Munchausen Syndrome

• Munchausen syndrome, referred to as a factitious disorder, is a mental illness that involves the sufferers causing or pretending to have physical or psychological symptoms in themselves.
• Adults aged 20-40 years are most likely to develop Munchausen syndrome. Women with knowledge of health care and men with few family relationships are particularly vulnerable to developing this disorder.
• Munchausen syndrome often follows or coexists with Munchausen syndrome by proxy.
• Munchausen syndrome tends to occur in a small portion of the United States population, more often in subpopulations like people who have been diagnosed with psychosis or fever of unknown origin.
• The symptoms of Munchausen syndrome has been described since at least biblical times. It was named for Baron Karl Friedrich von Munchausen, an 18th-century man who was in the Russian military and was known to tell untrue stories about the battles he participated in.
• Munchausen syndrome by proxy (MSBP) is a fabrication of illness by a third person that allows the third person, usually the victim's mother, to assume the role of caregiver.
• Although there is no specific cause for Munchausen syndrome, risk factors for the disorder tend to be psychological, like having borderline or antisocial personality symptoms or a grudge against the medical profession and society, like having a personal or family history of serious illness or a history of neglect, abuse, or other maltreatment.
• Due to the chronic nature of the condition, as well as the tendency of sufferers to discontinue treatment, care for individuals with Munchausen syndrome is difficult. No single approach is consistently effective in managing this illness.
• Prevention or early treatment of the factors that put people at risk for developing Munchausen syndrome are important aspects of decreasing the likelihood that the disorder will develop. Once symptoms of the condition are assessed, the earlier it is addressed, the better the likely outcome.

Munchausen syndrome, referred to as a factitious disorder, is a mental condition in which sufferers cause or pretend to have physical or psychological symptoms in themselves. It is thought to be motivated only by a desire to assume the role of a sick person rather than by financial gain, improving his or her physical condition, avoiding responsibility, drug seeking, or some other benefit, as occurs in malingering.

Research study results differ in terms of identifying groups that are most at risk for developing the disorder.

• Some statistics describe women with health training may be more susceptible to developing Munchausen syndrome, especially the physical symptoms thereof. However, other studies indicate that men and women develop Munchausen syndrome with equal frequency.
• Still, other research describes unmarried middle-aged men who are estranged from their families as being the most at risk for developing this condition.
• While the condition may occur at any age, it seems to most often develop in late adolescence or early adulthood and is either preceded by or coexists with Munchausen syndrome by proxy.
• Estimates of how often Munchausen syndrome occurs are a small percentage of the population of the United States, but it can be significantly higher in some subpopulations. For example, some people with fever of unknown origin have Munchausen syndrome.
• Some people who were previously diagnosed as having psychosis were found to have this disorder as well.

History of Munchausen syndrome

Even before having its current name, this condition has been described since at least biblical times. For example, sufferers of this syndrome during the Middle Ages went as far as scraping off their skin and putting leeches in their mouths to induce bleeding.

This illness was named for Baron Karl Friedrich von Munchausen. He lived from 1720 to 1797, was born in Germany, joined the Russian military, and was known to tell fantastic stories about the battles he participated in. For example, he reportedly claimed to ride cannonballs and travel to the moon.

• In contrast to Munchausen syndrome, Munchausen syndrome by proxy (MSBP) is a fabrication of sickness by a third person, usually a caretaker, which allows the third person to assume the sick role. The caretaker involved in the development of MSBP is usually the victim's mother.
• This illness involves psychological abuse and may also include physical abuse and medical neglect if symptoms are induced rather than just made up.
• Although both Munchausen syndrome and somatoform disorders can be characterized by physical complaints, Munchausen syndrome is different in that the complaints are consciously invented or caused by the sufferer him- or herself. For example, individuals with somatization disorder, conversion disorder, and people who are hypochondriacs are convinced that they really suffer from physical symptoms, have a deficit in movement or sensory function, or believe they are seriously ill, respectively.

Although there is no specific cause for Munchausen syndrome, like most other mental disorders, it is understood to be the result of a combination of biological vulnerabilities, ways of thinking, and social stressors. Little is known about the specific biological risk factors from which individuals with Munchausen syndrome are more likely to suffer.

Psychologically, sufferers of this mental illness may have an increased need for control, an imbalance in the level of self-esteem (either low or excessively high), and a tendency to suffer from depression, anxiety, or substance-abuse disorders.

Personality traits of individuals who have a history of feigning or inducing symptoms in themselves include some that are in common with borderline personality disorder (for example, if the person dissociates or has another disturbance in their identity/sense of self; has unstable relationships, recurrent instances of self-mutilation, and/or experiences recurrent thoughts or attempts at suicide) or antisocial personality disorder (for example, a tendency to lie, disregard the safety of themselves or others, and to have little empathy for others).

Risk factors for people with Munchausen syndrome include:

• enduring a significant negative event (trauma) during their childhood (such as a serious illness of themselves,
• a close family member or friend), having a grudge against the medical profession or having been themselves the victim of neglect,
• physical or sexual abuse, or other forms of childhood maltreatment.

