Munchausen Syndrome

Munchausen (MUNCH-how-zen) syndrome is a mental disorder in which a person pretends to be physically ill or produces the symptoms of illness in order to take on the role of a patient. In recent years, the condition has been classified as a "factitious ^* disorder" by the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders. Factitious disorders include pretending to be mentally ill.

How Did Munchausen Syndrome Get Its Name?

The disorder is named for Karl Friedrich Hieronymus, Baron von Munchausen (1720-1797), a German nobleman, soldier, and huntsman who was known for making up exaggerated stories of his exploits and adventures. The disorder itself was not recognized and fully described until the twentieth century, however, when the simpler form of the name, "Munchausen," was applied to it.

What Are the Signs of the Disorder?

There are a great many symptoms that may be faked or produced in Munchausen syndrome. For example, a person may complain of abdominal pain, fever, rashes, bleeding, irregular heartbeat, dizziness, fainting spells, or seizures. These symptoms may appear to be signs of such disorders as appendicitis ^* , dermatitis ^* , anemia ^* , a heart problem, or a brain tumor, even though the person never actually had the symptoms they complained of.

People with Munchausen syndrome often are very knowledgeable about medicine and hospitals. They may pretend to have a disease by complaining of a symptom, such as pain, that they do not have. Sometimes they exaggerate or imitate a disorder, such as seizures, that they really do have. Some people may actually injure themselves to create a symptom. For example, they may make themselves bleed to produce anemia. They also may describe an elaborate but false medical history to their physicians and demand medical tests and treatment with drugs or even operations. If the faking of people with Munchausen syndrome is discovered and they are denied treatment, they may start all over again, attempting to fool another doctor at another hospital. In some cases, this process may be repeated throughout a person's life.

What Causes Munchausen Syndrome?

The basic cause for the behavior of people with Munchausen syndrome is believed to be an intense need for care and sympathy. Why people with the disorder have this driving need differs for each person. Often, the disorder begins in early adulthood, after hospitalization for a true medical condition. Other influencing factors may include an important past relationship with a physician, medical employment, or even ill will harbored toward the medical profession.

Diagnosis and Treatment

The two main tasks for a physician diagnosing Munchausen syndrome are to determine that the patient does not really have the illness that the symptoms suggest and that he or she is not malingering. Malingering means that a person is pretending to have an illness because of some life situation, such as wanting to avoid military duty, work, or school.

Munchausen syndrome is treated with psychotherapy. The therapist attempts to help patients understand why they have an excessive need for sympathy, care, and attention. Therapists also help patients find more honest and less destructive ways to satisfy their emotional needs. In the meantime, attempts are made to protect the patient from having unnecessary operations or other medical procedures.

Munchausen Syndrome by Proxy

A variation of Munchausen syndrome, called Munchausen syndrome by proxy, occurs when a caregiver (often the mother) falsely claims that a child is ill. ("By proxy" means acting as a substitute for another.) The caregiver may either pretend that the child is ill or do something to cause a symptom or illness. For example, she may give the child too much of a laxative, causing diarrhea. Sometimes, causing illness may seriously harm the child or even result in death.

It is believed that people with Munchausen syndrome by proxy seek to gain attention as devoted caregivers rather than for being sick patients, as in Munchausen syndrome. They often have troubled marriages or may have suffered some type of abuse as a child. Munchausen syndrome by proxy is considered a form of child abuse, and in most states suspicion of this disorder must be reported to a child protective agency.