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An Understanding of Munchausen Syndrome

Lorna is a qualified psychologist and writer with an interest in drawing awareness to and informing others of mental health issues.

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.

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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.

Causes

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.

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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.

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Symptoms

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.

Diagnosis

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.
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Treatment

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

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.

Therapy

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.

Hospitalisation

A temporary stay in a mental health hospital may be necessary for those whose condition is becoming life-threatening.

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Self-Help

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.

Final Thoughts

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.

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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.

References

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2019 Lorna Lamon

Comments

Lorna Lamon (author) on April 04, 2020:

It is frightening Peggy and they are very aware of what they are doing. They do need help and a better understanding of the disorder is also necessary. However, in my opinion it is definitely child abuse and children need to be protected at all costs. Thank you for commenting - appreciated. Take care.

Peggy Woods from Houston, Texas on April 04, 2020:

I once saw a movie where Munchausen Syndrome by Proxy was happening. Bad as Munchausen Syndrome is for an adult to suffer, I think harming a child or some other person, is even worse. That certainly is a severe form of psychological illness.

Lorna Lamon (author) on February 29, 2020:

Hello Vidya, Unfortunately this is a difficult disorder to diagnose and treat. However, I entirely agree, when it comes to protecting children we have to be extremely vigilant. Thank you for visiting and I appreciate your comments.

VIDYA D SAGAR on February 29, 2020:

Very interesting and informative article Lorna. I don't know such a disorder did exist though I had seen it portrayed in one or two series that I watched. Yes it is quite dangerous when kids are involved and should be treated urgently. Thanks for sharing.

Lorna Lamon (author) on January 18, 2020:

Hi Lorna, It's a very difficult illness to understand and quite complicated. There is also a lot of sadness attached to this illness and more research is needed in order to properly treat the condition. Lovely to see you and thank you for commenting.

Lorna Lamon on January 18, 2020:

Hi Lorna, It is an extremely difficult illness to understand and difficult to treat. Lovely to see you and thank you for commenting.

LornsA178 on January 17, 2020:

I never heard of such mental illness before. Somewhat the same with health anxiety. Thanks for this great article Lorna!

Lorna Lamon (author) on November 20, 2019:

It's a very complicated illness and one that needs more research Lynne, however, I have tried to explain it to the best of my ability and I am glad you found it useful. I always appreciate your insight and comments.

Lynne Samuel from Malaysia on November 19, 2019:

Very informative. I didn't know such an illness exists, which now that I know explains a lot. There could have been people in my life suffering from this illness and would benefit from going to the right kind of doctor. Thank you, Lorna.

Lorna Lamon (author) on October 28, 2019:

Hi Wendy, Thank you for visiting and for your kind comments. CBT does refer to Cognitive Behavioral Therapy and is used to treat this condition. Unfortunately Mental Health does not receive the attention or funding it should and sadly the stigma of having a mental health condition still exists. I feel with awareness comes understanding and empathy. Glad you enjoyed the article.

TripleAMom from Florida on October 27, 2019:

Hi Lorna, excellent article. I'm an LCSW in private practice and this is one disorder I have not worked with. When you said CBD therapy did you mean CBT (Cognitive Behavioral Therapy) or is CBD another type of therapy that I am not identifying? Just curious.

Mental health is still such a stigma, we need to be getting this info out there.

Lorna Lamon (author) on October 24, 2019:

Hi JC, Thank you for your question.

There are no connections between Munchausen Syndrome and ARFID. Even though ARFID does not match the criteria for traditional eating disorders, those diagnosed with the disorder will eat only a limited range of foods, and may develop phobias around trying new foods. This disorder is not related to body issue concerns or attention seeking. It is thought to be more prevalent in children with Autism, and may be the result of eating junk food as a child which is highly addictive.

I'm glad you enjoyed the article.

JC Scull from Gainesville, Florida on October 23, 2019:

Well...I guess I am full of questions today!!!

One more question for you.

Are there any connections between Munchausen Syndrome and ARFID?

Awesome article.

Lorna Lamon (author) on September 23, 2019:

Thank you for visiting Prantika and commenting. This is a difficult disorder to diagnose and treat and I agree that with awareness comes understanding.

Prantika Samanta from Kolkata, India on September 23, 2019:

Thank you for such a great article with so much details. I have heard about the disorder but did not much about it. Self-help is crucial along with medications and therapy. This article will definitely help create awareness.

