Encyclopaedia


Munchausen's syndrome

Introduction

What is Munchausen's syndrome?

Munchausen's syndrome is a rare psychological and behavioral condition where someone pretends to be ill, or sometimes induces symptoms of illness in themselves. Munchausen's syndrome is also known as factitious disorder.

Munchausen's syndrome is named after a German aristocrat, Baron Munchausen, who became famous for telling wild, unbelievable tales about his exploits and past.

People with Munchausen's syndrome can show different types of behaviour, such as:

  • Pretending to have psychological symptoms: for example, claiming to hear voices or claiming to see things that are not really there.
  • Pretending to have physical symptoms: for example, claiming to have chest pain or stomach ache.
  • Actively seeking to make themselves ill: such as deliberately infecting a wound by rubbing dirt into it.

Some people with Munchausen's syndrome may spend years travelling from hospital to hospital faking a wide range of illnesses. When it is discovered that they are lying, they may suddenly leave hospital and move to another district.

People with Munchausen's syndrome know they are fabricating symptoms and can be highly manipulative, but their behaviour brings them no obvious benefit. Instead, they are often willing to undergo painful, and sometimes, life-threatening surgery even though they know it is unnecessary. There have been several cases where people have died due to complications arising from treatment that was not actually necessary.

How common is Munchausen's syndrome

It is not known exactly how common Munchausen's syndrome is. Some experts believe that Munchausen's syndrome is under-diagnosed because many people with the condition may succeed in deceiving medical staff. But it is also possible that cases of Munchausen's syndrome are over-diagnosed because the same person could travel from hospital to hospital.

A fairly large study that was carried out in a Canadian hospital estimated that, out of 1,300 patients, 10 were faking the symptoms of illness.

Who is affected

There appears to be two distinct groups of people who are affected by Munchausen's syndrome:

  • women who are 20 to 40 years of age, who often have a background in healthcare, such as working as a nurse or a medical technician
  • unmarried white men who are 30 to 50 years of age

It is unclear why this is the case.

Outlook

The outlook for Munchausen's syndrome is mixed. Some people (usually women) with the condition will experience one or two episodes before admitting that they need medical help. However, others (usually men) will deny that they have a problem and therefore never get the medical help that they need.

 

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Symptoms

Warning signs of Munchausen's syndrome

Warning signs that somebody may have Munchausen's syndrome include:

  • frequent visits to hospitals in different areas,
  • claiming to have a history of complex and serious medical conditions, yet there is little documentary evidence to support this; a common ruse is for people to claim they have spent a long time out of the country,
  • symptoms that do not correspond to the results of tests,
  • symptoms that get worse for no apparent reason,
  • the person has a extremely good medical knowledge,
  • the person receives very few, or no, visitors in hospital; many people with Munchausen's syndrome adopt a solitary lifestyle and have little contact with any friends of family,
  • a willingness to undergo, often painful or dangerous, tests and procedures, report symptoms that are vague and inconsistent, or report a pattern of symptoms that are ‘textbook examples’ of certain conditions
  • tell highly unbelievable and often very elaborate stories about their past, such as claiming to be a decorated war hero or that their parents are fantastically rich and powerful

Patterns of behaviour in Munchausen's syndrome

There are four main ways in which people with Munchausen's syndrome can feign or induce illnesses which are outlined below.

  • Lying about symptoms - often they choose symptoms that are hard to disprove, such as having severe headaches or they may pretend to have a seizure or pass out.
  • Tampering with test results - such as heating thermometers to suggest fever or adding blood to urine samples.
  • Self-infliction - they may cut or burn themselves, poison themselves with drugs or an overdose of medication, or eat food that has been contaminated with bacteria.
  • Aggravate pre-existing conditions - such as rubbing dirt or dog faeces into wounds to cause an infection, or reopen previously healed wounds.

Munchausen's by internet

A relatively new condition has been labelled Munchausen's by internet. This is where a person joins an internet support group for people with a serious health condition, such as cystic fibrosis or leukaemia, and then claims to have the illness themselves.

While these actions may only be confined to the internet, they can have an incredibly destructive effect on support groups and online communities. People with genuine health conditions have reported feelings of betrayal and anger upon discovering that they have been lied to.

One expert on Munchausen’s by internet has compiled a list of warning signs that indicate that someone may be affected by the condition: 

  • Their posts and messages seem to contain large chunks of information that appear to have been directly copied from health websites, such as NHS Choices.
  • They report experiencing symptoms that appear to be much more severe than most people would experience, such as having a constant blinding headache in a support group for people with migraines.
  • They claim to have near-fatal bouts of illness followed by a miraculous recovery.
  • They make fantastic claims which they later contradict or which others disprove at a later date. For example, they may claim to be attending a certain hospital that does not actually exist. 
  • They claim to have continual dramatic events in their life, such as loved ones dying or being the victim of a violent crime, particularly when other group members have become a focus of attention.
  • They feign an attitude of unconcern when they talk about serious problems, probably to attract attention and sympathy.
  • Other ‘people’ claim to post on their behalf, such as a parent or partner, but they use exactly the same pattern of writing.

 

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Causes

Many people with Munchausen's syndrome refuse to co-operate with any sort of psychiatric treatment or psychological profiling. Because of this, there is little available evidence about the possible causes of the condition.

