An Understanding of Munchausen Syndrome
Sometimes referred to as ‘Factitious Disorder’, Munchausen Syndrome is a rare psychological and behavioural condition where the person feigns illness or produces symptoms of illness with the intention of having people care for them, or of being the centre of attention. The condition is named after a German aristocrat, Baron Munchausen, who became famous for fabricating and embellishing tales of his war exploits which he made in order to receive praise and attention.
The condition is most likely to occur in adults aged 20-40 years and is more prevalent in men with few family relationships. Women diagnosed with the condition tend to be very knowledgeable about the health care system and health care in general. Munchausen Syndrome differs from hypochondria and malingering in that people who have hypochondria do believe they are ill but do not manipulate others, and people who malinger pretend to be ill to gain a benefit such as trying to obtain compensation.
It is thought that someone suffering with Munchausen Syndrome is unable to achieve a real sense of their own identity, which may result in them not being able to form and establish meaningful relationships in their lives. In order to overcome how this makes them feel, the person by ‘pretending to be sick’ will adopt an identity which gives not only unconditional support but acceptance from others. This is further reinforced if they are admitted to hospital, where they see themselves as having a place in a social network where they can feel validated.
Even though there is no specific cause for Munchausen Syndrome, this mental disorder is thought to be a combination of social stressors, distorted thinking processes and biological vulnerabilities which include:
- Childhood abuse, either physical or sexual abuse.
- Being neglected as a child.
- Having a serious illness as a child which affected them negatively.
- Increased need for control.
- Very low or extremely high self-esteem.
- Loss of sense of self.
- Antisocial and has a tendency to lie.
- Lack of empathy.
Munchausen Syndrome is extremely complex and more research needs to be carried out in order to better understand the condition. Various personality disorders which may be linked to Munchausen Syndrome are:
Narcissistic Personality Disorder
Where the person is constantly at war with their mind, viewing themselves as being exceptionally special yet fearing they are worthless. If attending a clinic or hospital, they will expect to be given priority over all other patients, basking in the glory of being the centre of attention.
Antisocial Personality Disorder
A real sense of power and control is achieved through the manipulation of others. The person will manipulate and deceive doctors or health care staff to achieve this outcome.
Borderline Personality Disorder
The ongoing struggle to control how they feel, resulting in constantly swinging between positive and negative views of other people.
Types of Munchausen Syndrome
Munchausen Syndrome by Internet
Although relatively new, Munchausen Syndrome by Internet is where a person joins a support group on the Internet for people with a serious health condition, such as cancer, and then claims to have the illness themselves. Unfortunately, these actions have a negative impact on support groups as people with a genuine health condition feel angry and betrayed in discovering they have been lied to. There are various signs that someone’s posts are not genuine, such as:
- Reporting on symptoms that are extremely severe and most people would not experience.
- Claiming to have attended a certain hospital that does not exist.
- In a bid to attract more sympathy they pretend to be unconcerned when they discuss their issues.
Munchausen Syndrome by Proxy
Poorly understood and extremely controversial, Munchausen Syndrome by Proxy is now emerging as a serious form of child abuse which comprises both physical and psychological abuse and medical neglect. “By proxy” means “through a substitute”, and in this case the parent or caretaker of the child will either make up fake symptoms or cause real symptoms to make it appear the child is ill.
Most commonly seen in mothers of children under the age of 6 where the mother has an overwhelming craving for attention and sadly may even risk the life of her child to achieve it. Very often, doctors and healthcare workers fail to spot the signs as the mother appears to be caring and attentive to their child. As a result, many cases are undetected due to the person’s ability to induce symptoms in the child and manipulate doctors.
It is only when the child is a frequent visitor to the clinic or hospital presenting with illnesses and injuries that doctors begin to suspect child abuse. Also, their suspicions may be aroused if a child becomes worse when under the care of the mother and improves under medical care. In such cases the child is removed from the abuser, who may face criminal charges. Psychiatric counselling is usually recommended for those people who have Munchausen Syndrome by Proxy.
There are various symptoms and warning signs which indicate that a person may have Munchausen Syndrome, which include:
- Symptoms that are at odds with the test results.
- The person’s knowledge of medicine and medical procedures is excellent.
- Painful tests and procedures are willingly undergone by the person.
