Munchausen Syndrome

Munchausen syndrome is a factitious disorder, a mental disorder in which a person repeatedly and deliberately acts as if they have a physical or mental illness when they are not really sick. Munchausen syndrome is considered a mental illness because it is 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 of the 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 usually refers to a factitious disorder with mostly physical symptoms, the term is sometimes used to refer to factitious disorders in general. In this article, Munchausen syndrome refers to the type of factitious disorder with mostly physical symptoms.

What Are the Symptoms of Munchausen Syndrome?

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

• 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 with others or 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 doctors to meet with or talk to family, friends, or prior doctors
• Problems with identity and self-esteem

What Causes Munchausen Syndrome?

The exact cause of Munchausen syndrome is not known, but researchers are looking at the role of biological and psychological factors in its development. Some theories suggest that a history of abuse or neglect as a child, or a history of frequent illnesses that required hospitalization might be factors in the development of the syndrome. Researchers are also studying a possible link to personality disorders, which are common in people with Munchausen syndrome.

How Common Is Munchausen Syndrome?

There are no reliable statistics regarding the number of people in the U.S. who suffer from Munchausen syndrome, but it is considered to be a rare condition. Obtaining accurate statistics is difficult because dishonesty is common with this illness. In addition, people with Munchausen syndrome tend to seek treatment at many different health care facilities, which can lead to misleading statistics.

In general, Munchausen syndrome is more common in men than in women. While it can occur in children, it most often affects young adults.

How Is Munchausen Syndrome Diagnosed?

Diagnosing Munchausen syndrome is very difficult because of, again, the dishonesty that is involved. Doctors must rule out any possible physical and mental illnesses before a diagnosis of Munchausen syndrome can be considered.

If the doctor finds no physical reason for the symptoms, or if the pattern of physical symptoms that someone describes suggests that they may be self- inflicted, then they will likely 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 specially designed interview and assessment tools to evaluate a person for Munchausen syndrome. The doctor bases their diagnosis on the exclusion of actual physical or mental illness and their observation of the patient's attitude and behavior.

How Is Munchausen Syndrome Treated?

Although a person with Munchausen syndrome actively seeks treatment for the various disorders they invent, 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 their misuse or overuse of medical resources. Once this goal is met, treatment aims to work out any underlying psychological issues that may be causing the person's behavior. Another key goal is to help patients avoid dangerous and unnecessary medical diagnostic or treatment procedures (such as surgeries), often sought from different doctors who may be unaware that physical symptoms are either being faked or self-inflicted.

As with other factitious disorders, the primary treatment for Munchausen syndrome is psychotherapy or talk therapy (a type of counseling). Treatment usually focuses on changing the thinking and behavior of the individual (cognitive-behavioral therapy). Family therapy may also be helpful in teaching family members not to reward or reinforce the behavior of the person with the disorder.

There are no medications to treat factitious disorders themselves. Medication may be used, however, to treat any related illness, such as depression or anxiety. The use of medications must be carefully monitored in people with factitious disorders due to the risk that the drugs may be used in a harmful way.

What Is the Outlook for People With 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 may suffer from reactions or health problems associated with multiple tests, procedures, and treatments; and are at high risk for substance abuse and attempts at suicide

Because many people with factitious disorders deny they are faking or causing their own symptoms and will not seek or follow treatment, recovery is dependent on a doctor or loved one identifying or suspecting the condition in the person and encouraging them to receive proper medical care for their disorder and sticking with it.

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.

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