Theories

There are two main theories about the root cause of Munchausen's syndrome. The condition may be the result of:

  • emotional trauma (deeply upsetting experiences) that occurred during a person’s childhood
  • a personality disorder: a mental health condition that causes patterns of abnormal thinking and behaviour

The two theories are discussed in more detail below.

Childhood trauma

Some experts have suggested that many cases of Munchausen's syndrome may be the result of parental neglect and abandonment, resulting in feelings of considerable childhood trauma.

As a result of this trauma, a person may have unresolved issues with their parents that cause them to fake illness. They may do this for a number of reasons, for example because they have:

  • a compulsion to punish themselves (masochism) by making themselves ill because they feel unworthy
  • a need to feel important and be the centre of attention
  • a need to pass responsibility for their wellbeing and care onto other people

There is also some evidence to suggest that people who have had extensive medical procedures, or received prolonged medical attention during childhood or adolescence, are more likely to develop Munchausen's syndrome when they are older.

This may be because they associate their childhood memories with a sense of being cared for. As they get older they try to obtain the same feelings of reassurance by pretending to be ill.

Personality disorders

There is some evidence that many people with Munchausen's syndrome have a personality disorder.

Personality disorders are a type of mental health condition where an individual has a distorted pattern of thoughts and beliefs about themselves and others. This leads them to behave in ways that most people would regard as disturbed and abnormal.

One theory is that there may be people with Munchausen's syndrome who have an antisocial personality disorder that causes them to take pleasure in manipulating and deceiving doctors. They may see doctors as authority figures and by tricking them it may give them a sense of power and control.

 

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Diagnosis

Diagnosing Munchausen's syndrome can be very challenging for medical professionals. People with the condition are often accomplished liars and are skilled at manipulating and exploiting a doctor's concern for their patient, and the doctor's natural curiosity in investigating unusual medical conditions.

If a health professional does suspect a person may have Munchausen's syndrome they will usually make a detailed study of that person's health records to look for any inconsistencies between their claimed and actual medical history. They may also attempt to talk to their family and friends to see if their claims about their past are true.

Health professionals can also run a number of clinical tests to check for evidence of self-inflicted illness or tampering of clinical test. For example, the person's blood can be checked for traces of medication that the person should not be taking, but which could explain their symptoms.

Doctors will also want to rule out other possible motivations for their behaviour, such as faking illness for financial gain, or because they want access to strong painkillers.

A diagnosis of Munchausen's syndrome can usually be confidently made if there is:

  • clear evidence of fabricating or inducing symptoms,
  • the person prime motivation is to be seen as sick, and
  • there is no other likely reason or explanation for their behaviour.
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Treatment

Treating Munchausen's syndrome can be very difficult because most people refuse to admit that they have a problem and will not co-operate with suggested treatment plans.

Non-confrontational approach

As a result of this, some experts have suggested that healthcare professionals adopt a gentle, non-confrontational approach. Therefore, rather than directly accusing the person of lying, they may suggest to them that they have complex health needs and may benefit from a referral to a psychiatrist. However, this suggestion is often rejected.

Other experts argue that a person with Munchausen's syndrome should be confronted directly with a question about why they have lied and whether they suffer from stress and anxiety.

One of the biggest ironies surrounding Munchausen's syndrome is that people with this condition have a mental health condition and are genuinely ill, but they will often only admit to having a physical illness. 

If a person admits to their behaviour, they can be referred to specialist psychiatric services for further treatment (see below).

If the person does not admit to lying, most experts in the field argue that the doctor in charge of their care should minimise any future medical contact with them. This is because the doctor-patient relationship is based on trust, so if a doctor has compelling evidence that they can no longer trust a patient, they are unable to continue as that person’s doctor.

Psychiatric treatment

If someone admits that they have a problem, and co-operates with treatment, it may be possible to help them to control the symptoms of Munchausen's syndrome.

There is no standard treatment for the condition, but a combination of psychoanalysis and cognitive behavioural therapy (CBT) has shown some success in helping people to control their symptoms.

Psychoanalysis

Psychoanalysis is a type of psychotherapy that is based on the theories of Sigmund Freud. Freud suggested that unconscious beliefs or motivations, often formed during early childhood, can be the cause of many psychological conditions. Psychoanalysis attempts to uncover and resolve these unconscious beliefs and motivations.

See the topic about Psychotherapy for more information about psychoanalysis.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) works by helping people to identify unhelpful and unrealistic beliefs and behavioural patterns that they may have. A specially trained therapist teaches the person receiving CBT ways of replacing the unrealistic beliefs with more realistic and balanced ones.

See the topic about CBT for more information about the technique.

Family therapy

People with Munchausen's syndrome who are still in close contact with their family may also benefit from having family therapy. Family therapy involves the person with Munchausen's syndrome and their close family members discussing how the condition has affected the family and the positive changes that the person and their family can make.

Members of the family can also be advised about effective ways to avoid ‘reinforcing’ the person’s abnormal behaviour. For example, they can be taught to recognise when the person is trying to play ‘the sick role’ and then avoid showing them concern or offering support. 

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Selected links

NHS Direct Wales Encyclopaedia topics

CBT

Munchausen's syndrome by proxy

Psychiatry

Psychotherapy

External Links 

Mental Health Foundation

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.

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