals may even see the correct spelling as a typo.

A patient with Munchausen syndrome will typically give a credible and remarkable history, which is completely made up. An individual with Munchausen syndrome may go from hospital-to-hospital, pretending to have medical or surgical diseases and giving invented information about their medical history and social background. Some patients may have managed to con medical personnel into giving them unnecessary surgical procedures, resulting in a gridiron abdomen - a mass of scars on the abdomen as a result of these surgeries. In some cases, patients may ingest substances or inject themselves in order to induce illness.

Munchausen syndrome is one of the mental conditions called factitious disorders that are either invented or self-inflicted. Factitious disorders can be either physical or psychological. Munchausen syndrome is the most severe and long-lasting (chronic) form of factitious disorder.

Richard Asher, an English doctor, coined the phrase Munchausen syndrome in 1951 in an article in the medical journal The Lancet, after the German cavalry office Baron Karl Friedrich Hieronymous von Munchhausen (1720-1797), known for his fanciful, incredible tales about his exploits and past.

The syndrome itself was discovered by Henry Miege in 1893. Famous French neurologist, Jean Charcot, referred to Miege's writings later on. Karl Menninger, an American psychiatrist, discussed the descriptions and writings made by Miege and Charcot 40 years later in a paper entitled "Polysurgery and Polysurgical Addiction".

According to Medilexicon's medical dictionary, Munchausen syndrome is :
"Repeated fabrication of clinically convincing simulations of disease for the purpose of gaining medical attention; a term referring to patients who wander from hospital to hospital feigning acute medical or surgical illness and giving false and fanciful information about their medical and social background for no apparent reason other than to gain attention."

Munchausen syndrome is a rare condition. Experts say it is very hard to know exactly how common it is because patients use false names, visit different hospitals and health care professionals, and can become very adept at avoiding detection. The condition appears to be more common among males than females. Most diagnosed Munchausen syndrome patients tend to be middle-aged or young adults.

What are the signs and symptoms of Munchausen syndrome?

A symptom is something the patient feels and reports, while a sign is something other people, including the health care provider can detect. For example, a headache may be a symptom while a rash might be a sign.

Munchausen syndrome signs and symptoms are all associated with the faking or deliberately inducing illness or causing injury in order to satisfy deep emotional needs. The patient will be incredibly resourceful in his/her attempts not to be found out; this makes it extremely difficult for the health care provider to detect signs of a serious mental disorder.

If a person fakes an illness or injury to win a lawsuit or get some days off work he/she does not have Munchausen syndrome. There is no link between hypochondria and Munchausen syndrome. People with hypochondria really believe they are ill, while a person with Munchausen syndrome desperately wants medical attention, and will either fake signs and symptoms or induce illness or injury in order to get that attention.

Signs and symptoms of Munchausen syndrome include:

• Fanciful stories about several medical problems - often there is little documentary evidence. A common ruse is to say that they have been out of the country for a long time.


• Often being hospitalized.


• Symptoms which are inconsistent, tenuous or vague. They may not match the results of tests.


• Symptoms which unexpectedly get worse (for no logical reason).


• A desire to undergo lots of tests.


• The patient has surprisingly good medical knowledge.


• Desire and keenness to undergo surgical procedures, even risky ones.


• Seeking treatment from many different doctors.


• Seeking treatment from many different hospitals.


• Unwillingness to allow the health care provider to talk to friends or family.


• Frequently asking for painkillers and other drugs.


• Having very few or no visitors when in hospital.


• If confronted with their behavior, they may become defensive, aggressive or leave the hospital or health care provider and never return.

How does the patient feign illness?

It can be very difficult for doctors, nurses, other health care providers, friends and relatives to know whether the signs and symptoms are made up or deliberately induced. The patient may invent signs and symptoms or cause illness or injury by:

• Reporting a fictitious medical history - health care providers, friends, and relatives may be told an untrue medical history, such as claiming to have had cancer or some other major disease.


• Feigning symptoms - pretending to have pain, seizures, or even fainting. Often symptoms are selected carefully and tend to be those that are difficult to disprove, such as having very bad headaches.


• Hurting themselves - this may include injecting themselves with bacteria, feces, or some other substance. They may burn their skin or cut it. They may take medicines to provoke symptoms of diseases - such drugs as blood thinners, chemotherapy medicines and diabetes drugs may be used.


• Stop the healing process - cuts and wounds may be opened up to prevent healing.


• Tampering with tests - this may include heating up thermometers when their temperature is taken, tampering with laboratory tests, contaminating urine and blood samples.

What are the risk factors for Munchausen syndrome?

A risk factor is something which increases the risk of developing a condition or illness. For example, somebody who practiced boxing professionally for many years has a higher risk of developing brain damage than other people. Therefore, we say that boxing, especially long term professional boxing is a risk factor for brain damage.

