Munchausen Syndrome

What is Munchausen syndrome?

Munchausen syndrome is a type of factitious disorder, or mental illness, in which a person repeatedly acts as if he or she has a physical or mental disorder when, in truth, he or she has caused the symptoms. People with factitious disorders act this way because of an inner need to be seen as ill or injured, not to achieve a concrete benefit, such as financial gain. They are even willing to undergo painful or risky tests and operations in order to get the sympathy and special attention given to people who are truly ill. Some will secretively injure themselves to cause signs like blood in the urine or cyanosis of a limb. Munchausen syndrome is a mental illness associated with severe emotional difficulties.

Munchausen syndrome—named for Baron von Munchausen, an 18th century German officer who was known for embellishing the stories of his life and experiences—is the most severe type of factitious disorder. Most symptoms in people with Munchausen syndrome are related to physical illness—symptoms such as chest pain, stomach problems, or fever—rather than those of a mental disorder.

Note: Although Munchausen syndrome most properly refers to a factitious disorder with primarily physical symptoms, the term is sometimes used to refer to factitious disorders in general. In this article, Munchausen syndrome refers to a more dramatic form of factitious disorder with physical symptoms.

What are the symptoms of Munchausen syndrome?

People with this syndrome deliberately produce or exaggerate symptoms in several ways. They might lie about or fake symptoms, hurt themselves to bring on symptoms, or alter diagnostic tests (such as contaminating a urine sample). Possible warning signs of Munchausen syndrome include the following:

• Dramatic but inconsistent medical history
• Unclear symptoms that are not controllable and that become more severe or change once treatment has begun
• Predictable relapses following improvement in the condition
• Extensive knowledge of hospitals and/or medical terminology, as well as the textbook descriptions of illnesses
• Presence of multiple surgical scars
• Appearance of new or additional symptoms following negative test results
• Presence of symptoms only when the patient is alone or not being observed
• Willingness or eagerness to have medical tests, operations, or other procedures
• History of seeking treatment at numerous hospitals, clinics, and doctors’ offices, possibly even in different cities
• Reluctance by the patient to allow health care professionals to meet with or talk to family, friends, or prior health care providers
• Problems with identity and self-esteem
• More comfortable being in the hospital than you might think
• Medical knowledge may be quite extensive from many hospitalizations or prior work

There are many forms this disorder may take: feigning cancer, cardiac disease, skin disorders, infections, bleeding disorders, metabolic disorders, chronic diarrhea, and many more.

What causes Munchausen syndrome?

The exact cause of Munchausen syndrome is not known, but researchers believe both biological and psychological factors play a role in the development of this syndrome. Some theories suggest that a history of abuse or neglect as a child, or a history of frequent illnesses requiring hospitalization, might be factors associated with the development of this syndrome. Researchers also are studying the possible link with personality disorders, which are common in individuals with Munchausen syndrome.

How common is Munchausen syndrome?

There are no reliable statistics regarding the number of people in the United States who suffer from Munchausen syndrome, but it is considered to be rare. Obtaining accurate statistics is difficult because of dishonesty in representation. In addition, people with Munchausen syndrome tend to seek treatment at many different health care facilities, which causes misleading statistics. These patients are more often males (2:1), but in other factitious disorders, females are more frequent.

While Munchausen syndrome can occur in children, it most often affects young adults.

How is Munchausen syndrome diagnosed?

Diagnosing Munchausen syndrome is very difficult because of the dishonesty that is involved. Doctors must rule out any possible physical and mental illnesses, and often use a variety of diagnostic tests and procedures before considering a diagnosis of Munchausen syndrome.

If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist — mental health professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use a thorough medical history and physical, laboratory imagery, and psychological assessment tools to evaluate a person for Munchausen syndrome. The doctor bases his or her diagnosis on the exclusion of actual physical or other psychiatric disorders, and his or her observation of the patient’s attitude and behavior. However, personality concerns are prominent and can make it that much more confusing to sort out organic from factitious etiologies.

Questions to be answered include:

• Do the patient's reported symptoms make sense in the context of all test results and assessments?
• Do we have collateral information from other sources that confirm the patient's information? (If the patient does not allow this, this is a helpful clue.)
• Is the patient willing to take the risk for more procedures and tests than you would expect?
• Are treatments working in a predictable way?

The doctor then determines if the patient’s symptoms point to Munchausen syndrome as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Test Revision (DSM-IV-TR), which is the standard reference book for recognized mental illnesses in the United States.

How is Munchausen syndrome treated?

Although a person with Munchausen syndrome actively seeks treatment for the various disorders he or she invents, the person often is unwilling to admit to and seek treatment for the syndrome itself. This makes treating people with Munchausen syndrome very challenging, and the outlook for recovery poor. If caretakers can protect the patient from self-harm and educate him or her about consequences that can occur, it may be helpful. Trying to reduce his or her care through only one physician, or two working closely together (psychiatrist and internist), is also suggested.

When treatment is sought, the first goal is to modify the person’s behavior and reduce his or her misuse or overuse of medical resources. Once this goal is met, treatment aims to work out any underlying psychological issues that might be causing the person’s behavior or help him or her find solutions to housing or other social needs.

As with other factitious disorders, the primary treatment for Munchausen syndrome is psychotherapy (a type of counseling). Treatment likely will focus on changing the thinking and behavior of the individual (cognitive-behavioral therapy). Family therapy also might be helpful in teaching family members not to reward or reinforce the behavior of the person with the disorder, but often the person is estranged from his or her family.

There are no medicines to treat factitious disorders themselves. Medicine might be used, however, to treat any related disorder—such as depression, anxiety, or a personality disorder. The use of medicines must be carefully monitored in people with factitious disorders due to the risk that the drugs might never be picked up from the pharmacy or might be used in a harmful way.

What are the complications of Munchausen syndrome?

People with Munchausen syndrome are at risk for health problems (or even death) associated with hurting themselves or otherwise causing symptoms. In addition, they might suffer from reactions or health problems associated with multiple tests, procedures, and treatments, and are at high risk for substance abuse and suicide attempts.

What is the prognosis (outlook) for people with Munchausen syndrome?

Some people with Munchausen syndrome suffer one or two brief episodes of symptoms. In most cases, however, the disorder is a chronic, or long-term, condition that can be very difficult to treat. Further, many people with Munchausen syndrome deny they are faking symptoms and will not seek or follow treatment. Even with treatment, it is more realistic to work toward managing the disorder rather than to try curing it. Avoiding unnecessary, inappropriate admissions to the hospital, testing, or treatment is important.

Can Munchausen syndrome be prevented?

There is no known way to prevent this disorder. However, it might be helpful to begin treatment in people as soon as they begin to have symptoms.

References

Phillips KA. Munchausen Syndrome. http://www.merckmanuals.com Accessed December 14, 2010.

Huffman JC, Stern TA. The diagnosis and treatment of Munchausen’s syndrome. General Hospital Psychiatry.2003;25:358–363. http://www.sciencedirect.com

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