Munchausen syndrome (Factitious Disorder Imposed on Self) – Overview

Definition

Munchausen syndrome (also known as factitious disorder imposed on self) is a mental health disorder where you falsify, exaggerate, or induce physical, emotional or cognitive disorders. 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 getting medications or financial gain. This is distinguishable from malingering which is where someone exaggerates or fakes an illness to, for example, get out of work.

If you have Munchausen syndrome, you may undergo painful or risky medical tests and operations in order to get the sympathy and special attention given to people who are truly ill. You may secretly injure yourself to cause signs of illness. You may add blood to your urine, or use a rubber band to cut off circulation to a limb. Some people will cut or burn themselves, poison themselves, reopen wounds, rub feces or dirt into a wound to cause infection, or eat food contaminated with bacteria.

Munchausen Syndrome is named after Baron von Munchausen, an 18th century German officer who was known for embellishing the stories of his life and experiences. Most symptoms in people with this disorder are related to physical illness symptoms such as chest pain, stomach problems, or fever rather than those of a mental disorder. While some symptoms are self-imposed, others are exaggerated. For example, you may embellish symptoms about vision loss, seizures, joint pain, headaches, weakness, vomiting and diarrhea.

Epidemiology

Whether the epidemiology of factitious disorder differs in countries other than the United States is unclear. Case reports indicate that the diagnosis has been made in eastern Europe, Mediterranean countries, Asia, Africa, and South America. Of patients referred to the consultation-liaison service of a large teaching hospital in Toronto, 0.8% (10 of 1288) had factitious disorder. Physicians surveyed in Germany regarding the 1-year prevalence of factitious disorder among their patients provided an average estimate of 1.3%.

Types of Munchausen Syndrome

The mental condition is categorised into four different types.

1. Factitious disorder with mostly psychological symptoms

Individuals who fall under this type tend to mimic behavioural patterns of a mental disorder such as schizophrenia. The individual can appear confused, make absurd statements and report hallucinations, such as hearing voices. Ganser syndrome, also termed as prison psychosis falls under this category and the individuals tend to have episodes of abnormal behaviour that are usually displayed by individuals with real mental disorders.

2. Factitious disorder with mostly physical symptoms

Individual under this category tend to claim that they have symptoms pertaining to physical illness such as chest pain, stomach problems, or fever.

3. Factitious disorder with both psychological and physical symptoms

Individuals who fall under this category tend to display symptoms of both physical and mental illness.

4. Factitious disorder not otherwise specified

People who fall under this category do not fabricate the symptoms of severe illness on themselves but on others. The disorder is termed as factitious disorder by proxy and also, Munchausen’s syndrome by proxy. It is mostly reported in mother, with some rare cases in fathers too who harm their children to received attention.

Types of behaviour

People with Munchausen’s syndrome can behave in a number of different ways, including:

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 a stomach ache

Actively trying to get 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’s discovered they’re lying, they may suddenly leave hospital and move to another area.

People with Munchausen’s syndrome can be very manipulative and, in the most serious cases, may undergo painful and sometimes life-threatening surgery, even though they know it’s unnecessary.

Munchausen syndrome risk factors

Several factors may increase the risk of developing factitious disorder, including:

• Childhood trauma, such as emotional, physical or sexual abuse
• A serious illness during childhood
• Loss of a loved one through death, illness or abandonment
• Past experiences during a time of sickness and the attention it brought
• A poor sense of identity or self-esteem
• Personality disorders
• Depression
• Desire to be associated with doctors or medical centers
• Work in the health care field

Factitious disorder is considered rare, but it’s not known how many people have the disorder. Some people use fake names to avoid detection, some visit many different hospitals and doctors, and some are never identified all of which make it difficult to get a reliable estimate.

Causes of Munchausen syndrome

The cause of factitious disorder is not known. Risk factors for developing this include childhood trauma, depression, personality disorders, among others.

Factitious disorder usually presents as recurrent episodes of deceptive behavior. The onset of factitious disorder is typically in early adulthood, often after a person has been hospitalized for a medical or psychiatric condition. Factitious disorder imposed on another person, or also known as Munchausen by proxy, may become apparent after the hospitalization of the individual’s victim.

Munchausen syndrome symptoms

Signs of syndrome may include:

• Telling dramatic stories about several medical problems, often with little documentary evidence
• Frequent hospitalization
• Multiple scars
• Symptoms that are inconsistent or vague and that do not match the results of tests
• Symptoms that unexpectedly get worse, for no logical or medically explicable reason
• A desire to undergo medical tests and surgical procedures
• A surprisingly good textbook knowledge of diseases and conditions
• Visiting many different doctors and hospitals
• Unwillingness to allow the health care provider to talk to friends or family
• Frequently asking for painkillers and other drugs
• Having very few or no visitors when in hospital

If the person is challenged about their story, they may become defensive or aggressive, or they may leave the hospital or health care provider and never return.

Complications of Munchausen syndrome

A person with Munchausen syndrome is at risk of many complications including:

• Side effects from prescription medicines, including overdose
• Complications from poisoning or self-harm practices
• Complications from medical procedures or surgeries
• Death from self-harm or complications of medical intervention

Diagnosis and test

Diagnosing syndrome can be very hard because of all of the dishonesty associated with the disorder. Doctors must first rule out any possible physical and mental illnesses before considering a diagnosis of Munchausen syndrome.

Additionally, in order to be diagnosed with Munchausen syndrome/factitious disorder imposed on self, the following four criteria must be met:

• Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception
• The individual presents himself or herself to others as ill, impaired, or injured
• The deceptive behavior is evident even in the absence of obvious external rewards
• The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder

Treatment and medications

Although people with Munchausen syndrome may actively obtain treatment for the numerous disorders they create, they typically do not want to admit to and seek treatment for the actual syndrome.

People affected with factitious disorder imposed on self deny they are faking or causing their own symptoms, so obtaining treatment tends to be dependent on somebody else suspecting that the person has this disorder, persuading the individual to receive treatment, and encouraging the person to stick to treatment goals.

Psychotherapy

The main treatment goal for Munchausen syndrome is to change the person’s behavior and lessen the misuse/overuse of medical resources. Treatment usually consists of psychotherapy (mental health counseling).

During treatment sessions, the therapist may try to challenge and assist in changing the thinking and behavior of the person (this is known as cognitive behavioral therapy). Therapy sessions may also try to uncover and address any underlying psychological issues that may be causing the person’s behavior.

In addition to individual therapy, treatment may also include family therapy. Teaching family members how to properly respond to a person diagnosed with Munchausen syndrome can be helpful.

The therapist can teach family members not to reward or reinforce the behavior of the person with the disorder. This may make lower the person’s need to appear sick since they may no longer be receiving the attention they are seeking.

Medication

Medication is typically not used in the treatment of FDIS. If the person is also experiencing anxiety or depression, however, a doctor may prescribe medication, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, and tricyclic antidepressants (TCAs).

If this is the case, it is important that the person is closely monitored because of the higher likelihood of using these medications to purposely hurt themselves.

Prevention of Munchausen syndrome

Because the cause of Munchausen syndrome is unknown, formulating a prevention strategy is difficult. Some medical facilities and healthcare practitioners have attempted to limit hospital admissions for Munchausen patients by sharing medical records. While these attempts may curb the number of hospital admissions, they do not treat the underlying disorder and may endanger Munchausen sufferers that have made themselves critically ill and require treatment. Children who are found to be victims of persons with Munchausen by proxy syndrome should be immediately removed from the care of the abusing parent or guardian.