Munchausen Syndrome

People with Munchausen syndrome intentionally cause signs and symptoms of an illness or injury by inflicting medical harm to their body, often to the point of having to be hospitalized.

Munchausen syndrome describes a condition in which a person intentionally fakes, simulates, worsens, or self-induces an injury or illness for the main purpose of being treated like a medical patient. Munchausen syndrome is named after a German military man, Baron von Munchausen, who traveled around telling fantastic tales about his imaginary exploits. In 1951, Richard Asher applied the term to people traveling from hospital to hospital, fabricating various illnesses. The term Munchausen syndrome is often used interchangeably with factitious disorder. Factitious disorder refers to any illness that is intentionally produced for the main purpose of gaining attention associated with assuming the sick role, although that purpose is unknown to the "sick" person.

Munchausen syndrome most appropriately describes people who have a chronic variant of a factitious disorder with mostly physical signs and symptoms, although there are reports in the literature regarding psychological Munchausen syndrome, meaning that the simulated symptoms are psychiatric in nature.

What Are the Signs and Symptoms of Munchausen Syndrome?

People with Munchausen syndrome intentionally cause signs and symptoms of an illness or injury by inflicting medical harm to their body, often to the point of having to be hospitalized. These people are sometimes eager to undergo invasive medical interventions. They are also known to move from doctor to doctor, hospital to hospital, or town to town to find a new audience once they have exhausted the workup and treatment options available in a given medical setting. People with Munchausen syndrome may also make false claims about their accomplishments, credentials, relations with famous people, etc.

What is Munchausen by Proxy Syndrome?

A related condition, called Munchausen by proxy syndrome, was described using that term in 1977 by Roy Meadow in cases involving caregivers who fake symptoms by causing injury to someone else, often a child, and then want to be with that person in a hospital or similar medical setting. Since mothers continue to be the primary caregivers in many societies, the mother is often the individual identified as having Munchausen syndrome by proxy, but anyone in the role of parent or caregiver may develop this condition.

The causes of Munchausen syndrome are unknown. Some experts suggest that it is a defense mechanism against sexual and aggressive impulses. Others believe it may be a form of self-punishment. Determining an exact cause is difficult because people with Munchausen syndrome are not open and honest about their condition, making research on them nearly impossible. Risk factors for Munchausen syndrome and Munchausen syndrome by proxy include a background in daycare or health care in the involved parent, marital problems between parents, or personality disorders like a borderline personality disorder.

Individuals with Munchausen syndrome intentionally produce or exaggerate symptoms. They may lie about or fake symptoms, self-induce injury to cause symptoms, or alter the results of tests by contaminating samples such as a urine samples. Signs and symptoms of Munchausen syndrome may include,

• dramatic medical history of serious illness,
• often with inconsistent details of the problem,
• symptoms that fit a diagnosis too perfectly or lack of signs that go with symptoms (for example, no sign of dehydration yet the person complains of diarrhea and vomiting),
• symptom that change or worsen once treatment is begun,
• history of seeking care at numerous other doctors, offices, or hospitals, eagerness to undergo exams, tests, and procedures,
• reluctance to let health care professionals contact previous health care professionals or family and friends, and
• evidence of multiple surgical scars.

Depending on the symptoms, almost any laboratory test can be used to determine if the symptoms result from a true disease process.

• Test results that are inconsistent or atypical of the claimed illness may be an indication of Munchausen syndrome.
• Imaging studies (such as X-rays or scans) may be helpful in diagnosing Munchausen syndrome. Many claimed medical problems, such as tumors, can be easily viewed with imaging tests.

Initially, the medical care of people with Munchausen syndrome is aimed at relieving the claimed symptoms and any injury made by the person to induce the symptoms. Treating people who have Munchausen syndrome is difficult because they are often unwilling to admit they have it. The treating doctor must be very judicious with invasive diagnostic tests or surgeries, yet try not to miss serious medical conditions. Many people with Munchausen syndrome experience long-term medical complications from illnesses they have induced or from the mechanisms used to treat them. Psychotherapy of various types (strategic, psychodynamic, cognitive) has been reported anecdotally to be of benefit in selected cases.

Medications can be useful if conditions exist along with the Munchausen syndrome. Serotonin reuptake inhibitors can be helpful in people with Munchausen syndrome who also have (comorbid) depression, and at least theoretically, low-dose antipsychotics can help those with coexisting borderline personality disorder. People with Munchausen syndrome can induce or develop authentic illnesses requiring surgery, but further surgical procedures should be treated with great caution.

Medications can be useful if conditions exist along with the Munchausen syndrome.

• Serotonin reuptake inhibitors can be helpful in people with Munchausen syndrome who also often have (comorbid) depression, and at least theoretically, low-dose antipsychotics can help those with coexisting borderline personality disorder.

People with Munchausen syndrome can induce or develop authentic illnesses requiring surgery, but further surgical procedures should be treated with great caution.

People with Munchausen syndrome are rarely treated successfully. They are reluctant to seek treatment for the psychological problem and are generally unwilling to undergo psychiatric treatment. The self-inflicted illnesses and injuries of people with Munchausen syndrome can cause serious consequences. These individuals often undergo several unnecessary surgeries throughout their lifetime.

The prognosis for Munchausen syndrome by proxy (MSBP) is very poor if the child involved is left in the home. The overall mortality rate is difficult to assess but is thought to be between 6% and 10%; however, it can be as high as one-third when poisoning or suffocation are involved. There is also a high rate of chronic illness (morbidity) and death (mortality) in siblings of children with MSBP.

There is no known way to prevent Munchausen syndrome.

Factitious Disorders, Munchausen & Munchausen by Proxy Page

Nemours Foundation, Munchausen by Proxy