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Introduction 

Munchausen's syndrome is a psychological and behavioural condition where someone pretends to be ill or induces symptoms of illness in themselves.

It is also sometimes known as factitious disorder.

People with the condition intentionally produce or pretend to have physical or psychological symptoms of illness.

Their main intention is to assume the "sick role" to have people care for them and be the centre of attention.

Any practical benefit for them in pretending to be sick – for example, claiming incapacity benefit – is not the reason for their behaviour.

Munchausen's syndrome is named after a German aristocrat, Baron Munchausen, who became famous for telling wild, unbelievable tales about his exploits.

Types of behaviour

People with Munchausen's syndrome can show different types of behaviour, 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 feigning a wide range of illnesses. When it is discovered they are 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 is unnecessary.

What causes Munchausen's syndrome?

Munchausen's syndrome is a complex and poorly understood condition. It is still unclear why people with the condition behave in the way they do.

Some experts have argued that Munchausen's syndrome is a type ofpersonality disorder.

Personality disorders are a type of mental health condition where an individual has a distorted pattern of thoughts and beliefs about themselves and others.

This leads them to behave in ways most people would regard as disturbed and abnormal.

Another theory is that the condition may be the result of parental neglect and abandonment, where only real or imagined illness gives them feelings of care.

Treatment

Treating Munchausen's syndrome can be challenging, as most people with the condition refuse to admit they are faking illness.

For those who do admit their behaviour is abnormal, talking therapies such as cognitive behavioural therapy can sometimes be effective.

Who is affected?

From the available case studies, there appear to be two relatively distinct groups of people affected by Munchausen's syndrome:

  • women aged 20 to 40 years old, who often have a background in healthcare, such as working as a nurse or a medical technician
  • unmarried white men who are 30 to 50 years old

It is unclear why this is the case. It is also not known exactly how common Munchausen's syndrome is.

Some experts believe it is underdiagnosed because many people with the condition succeed in deceiving medical staff. It is also possible cases may be overdiagnosed as the same person could use different identities.

A large study carried out in a Canadian hospital estimated that out of 1,300 patients, there were 10 who were faking symptoms of illness.

Symptoms of Munchausen's syndrome 

Symptoms and signs of Munchausen's syndrome may include pretending to be ill or self-harming to aggravate or induce illness.

There are four main ways people with Munchausen's syndrome fake or induce illnesses, including:

  • lying about symptoms – for example, choosing symptoms that are difficult to disprove, such as having a severe headache or pretending to have a seizure (fit) or to pass out
  • tampering with test results – for example, heating a thermometer to suggest a fever or adding blood to a urine sample
  • self-infliction – for example, cutting or burning themselves, poisoning themselves with drugs, or eating food contaminated with bacteria
  • aggravating pre-existing conditions – for example, rubbing faeces into wounds to cause an infection, or reopening previously healed wounds

Other signs

Some clues that a person may have Munchausen's syndrome include:

  • making frequent visits to hospitals in different areas
  • claiming to have a history of complex and serious medical conditions with little documentary evidence to support this – people often claim they have spent a long time out of the country
  • having symptoms that do not correspond to test results
  • having symptoms that get worse for no apparent reason
  • having very good medical knowledge
  • receiving few or no hospital visitors – many people with Munchausen's syndrome adopt a solitary lifestyle and have little contact with friends or family
  • being willing to undergo often painful or dangerous tests and procedures
  • reporting symptoms that are vague and inconsistent, or reporting a pattern of symptoms that are "textbook examples" of certain conditions
  • telling highly unbelievable and often very elaborate stories about their past – such as claiming to be a decorated war hero or that their parents are fantastically rich and powerful

Munchausen's by internet

A relatively new condition has been labelled Munchausen's by internet. This is where a person joins an internet support group for people with a serious health condition, such as cystic fibrosis or leukaemia, and then claims to have the illness themselves.

While these actions may only be confined to the internet, they can have an incredibly destructive effect on support groups and online communities. People with genuine health conditions have reported feelings of betrayal and anger upon discovering they have been lied to.