The specific signs and symptoms of Munchausen syndrome can be extremely varied, from heart symptoms like fainting and chest pain, to ear problems seen by specialists in that area, to overtly psychiatric symptoms like hallucinations. The most common physical symptoms tend to include:

• belly pain,
• diarrhea,
• nausea and vomiting,
• trouble breathing, and
• blackouts.

Although the specific symptoms that the individual complains of are nearly limitless, sufferers may have in common a pattern of certain behaviors. These behaviors include:

• seeking treatment at several care providers and hospitals,
• providing inconsistent medical history,
• having symptoms that are exaggerated, vague, and/or inconsistent with test results,
• having an illogical course to their illness, usually worsening,
• an unwillingness to allow current health care professionals to talk to family members or previous care providers,
• being excessively pleased to be subjected to multiple tests and procedures, as well as seeming happy to receive a medical diagnosis and have an excessive desire to receive medications.

People with this condition may also engage in self-injury, altering test results, and have predictable relapses. Interestingly, the symptoms of Munchausen syndrome are very similar in children and adolescents as they are in adults.

As occurs with some psychiatric conditions, there is ongoing debate about how to best understand and diagnose Munchausen syndrome. The diagnosis, now referred to as factitious disorder as indicated by the widely accepted criteria set by the Diagnostic and Statistical Manual of Mental Disorders (DSM) requires that the sufferer exhibit the following:

• Purposefully producing or pretending to have physical or mental-health signs or symptoms
• Presenting oneself as being sick, hurt, or impaired
• Engaging in the behaviors even when there are no obvious external motivators (like financial gain, avoiding legal problems, or improving physical well-being)

There is no specific definitive test, like an X-ray or a blood test, which can assess that a person has Munchausen syndrome. Therefore, practitioners perform a mental-health interview that looks for the presence of the symptoms previously described.

People with this condition may exhibit signs like having extensive knowledge of medical terminology, and they may have multiple surgical scars despite having little objective evidence of a diagnosable physical condition.

As with any mental health evaluation, the professional will work toward ruling out other mental conditions and ensuring that the individual does not have a primary medical illness or from medical issues that may cause emotional problems. He or she will often inquire about when the person has most recently had a physical examination, comprehensive blood work, and any other medical tests that a professional deems necessary to ensure that the person does not have a true medical condition rather than or in addition to potentially feigning or causing symptoms.

It is also important for the practitioner to review any available medical records and talk to other people who are in the person's life (like current or previous treating professionals, the spouse, or other family members) in order to explore the possibility that there is a pattern of the individual lying and/or faking symptoms in the past.

Because of the chronic nature of the condition and the tendency of sufferers to flee from care, the treatment of Munchausen syndrome can be a challenge. No one method is consistently effective in managing this illness.

• Confronting victims of Munchausen syndrome tends to be ineffective. In fact, people with this condition are more likely to prematurely end treatment in response to being confronted, only to resume seeking unnecessary tests, procedures, and other treatments from a new health-care provider.
• Therefore, maintaining a delicate balance between providing the sufferer of Munchausen syndrome with empathetic professional support with preventing their receiving more unnecessary tests and procedures is key to treating victims of this condition.
• For example, showing empathy for the difficulties that may have contributed to the development of the disorder, while encouraging the sufferer to develop new ways of managing their feelings are important aspects of addressing Munchausen syndrome.
• In addition to trying to foster a supportive relationship with the individual with this illness, many health-care professionals will remain in close contact with the family of the sufferer in order to educate loved ones about the victim's behaviors and need for attention.
• The professional may also greatly contribute to the person's recovery by maintaining frequent communication with other healthcare professionals in educating those providers about this condition and preventing the continued performance of unnecessary tests and procedures.
• Treating Munchausen syndrome by proxy includes the involvement of child protective services to ensure the safety and well-being of the person, usually a child, in whom symptoms are being fabricated or induced, usually by a caretaker.

Munchausen syndrome can have significant negative effects on the lives of those who suffer from it and on the community in general.

• This disorder is thought to result in about $40 million per year in unnecessary tests and other medical costs.
• The chronic nature and tendency for people with this illness to be at odds with the medical community puts sufferers at risk for multiple recurrences of symptoms.
• The associated high completed suicides at a rate of 30%-70% is another potential complication of this condition, and males tend to have worse outcomes than females.
• The outcomes for Munchausen syndrome by proxy tends to be quite poor if the victim of the abuse remains in the care of the perpetrator.
• People with Munchausen syndrome who have no other psychiatric illness seem to have a better chance of full recovery than those who also suffer from another mental illness. However, when a person with another psychiatric disorder gets treatment for that problem, their symptoms of Munchausen syndrome often improve as well.

Prevention or early treatment of the factors that place people at risk for developing Munchausen syndrome are important ways to decrease the likelihood that the illness will develop in a specific individual.

Prevention and early detection of child abuse, education of parents, and other family members of the importance of seeing the needs for attention by seriously ill family members and for those close to them may significantly help prevent Munchausen syndrome from occurring.

If signs of the illness are detected, the earlier they can be addressed, both following the onset of the illness and at the youngest age possible for the victim, the better the likely outcome.