Factitious disorder imposed on self

For feigned mental illness, see Malingering.

Factitious disorder imposed on self
Specialty	Psychiatry, psychology

Münchausen syndrome is a psychiatric disorder in which those affected feign disease, illness, or psychological trauma in order to draw attention or sympathy to themselves. It is in a class of disorders known as factitious disorders which involve "illnesses" whose symptoms are either self-induced or falsified by the patient. It is also sometimes known as hospital addiction syndrome.

Münchausen syndrome is related to Münchausen syndrome by proxy (MSbP/MSP), which refers to the abuse of another being (typically a child) as a result of having a psychological disorder.

Description

In Münchausen syndrome, the affected person exaggerates or creates symptoms of illnesses in themselves or their child/children in order to gain investigation, treatment, attention, sympathy, and comfort from medical personnel. In some extremes, people suffering from Münchausen's Syndrome are highly knowledgeable about the practice of medicine, and are able to produce symptoms that result in multiple unnecessary operations. For example, they may inject a vein with infected material, causing widespread infection of unknown origin, and as a result cause lengthy and costly medical analysis and prolonged hospital stay. The role of "patient" is a familiar and comforting one, and it fills a psychological need in people with Münchausen's. It is distinct from hypochondriasis in that patients with Münchausen syndrome are aware that they are exaggerating, whereas sufferers of hypochondriasis believe they actually have a disease.

A similar behavior called Münchausen syndrome by proxy has been documented in the parent or guardian of a child. The adult ensures that his or her child will experience some medical affliction, therefore compelling the child to suffer treatment for a significant portion of their youth in hospitals. Furthermore, a disease may actually be initiated in the child by the parent or guardian. This condition is considered distinct from Münchausen syndrome.

Origin of the name

The syndrome name derives from Baron Münchhausen (Karl Friedrich Hieronymus Freiherr von Münchhausen, 1720-1797) who purportedly told many fantastical and impossible adventures about himself, which Rudolf Raspe later published as The Surprising Adventures of Baron Münchausen.

In 1951, Richard Asher was the first to describe a pattern of self-harm, where individuals fabricated histories, signs, and symptoms of illness. Remembering Baron Münchausen, Asher named this condition Münchausen's Syndrome in his article in The Lancet in February 1951, quoted in his obituary in the British Medical Journal:

"Here is described a common syndrome which most doctors have seen, but about which little has been written. Like the famous Baron von Münchausen, the persons affected have always travelled widely; and their stories, like those attributed to him, are both dramatic and untruthful. Accordingly the syndrome is respectfully dedicated to the Baron, and named after him."

— British Medical Journal, R.A.J. Asher, M.D., F.R.C.P.

Originally, this term was used for all factitious disorders. Now, however, there is considered to be a wide range of factitious disorders, and the diagnosis of "Münchausen syndrome" is reserved for the most severe form, where the simulation of disease is the central activity of the affected person's life.

Treatment and Prognosis

Risk factors for developing Münchausen syndrome include childhood traumas, and growing up with caretakers who, through illness or emotional problems, were unavailable.

Medical professionals suspecting Münchausen's in a patient should first rule out the possibility that the patient does indeed have a disease state, but it is in an early stage and not yet clinically detectable. Providers need to acknowledge that there is uncertainty in treating suspected Münchausen patients, so that real diseases are not under treated. Then they should take a careful patient history, and seek medical records, to look for early deprivation, childhood abuse, mental illness.

Medical professionals should avoid surgical and diagnostic procedures, if they do not seem absolutely warranted – this may well anger the Münchausen patient who seeks out such procedures and attention. At the same time, providers should attempt to form an alliance with the patients, identifying with the emotional pain they may have suffered leading to this behavior.

Medical providers should consider working with mental health specialists to help treat the underlying mood or disorder and well as to avoid countertransference. Therapeutic and medical treatment should center on the underlying psychiatric disorder: a mood disorder, an anxiety disorder or borderline personality disorder. The patient's prognosis depends upon the category under which the underlying disorder falls; depression and anxiety, for example, generally respond well to medication and/or cognitive behavioral therapy, whereas borderline personality disorder, like all personality disorders, is presumed to be pervasive and more stable over time , thus offers the worst prognosis.

If a patient is at risk to himself or herself, inpatient psychiatric hospitalization should be initiated.

Illnesses and conditions commonly feigned in Münchausen patients

• Acid reflux
• AIDS
• Anemia
• Anxiety disorder
• Arthritis
• Back pain
• Bipolar disorder (manic depression)
• Cancer
• Cushing's Syndrome
• Depression
• Dissociative identity disorder
• Eating Disorders
• Fibromyalgia
• Heart disease, heart attack
• Immunodeficiency
• Infection
• Joint pain
• lupus
• Muscle pain
• Migraines
• kidney disease
• Post-traumatic stress disorder
• Seizures
• Sexual abuse
• Spousal abuse
• Suicidal ideation or suicide attempt

• May have multiple scars on abdomen due to repeated "emergency" operations

Note that many of these conditions do not have clearly observable or diagnostic symptoms.

See also

• Fabricated or induced illness, also known as Münchausen Syndrome by Proxy
• Histrionic personality disorder
• Munchausen by Internet
• Mythomania
• Psychosomatic illness

References

• Feldman, Marc (2004). Playing sick?: untangling the web of Münchausen syndrome, Münchausen by proxy, malingering & factitious disorder. Philadelphia: Brunner-Routledge. ISBN 0-415-94934-3.
• Fisher JA (2006). "Playing patient, playing doctor: Münchausen syndrome, clinical S/M, and ruptures of medical power". The Journal of medical humanities. 27 (3): 135–49. doi:10.1007/s10912-006-9014-9. PMID 16817003.
• Fisher JA (2006). "Investigating the Barons: narrative and nomenclature in Münchausen syndrome". Perspect. Biol. Med. 49 (2): 250–62. doi:10.1353/pbm.2006.0024. PMID 16702708.
• Friedel,Robert O., MD Borderline Personality Disorder Demystified, Pg 9-10, Münchausen syndrome, Münchausen syndrome by Proxy. ISBN 1-56924-456-1
• Davidson, G.; et al. (2008). Abnormal Psychology - 3rd Canadian Edition. Mississauga: John Wiley & Sons Canada, Ltd. p. 412. ISBN 978-0-470-84072-6. {{cite book}}: Explicit use of et al. in: |author= (help)

• Ashoka Prasad,A.G.Oswald:Munchausen's syndrome:an annotation[1]

External links

• Dr. Marc Feldman's Münchausen Syndrome, Malingering, Factitious Disorder, & Münchausen by Proxy Page - Page offering information on Münchausen and its many other names. Offers information on Dr. Feldman's books and his email address for interested parties.
• Article in Discover magazine, July 1993, by Abigail Zuger
• The Medea of the modern times