Throughout Mary’s childhood, her father Joe was chronically ill and would lie in his darkened room for weeks at a time. Joe would go to the emergency room complaining of headaches. Many tests were run, but the results always came back normal. The entire household revolved around Joe’s care: 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 suspected he had Munchausen’s syndrome.
What Is Munchausen’s Syndrome?
Munchausen’s syndrome describes a psychological disorder discovered in the 20th century in which someone chronically either makes themselves sick or fabricates illness in order to play the patient role and be rewarded with attention. In the 21st century, this condition is commonly referred to as factitious disorder or as fabricated or induced illness (FII).
In 1951, British endocrinologist and hematologist Dr. Richard Asher coined the term “Munchausen’s syndrome.” While overseeing the mental ward of a hospital, he witnessed the recurring phenomenon of people presenting with a problem, 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 Munchhausen, an 18th-century German nobleman who told outrageously tall tales about his military exploits in the Russo-Turkish War of 1735, inspiring many books that further exaggerated his feats.
Munchausen’s disease is a mental health disorder and is referred to as factitious disorder imposed on self in the Diagnostic and Statistic Manual of Mental Disorders (DSM-5). However, most of the symptoms are physical (such as chest pain, fever, vomiting), not mental (such as depression or anxiety). Patients may claim to have a rare illness such as Boursin syndrome and willingly undergo all kinds of painful and intrusive tests, and sometimes surgery, to validate their illness. However, because the condition is rooted in mental health, their physical ailments aren’t healed by the treatments they undergo.
What’s interesting about Munchausen’s syndrome is that aside from the attention received from being sick, the sufferer receives no obvious external reward, such as desired medication, getting out of work or financial gain. This is how Munchausen’s differs from malingering, in which someone fakes or creates an illness for personal benefit, such as avoiding legal trouble, reaping a monetary windfall or another advantage that directly improves their life.
What Is Munchausen’s by Proxy?
A second form of Munchausen’s syndrome is Munchausen’s by proxy, also called factitious disorder imposed on another. In this chilling disease, a caretaker (usually a woman) fabricates symptoms of illness in another to get attention. This can be anyone in their care, including elderly adults, disabled people or even pets. However, it’s most often children. Health experts call it “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. They often tamper with medical results to gain credibility (such as adding blood to urine samples, falsifying medical records and even causing 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. Many children have even died due to Munchausen’s by proxy.
This begs the question: What would induce a caretaker to seek attention by harming another, especially their children? While mental illness isn’t easily understood, an interesting connection is that a majority of the caretakers who take part in Munchausen’s by proxy suffer from Munchausen’s themselves. This creates an intergenerational transmission of factitious disorders.
Possible causes of Munchausen’s 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
How to Identify Munchausen’s Syndrome
Munchausen’s can go undiagnosed for years due to the duplicity involved. Those who suffer from Munchausen’s are often incredibly skilled at hiding it, sometimes even having textbook knowledge of their presenting condition. This complicates things as they know how to expertly manifest 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’s in the Media vs. Reality
Munchausen’s by proxy has been an alluring story line in shows on HBO and Hulu as well as several mainstream films and novels. Experts on Munchausen’s by proxy, however, find the portrayals of these mothers (all are mothers) aren’t realistic. In these portrayals, 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 this disease. One skeptical nurse or doctor doesn’t make a difference.
The ubiquity of social media and the internet has also popularized Munchausen’s 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’s is statistically 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’s.
Is There a Cure?
The first step towards a cure is to stop the person’s harmful actions towards themselves or their dependent. Therapy can be effective if the person admits they have a problem, but medication is not generally prescribed as it can be abused.
Restore has experience helping those with both Munchausen’s and Munchausen’s by proxy. If you feel like you or someone in your family suffers from this, our compassionate team of specialists is here to help. Call us today and begin your journey to recovery.
