The Munchausen syndrome is regarded as a factitious disorder. It is a type of mental disorder, wherein people pretend to have certain physical or psychological symptoms in them. People who are between the ages 20-40 years old are more prone to developing the disorder. Men who have few family relationships and women who have knowledge about health care tend to be more prone to developing the illness.
Munchausen syndrome likely coexists or follows with Munchausen syndrome by proxy (MSBP). In the United States alone, the condition is known to occur in small portions, especially in certain subpopulations where people have been earlier diagnosed with fever of unknown origin (FUO) or psychosis.
This syndrome is known to be mainly motivated with the desire to assume the role of a sick person instead of other reasons such as financial gain, trying to avoid any kind of responsibility, improvement in his or her physical condition, trying to seek out drugs, or other benefits that occur in malingering. Individuals with Munchausen syndrome tend to intentionally fake, simulate, or self-induce any kind of injury or medical illness to make them look weak and sick.
Research studies have different results in terms of the identification of individuals who are most at risk of developing the disorder.
- Women - According to certain statistics, women in the healthcare industry are more susceptible to developing this particular syndrome usually in the form of physical symptoms.
- Both Men and Women - Other studies indicate that both men and women can equally develop the mental disorder.
- Unmarried Men - According to other research studies, unwed middle-aged men who are also estranged from their families are more prone to developing the syndrome.
Although the condition can occur at any age, it is known to develop during the period of late adolescence or in the early adult stage.
Munchausen syndrome by proxy (MSBP) is a mental problem, wherein a caregiver fabricates illness of a person, who is under his or her care. It can be a young child, an older adult, or someone who has a disability. MSBP is considered as a form of elder or child abuse since caregivers victimize vulnerable individuals.
Caregivers who have MSBP may lie about their patient's symptoms, tamper test results to make their patients appear sick, or physically abuse their patients to produce convincing symptoms.
Before the mental disorder got its name, it had been described as far back as the biblical times. One of the examples would be that the individuals who had this disorder during the Medieval Period would scrape off their skin or put leeches into their mouth to induce bleeding.
This mental disorder got its name from Baron Karl Friedrich von Munchausen. He was born in Germany and lived from 1720 to 1797. He was part of the Russian military and was quite famous for telling fantastic stories about the various battles he encountered. During the late 18th century, he entertained dinner guests with his adventures when he was in the Russo-Turkish War. In one of his stories, he had reportedly claimed to ride cannonballs as well as travel to the moon.
In 1785, Rudolf Erich Raspe, a German writer and scholar, published a book about a fictional character who closely resembled the traits of Baron Munchausen, who told many impossible and fantastic stories about his experiences and accomplishments. His book and the character he created became a sensation, which established a literary personification of an ostentatious liar.
Richard Asher was the first to describe and show the pattern of self-harm in 1951. According to Asher, there were individuals who fabricated the signs and symptoms of their illness as well as their medical histories. By remembering Baron Munchausen, Asher named such condition as the Munchausen’s Syndrome in his 1951 article published in The Lancet.
There is no exact cause for Munchausen syndrome. However, like other mental illnesses, it may be a result of a combination of factors such as:
- Ways of thinking
- Social stressors
- Biological vulnerabilities
There is very little information about the syndrome's exact biological risk factors. When it comes to psychological factors, individuals with this mental illness may have:
- A greater need for control
- Imbalanced self-esteem (too high or too low)
- Inclination toward depression, anxiety, or substance abuse
Most personality traits of people who have a medical history of the symptoms of this mental disorder include:
- Borderline Personality Disorder (BPD) - An individual has a disturbance in his or her self-identity, often have shaky relationships, or have recurrent suicidal attempts or thoughts.
- Antisocial Personality Disorder - A person may be insensitive to other people’s emotions, have a tendency to lie, or may not care for their safety or the safety of others.