Lorna Lamon (author) on September 21, 2019:

Hi Li-Jen, Glad you enjoyed the article. I feel there is still a stigma attached to Mental health, and I hope these articles offers an insight into extremely difficult conditions. Thank you for visiting and commenting.

Li-Jen Hew on September 21, 2019:

Hi Lorna. Good of you for not shying away from a topic regarding mental health! I hope that mental illness does not really take away who we are but is seen as a condition that's hard to control. Thank you for this article!

Lorna Lamon (author) on September 19, 2019:

Sadly this can be the case and until more research into this disorder is carried out then innocent people will suffer. There are so many facets to this disorder which makes it difficult to diagnose and in my years as a psychologist I have never come across it. Thank you for commenting Patricia.

Patricia Scott from North Central Florida on September 19, 2019:

This is a sad and often mis-diagnosed condition. Sometimes when doctors cannot explain an illness they want to call it Munchausen. Not to say that it does not occur because it does. But I had a friend who was targeted because they could not diagnose her child's condition and it almost destroyed the lives of the family. The child was finally diagnosed 4 years later with a rare medical condition that he lives with decades later. I wrote about her story here on HubPages. So yes...this is a real and scary disorder but can be used as a catch all at times. Thank you for sharing. ps

Lorna Lamon (author) on September 19, 2019:

Many thanks for commenting Dora. It is a terrible condition and not enough information is readily available. I'm glad this article gave you the information you didn't have.

Dora Weithers from The Caribbean on September 19, 2019:

Thanks for these details on this terrible condition. Learned so many new facts about it.

Lorna Lamon on September 19, 2019:

Thank you for your kind comments Neela and I am glad you found the article informative.

Neela S from India on September 18, 2019:

Beautiful article... so very informative...

Lorna Lamon (author) on September 18, 2019:

Thank you for your kind comments Lora. It is unfortunate that not only research of this disorder but awareness is sadly lacking. If it can be diagnosed early then the necessary steps can be put in place, however, there are quite a few variations of the disorder which make it so difficult to diagnose and treat.

Lora Hollings on September 17, 2019:

This is a fascinating article, Lorna. As I was reading, I couldn't help but wonder how many people could be suffering from this serious disorder and not get the treatment that they need. As you state in your article, because they go to such lengths to not only deceive others but to continue pursuing their maladaptive behavior, they may at some point become victims of their illness shortening their own lives or even the lives of others. I hope that more research is done and that they can find treatments that can help break this pattern of behavior before it ends in tragedy. Wonderfully written! Thanks for sharing.

Lorna Lamon (author) on September 16, 2019:

I believe that there is more awareness regarding Munchausen by Proxy, however, more research needs to be undertaken into this mental condition. Many thanks for commenting.

Liz Westwood from UK on September 16, 2019:

I first came across this with the case of Beverley Allitt, a nurse responsible for the deaths of babies in her care nearly 30 years ago. Munchhausen by proxy was mentioned and she has been detained in a secure psychiatric unit ever since. Your article gives a clear explanation of the syndrome and its different aspects.

Lorna Lamon (author) on September 15, 2019:

Hi Pamela, I have friends in the medical field who have come across Munchausen by Proxy cases, and I feel these are the most tragic. Not enough is know about the causes and how extreme this disorder can be. I hope that with ongoing research they will be able to find the answers. Many thanks for commenting.

Lorna Lamon (author) on September 15, 2019:

It does have similarities Shey, however, psychologically much more severe. Thank you for visiting.

Lorna Lamon (author) on September 15, 2019:

It is a sad disorder Kathy and extremely difficult to treat. I hope with ongoing research they will find an answer. Thank you for commenting.

Pamela Oglesby from Sunny Florida on September 15, 2019:

While I have heard of this disorder, to my knowledge I never ran across a patient with this disorder when I was working as a RN. This is really a sad disease and it does not sound like many really get treated or recover.

You wrote a very thorough, well-written article with numerous facts that were new to me.I think this is a sad disease for the patient and any family they might have.

Shey Saints from Philippines on September 15, 2019:

Wow. I thought this is the same with hypochondria. Glad I read this for additional knowledge.

Kathy Henderson from Pa on September 15, 2019:

A very sad disorder I had a patient who suffered with this years ago. If only they could be released from this pain and their hearts could be quieted. :(

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