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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, they have 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. 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
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 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
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.
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 a 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 mental illness, and his or her observation of
the patient’s attitude and behavior.
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 (DSM-IV), 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.
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 them 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.
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