- Visiting hospitals in different areas on a frequent basis.
- Their claim to have complex or serious medical conditions is not apparent in their medical history; however, in order to explain this, the person will say they have spent a long time out of the country.
Patterns of Behaviour
Feigning or inducing illnesses by people with Munchausen Syndrome are undertaken in four ways, which are:
- Self-infliction – the person may poison themselves, cut or burn themselves, or overdose on medication. In some instances they have been known to eat food that has been contaminated with bacteria.
- Aggravate pre-existing conditions – in this instance the person may rub dirt or faeces into wounds in order to cause an infection. They may also reopen previously healed wounds.
- Lying about symptoms – the person may pretend to have a seizure or claim to be suffering with a severe headache. These symptoms are deliberately chosen as they are difficult to disprove.
- Tampering with test results – in some cases the person may add blood to their urine samples or heat a thermometer to suggest they have a fever.
A diagnosis of Munchausen Syndrome can be extremely challenging as those with the condition are skilled at exploiting and manipulating the concerns of health professionals, very often lying in order to achieve their goal. A detailed study of the medical history of the person has to be undertaken in order to rule out any inconsistencies between their actual medical history and their claimed medical history. Family and friends may also be consulted regarding the person’s claims about their medical history.
Clinical tests such as taking the person’s blood will be carried out to check for evidence of self-inflicted illness. The blood will be checked for traces of medication which the person should not be taking and could explain their symptoms. Faking illness for financial gain or wanting access to painkillers will also need to be ruled out. A diagnosis of Munchausen Syndrome will only be confidently made if the doctor is convinced of the following:
- The person’s main motivation is to be seen as ill.
- There is evidence of inducing or fabricating symptoms.
- There is no other reason or explanation for their behaviour.
Unfortunately, treatment for Munchausen Syndrome can be very difficult, not least because the person rarely admits to having the condition. To further complicate matters, many people with Munchausen Syndrome suffer medical complications from the many illnesses they have induced; therefore, treatment of the person is initially aimed at relieving the claimed symptoms and any other injury made by the person themselves in a bid to induce symptoms. Realistically, treatment should be aimed at working towards managing the syndrome as opposed to trying to cure it.
Medication will only be used if the person is also suffering from depression or anxiety, and it is always advisable to closely monitor the person when taking medication as they may use it to harm themselves.
Changing the person’s behaviour, ultimately limiting their misuse of medical resources, is the main treatment goal for someone with Munchausen Syndrome. CBD therapy will allow the person to challenge their unhealthy thought processes and replace them with healthy, less destructive thought processes. During therapy, other mental health disorders such as anxiety and depression will also be addressed.
Family therapy will also be recommended as a full understanding of this condition is so necessary in helping family members cope and become a strong support network.
A temporary stay in a mental health hospital may be necessary for those whose condition is becoming life-threatening.
Professional treatment should also be combined with lifestyle and home care tips such as:
- Primary doctor – because of the nature of the condition it is recommended that the person has one primary doctor to manage their treatment plan.
- Resist urges – in many cases there is always the urge to seek out new medical professionals in a different part of the country. These urges can be extremely powerful, so it is important that they are discussed with the person’s therapist who will help them overcome these urges.
- Connecting – forming friendships and connecting with others is extremely difficult, therefore a trusted family member should adopt the role of confidant and be someone to share enjoyable times with.
- Treatment plan – it is so important to attend all therapy sessions and take any medications as directed. The therapist will teach the person coping strategies which will help the person control their emotions and stop them harming themselves.
Munchausen Syndrome is a severe mental illness where the person will feel compelled to harm themselves in a variety of ways in order to achieve a sense of self and acceptance from others. Difficult to diagnose, treatment may be refused by the person who, in some cases, may even instigate lawsuits against the medical professional as they cannot accept the diagnosis. It has been thought this can stem from feelings of resentment or may even be a way to continue their ruse in the courtroom.
It should be noted that people with Munchausen Syndrome do have insight into their disorder and are aware they are fabricating their illness. Sadly, the long-term prognosis is poor as most people will not admit to their maladaptive behaviours. Ongoing research in this field will hopefully result in a better understanding of the condition and how best to treat it.
© 2019 Lorna Lamon