Below are certain risk factors for individuals suffering from Munchausen syndrome:
- Physical or sexual form of abuse or other forms of childhood abuse
- Has gone through a significant trauma during childhood
- A friend or any close family member who has a grudge against the medical profession or a victim of neglect
Below are few of the common physical symptoms seen in an individual with Munchausen syndrome:
Most people who have the disorder often have a common pattern when it comes to seeking medical help from healthcare providers and hospitals:
- They have vague and exaggerated symptoms with unreliable test results
- They have an inconsistent medical history
- Have an absurd course of illness
- Have a worsening medical condition
- Do not allow healthcare providers to talk to their family members
- Feel delighted when they undergo numerous medical procedures or tests
- Feel happy when they learn about their medical diagnosis
- Feel excited and pleased to take prescribed medications
Individuals with this syndrome are also highly likely to commit self-injury, changing of test results as well as predictable relapse patterns. Other forms that this disorder may take include:
- Chronic diarrhea
- Heart disease
- Metabolic disorders
- Skin problems or disorders
- Bleeding disorders
- Other illnesses
Intriguingly, the symptoms of this mental illness in adults are quite the same in children and teenagers.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) has set some criteria for this factitious disorder, which include:
- Intentionally pretending to have signs or symptoms of impaired physical or mental health
- Deliberately display as being hurt, ill, or weak
- Demonstrate behavior without recognizable external reasons such as improving one’s physical wellness, financial gain, or escaping legal problems
There is no definitive test such as a specific blood test or X-ray that can assess an individual with Munchausen syndrome. For this reason, most healthcare providers carry out an interview regarding the patient’s mental health and identify the symptoms of mental illness.
Individuals with Munchausen syndrome may be knowledgeable of medical terms or have noticeable surgical scars without having a reliable proof of physical illness. Like any other evaluation of mental health, healthcare professionals usually work on ruling out other mental health problems along with making sure that the patient does not have a primary illness or health issues that may cause an emotional problem.
They would also ask if the patient recently had any physical examination, blood tests, or other medical procedures, which are needed to diagnose a medical condition. Reviewing medical records is also crucial along with talking to other people who are close to the patient to identify the possibility of causing or feigning symptoms or an incidence of faking or lying about the patient’s symptoms in the past.
Due to the disorder’s chronic nature and the tendency of patients to run away from care, the treatment of the condition can be quite challenging.
There is no specific method when it comes to effectively managing the disorder. Most of the time, confronting people with the disorder tends to have no effect. Moreover, individuals who have this mental illness are highly likely to end their treatment when they are confronted, but resume seeking treatments and unnecessary tests from a new doctor. Thus, the key to treating people with the disorder is to carefully maintain a balance of providing empathetic medical support and preventing the patients to undergo other unnecessary tests or medical procedures.
A good method of addressing the disorder would be showing empathy for the patient’s endeavors, which may have caused the development of the mental illness along with giving them encouraging support to develop other ways of dealing with their feelings or emotions.
Aside from establishing a supportive relationship with the patient, there are many doctors who remain in contact with the patient’s family to educate them about the patient’s need for attention and to make them better understand about the patient’s specific behavior. Doctors can greatly contribute to the patient’s recovery through frequent communication with other healthcare providers about the patient’s condition or progress as well as preventing the repetitive cycle of undergoing tests and other medical procedures.
Individuals with Munchausen syndrome who do not have other psychiatric issues tend to have a better chance of full recovery compared to people who have another mental disorder. However, the symptoms of patients with Munchausen syndrome often improve when their other psychiatric disorder is properly treated.
When treatment is sought, the primary goal is to change the patient’s behavior and to lessen the overuse of medical treatments or examinations. If this goal is met, treatment moves on to dealing with underlying mental issues, which might be the cause of the patient’s behavior and to assist the patient on how to solve existing or past problems.
Psychotherapy is a type of counseling, which is primarily used for the treatment of factitious disorders. The treatment usually concentrates on modifying the behavior and thinking of patients, which is why this treatment is also called as cognitive behavioral therapy (CBT).
- Family Therapy - It is another type of psychotherapy that specifically deals with the psychological health of the family. It helps family members to resolve conflicts and have an improved relationship. This therapy might help teach family members not to tolerate any family member with the Munchausen syndrome.
- Group Therapy - This type of psychotherapy involves one or more therapists, who treat patients in groups. It may be an ideal choice when it comes to patients who feel isolated or feel that nobody cares about their condition.
There are no specific medications when it comes to treating factitious disorders. Certain types of medicine may be used for the treatment of related disorders such anxiety, depression, or personality disorders, and not for the factitious disorder itself.
Treatment using medications in individuals who have factitious disorders must be closely monitored to eliminate the risk of not taking their medicine or the risk of using the drugs in a destructive way.
Is there a way to prevent this factitious disorder?
Unfortunately, there is no known way to prevent this mental disorder. The moment people show symptoms of the disorder, it might be helpful to start treatment right away.
Some individuals who have this factitious disorder may only suffer few episodes of the symptoms. However, in most cases, this mental illness is often a recurring condition, which can be quite difficult and challenging to treat. Many patients usually deny that they are only pretending to be sick and that they are only faking their symptoms. Thus, a better and more realistic approach to this condition is to work on managing the disorder instead of trying to cure it.
Moreover, it is also important for people to avoid unnecessary hospital admissions and undergoing numerous medical examinations or treatment.