Experts are not sure what causes Munchausen syndrome. However, the following factors may increase an individual's chances of developing the disease:

• A close relative with a serious condition or disease.
• A poor sense of identity.
• A serious childhood illness during which the patient was nursed and cared for.
• Childhood trauma, including physical, sexual or emotional abuse.
• Inadequate coping skills.
• Losing a loved one earlier on in life; could be due to death, illness or abandonment.
• Low self-esteem.
• Personality disorders.
• Wanting to and failing to become a health care professional.
• Working in health care.

Experts warn that some of the data mentioned above are often received from the patient, who has a tendency to invent and dramatize his/her medical and personal history. In other words, these are known risk factors, but be aware that the patient has a tendency to lie and dramatize.

What are the causes of Munchausen syndrome?

Experts say that there is extremely little evidence on the possible causes of the condition because patients refuse to cooperate with most kinds of psychiatric treatment or psychological profiling.

Most experts agree that Munchausen syndrome is a kind of personality disorder. A personality disorder is one in which the patient has a distorted pattern of thoughts and beliefs about themselves and other people. This pattern makes them behave in ways others consider as abnormal or disturbed.

Some psychiatrists and a significant number of psychologists say that those with Munchausen syndrome have an antisocial personality disorder which makes them enjoy manipulating and duping health care professionals. They see doctors as figures of authority and derive a sense of power and control when they deceive them.

It is also possible, say psychologists, that an individual with Munchausen syndrome is attempting to form relationships, trying to become more socially acceptable. A significant number of patients live solitary lifestyles and have no or very little contact with their family. Adopting the role of patient provides comfort, and being nurtured by doctors and other health care providers provides human contact and emotional warmth.

How is Munchausen syndrome diagnosed?

Many people with Munchausen syndrome are extremely good at manipulating and exploiting a health care provider's concern for the patient - they can be expert liars. They may have real symptoms and life-threatening conditions, even though these were self-inflicted. This can make effective and prompt diagnosis difficult.

When Munchausen's syndrome is suspected the doctor will review the patient's medical records and search for possible inconsistencies between what is documented and what the patient has told them. They will also try to get in touch with family or friends to find out whether claims about their medical history are true.

The medical team can also check blood and urine samples for traces of substances which would suggest they were deliberately ingested or injected and could explain their symptoms.

The patient's hospital room may be searched for injected materials or hidden medications or substances. However, this procedure has ethical considerations of its own.

Even if they suspect the patient may be faking it, they also have to try to determine whether it is Munchausen syndrome or an attempt to get strong painkillers or to make money (fake illness for a lawsuit).

The following factors will contribute towards making a diagnosis of Munchausen syndrome:

• There is compelling evidence that the patient is faking symptoms.


• There is compelling evidence that the patient has induced symptoms deliberately.


• There is compelling evidence that the patient's main aim is to be seen as sick.


• The patient's behavior cannot be put down to anything else, such as an attempt at financial gain or getting early retirement.

If you suspect a member of your family may have Munchausen syndrome and express this to the doctor, the physician will probably adopt an approach that reduces the likelihood of humiliation, which may result in the patient becoming defensive, aggressive and seeking medical help elsewhere. The doctor may reassure the patient that not having a clear explanation for medical signs and symptoms is stressful in itself, and suggest that the problem may be caused, or at least exacerbated by stress. Whatever approach the doctor takes, it will most likely gently steer the patient towards care with a mental health provider.

What are the treatment options for Munchausen syndrome?

Treating a patient with Munchausen syndrome can be extremely challenging. Most of them will deny ever having had such a problem, and will most likely be uncooperative, making it hard to get them to adhere to treatment plans.

In view of this, most good health care providers will adopt a gentle, non-confrontational approach. The patient may be told that they may have multi-faceted health requirements which include treatment with a psychiatrist or psychologist. Unfortunately, even the most "white-gloves" approach may not work, and the patient leaves and moves on to another hospital or doctor, or even another town.

Treatment may be possible, and sometimes effective, if the patient accepts he/she has a problem and cooperates with treatment.

A combination of psychoanalysis and CBT (cognitive behavioral therapy) is most likely to have the best results.

• Psychoanalysis - Sigmund Freud (1856-1939), Austria, developed psychoanalysis - a method of psychotherapy. His understanding of the mind was mainly based on interpretive methods, introspection and clinical observations. He focused on resolving unconscious conflict, mental distress and psychopathology. The main principle of Freud's theory was that the unconscious is responsible for most thought and behavior in everybody and the disorders of the mentally ill. Freud had a considerable influence in psychiatrist Carl Jung (Switzerland).


• CBT (cognitive behavioral therapy) - this helps people identify their unrealistic behavioral patterns and deal with the way we think about things and how they affect us emotionally. The aim of the therapist is to replace beliefs with more realistic and balanced ones. The therapy is based on present thinking, behavior and communication, rather than on past experiences and is oriented toward problem-solving. Put simply, CBT is aimed at helping people in the way they think (cognitive) and the way they act (behavior).

There is no standard treatment for Munchausen syndrome. If medications are prescribed, they will be for the treatment of other mental disorders that are also present, such as anxiety or depression.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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