Throughout Mary’s childhood, her father, Joe, was chronically ill and would lie in a darkened room for weeks at a time. He would go to the emergency room complaining of headaches, and yet the results of any tests doctors performed would always come back normal. The entire household revolved around Joe’s care. It affected the family’s diet, activities, noise level, schedule and finances. Although Joe went to multiple doctors over the years, no lab tests or MRIs ever revealed a physical abnormality. Finally, one specialist suggested that Joe had Munchausen syndrome.
What Is Munchausen Syndrome?
Munchausen syndrome is a psychological disorder that was first named in 1951 by British endocrinologist and hematologist Dr. Richard Asher. The term describes a self-diagnosis disorder where someone persistently either makes themselves sick or fabricates an illness to play the patient role and be rewarded with attention.
Asher was overseeing the mental ward of a hospital and noted the recurring phenomenon of people presenting with problems such as stomach pain, headaches or mysterious bleeding. After extensive testing and investigation, however, it was determined that these ailments were consciously and deliberately deceptive.
Asher named the condition after Baron von Munchausen, an 18th-century German nobleman and former military officer who was known for telling greatly embellished stories about his escapades. The Baron told stories of fighting 40-foot crocodiles, being sent to the moon and being fired out of a cannon and over a river. His stories inspired numerous books, which perpetuated his legend and further exaggerated his adventures.
In more recent years, the term Munchausen syndrome has fallen out of favor, and the condition is more commonly referred to as factitious disorder or as fabricated or induced illness (FII). The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) refers to the mental health disorder as factitious disorder imposed on self. It notes that most of the symptoms are physical but that treating the reported physical symptoms doesn’t help because the condition is rooted in mental health.
Common Presentations of Munchausen Syndrome
An individual with Munchausen syndrome may convince a doctor that they’re seriously unwell. They often present with chest pain, fever, vomiting or other physical symptoms.
People with Munchausen syndrome may convince medical professionals to run painful and intrusive tests to validate their illness. For example, they might:
- Pretend to be in pain
- Exaggerate genuine symptoms
- Fake or lie about symptoms that are hard to test for
- Make themselves unwell by ingesting toxic or otherwise harmful substances
- Tamper with blood or urine tests
- Ignore genuine medical issues until they become serious
- Open wounds or skip medication to slow recovery from an illness
In some cases, patients might claim to have a rare illness and willingly undergo all kinds of painful and intrusive tests or even surgery to validate their illness. These medical interventions don’t help the patient because the underlying issue is a mental health one.
Common Complications of Munchausen Syndrome
Munchausen syndrome is often misunderstood as simple attention seeking, but it can be a dangerous condition because people who are suffering from it often put themselves at risk. For example, they might:
- Overdose on prescription medications
- Experience harmful side effects if prescribed medications they don’t need
- Suffer from complications due to self-harm or ingesting toxic substances
- Be at risk of complications from unnecessary medical procedures or surgeries
Common Causes of Munchausen Syndrome
What’s interesting about Munchausen syndrome is that aside from the attention received by being sick, the sufferer receives no obvious external reward, such as desired medication, getting out of work or financial gain. This is how Munchausen syndrome differs from malingering, in which someone fakes or creates an illness for personal benefit, such as avoiding legal trouble or reaping a monetary windfall.
In many cases, people who suffer from Munchausen syndrome had a difficult childhood or were raised by someone who had the condition themselves.
Possible causes of Munchausen syndrome include:
- Low self-esteem or inflated self-image
- Childhood history of neglect or abuse
- History of childhood hospitalizations
- Difficult relationship with their parents
- Overwhelming feelings of guilt/a desire to be punished
- Biological or genetic factors
What Is Munchausen by Proxy?
Another, in some ways more harmful form of Munchausen syndrome is Munchausen by proxy. This is referred to as “factitious disorder imposed on another” in the DSM-5. In this chilling disease, a caretaker (usually a woman) fabricates symptoms of illness in a person under their care to get attention.
The victim in this case is most often a child, but it can be anyone in their care, including elderly adults, disabled people or even pets. Health experts call this phenomenon “medical child abuse.” As health care workers strive to understand the presenting condition, the actions of the outwardly concerned mother often exacerbate the problem. While appearing distraught, the caretaker fabricates conditions, such as urinary tract infections, renal issues, stomach problems, failure to thrive, allergies, asthma, vomiting and ketoacidosis.
To ensure ongoing attention and gain credibility, the caregiver will often tamper with medical tests. For example, they might add blood to urine samples, falsify medical records or even cause an infection. In one famous case, a mother shaved her daughter’s head regularly to make it look like she had undergone chemotherapy for leukemia, forced her to use a wheelchair and had her undergo unnecessary surgeries.
This raises the question: What would induce a caretaker to seek attention by harming another, especially a child? While mental illness isn’t easily understood, an interesting connection is that a majority of the caretakers who take part in Munchausen by proxy suffer from Munchausen themselves. This creates an intergenerational transmission of factitious disorders.
How to Identify Munchausen Syndrome
Munchausen syndrome can go undiagnosed for years due to the duplicity involved. Those who suffer from Munchausen syndrome are often incredibly skilled at hiding it, sometimes even having textbook knowledge of their presenting condition. This makes diagnosing the condition a challenge for health care workers because the patient knows what to say and do to present with the desired symptoms. However, over time, when no improvement is forthcoming, there are a few red flags:
- Vague descriptions of illness that seem plausible at first but aren’t confirmed by any tests or by deep scrutiny
- Multiple admissions to different hospitals that create lengthy medical records
- Inconsistencies between patient history and medical investigations
- Compliance with all kinds of discomfort and risk from medical procedures, even surgery
- Hostility when challenged about the presenting condition
Munchausen in the Media vs. Reality
Munchausen by proxy has been an alluring storyline in shows on HBO and Hulu, as well as several mainstream films and novels. Experts on Munchausen by proxy, however, find that the portrayals of these mothers (all are mothers) aren’t realistic. In mainstream media depictions of the disease, the mothers are looking to control their daughters, but in real life, the mothers are seeking attention from others. Also, in the media, whistleblowers make a difference in uncovering the syndrome. In reality, our medical system is extremely complicated and not set up to take on these cases. One skeptical nurse or doctor doesn’t make a difference.
The ubiquity of social media and the internet has also popularized Munchausen in unexpected ways. There’s a rise in a phenomenon called Munchausen by internet, in which medically healthy individuals fake their own illnesses on online support groups and other virtual environments for attention and sympathy. There are also hundreds of mothers every year who, for support and attention, either fabricate diseases for their children in online groups or even fabricate children they don’t have with diseases.
In reality, Munchausen syndrome is a rare disease precisely because of the surrounding deceit. It’s difficult to diagnose because most who suffer from it deny it. A doctor must first categorically rule out any physical illness and then use a variety of procedures to determine if they can make a diagnosis of Munchausen syndrome.
Is There a Cure?
The first step is to stop the person’s harmful actions toward themselves or their dependent. Therapy can be effective if the person admits they have a problem, but medication isn’t generally prescribed because it can be abused.
Restore Mental Health has experience helping those with both Munchausen and Munchausen by proxy. If you feel you or someone in your family suffers from this, our compassionate team of specialists is here to help. Contact us today and begin your journey to recovery.
