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
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
- 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
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.
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.
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