One expert on Munchausen's by internet has compiled a list of warning signs that indicate someone may be affected by the condition, including:

  • posts and messages that contain large chunks of information and appear to have been directly copied from health websites, such as Choices
  • reports of experiencing symptoms that appear to be much more severe than most people would experience
  • making claims of near-fatal bouts of illness followed by a miraculous recovery
  • making fantastic claims that they later contradict or others disprove at a later date – for example, they may claim to be attending a certain hospital that does not actually exist
  • claiming to have continual dramatic events in their life, such as loved ones dying or being the victim of a violent crime, particularly when other group members have become a focus of attention
  • feigning an attitude of unconcern when they talk about serious problems, probably to attract attention and sympathy
  • other "people" claiming to post on their behalf, such as a parent or partner, but they use exactly the same pattern of writing

Causes of Munchausen's syndrome 

There is little available evidence about the possible causes of Munchausen's syndrome because many people with the condition refuse to co-operate with psychiatric treatment or psychological profiling.

Based on the available research and case studies, there are several factors identified as possible causes of Munchausen's syndrome. These include:

  • emotional trauma or illness during childhood – this often resulted in extensive medical attention
  • a personality disorder – a mental health condition that causes patterns of abnormal thinking and behaviour
  • a grudge against authority figures or health professionals

Childhood trauma

Some experts have suggested many cases of Munchausen's syndrome may be the result of parental neglect and abandonment, resulting in feelings of childhood trauma.

As a result of this trauma, a person may have unresolved issues with their parents that cause them to fake illness. They may do this for a number of reasons. For example, this may be because they have:

  • a compulsion to punish themselves (masochism) by making themselves ill because they feel unworthy
  • a need to feel important and be the centre of attention
  • a need to pass responsibility for their wellbeing and care on to other people

There is also some evidence to suggest people who have had extensive medical procedures, or received prolonged medical attention during childhood or adolescence, are more likely to develop Munchausen's syndrome when they are older.

This may be because they associate their childhood memories with a sense of being cared for. As they get older, they try to obtain the same feelings of reassurance by pretending to be ill.

Personality disorders

There is some evidence many people with Munchausen's syndrome have a personality disorder.

Personality disorders are a type of mental health condition where an individual has a distorted pattern of thoughts and beliefs about themselves and others. This leads them to behave in ways most people would regard as disturbed and abnormal.

Some examples of the different personality disorders thought to be linked with Munchausen's syndrome include:

  • antisocial personality disorder – a person may take pleasure in manipulating and deceiving doctors, giving them a sense of power and control
  • borderline personality disorder – where a person struggles to regulate their feelings and often swings between positive and negative views of others
  • narcissistic personality disorder – where a person often swings between seeing themselves as special and fearing they are worthless

It could be that the person has an unstable sense of their own identity and also has difficulties establishing meaningful relationships with others.

Playing the "sick role" allows them to adopt an identity that brings unconditional support and acceptance from others with it. Admission to hospital also gives that person a clearly defined place in a social network.

Treating Munchausen's syndrome 

Treating Munchausen's syndrome can be difficult because most people refuse to admit they have a problem and will not co-operate with suggested treatment plans.

Some experts suggest healthcare professionals adopt a gentle non-confrontational approach, suggesting the person has complex health needs and may benefit from a referral to a psychiatrist.

Other experts argue that a person with Munchausen's syndrome should be confronted directly with a question about why they have lied and whether they suffer from stress and anxiety.

One of the biggest ironies surrounding Munchausen's syndrome is that people with the condition are genuinely mentally ill, but will often only admit to having a physical illness.

If a person admits to their behaviour, they can be referred to specialist psychiatric services for further treatment.

If the person does not admit to lying, most experts agree the doctor in charge of their care should minimise medical contact with them.

This is because the doctor-patient relationship is based on trust and if there is evidence the patient can no longer be trusted, the doctor is unable to continue treating them.

Psychiatric treatment

It may be possible to help someone control the symptoms of Munchausen's syndrome if they admit they have a problem and co-operate with treatment.

There is no standard treatment for the condition, but a combination of psychoanalysis and cognitive behavioural therapy (CBT) has shown some success in helping people control their symptoms.

Psychoanalysis

Psychoanalysis is a type of psychotherapy based on the theories of Sigmund Freud. Freud suggested unconscious beliefs or motivations, often formed during early childhood, can be the cause of many psychological conditions.

Psychoanalysis attempts to uncover and resolve these unconscious beliefs and motivations.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) works by helping a person identify unhelpful and unrealistic beliefs and behavioural patterns.

A specially trained therapist teaches the person ways of replacing unrealistic beliefs with more realistic and balanced ones.

Family therapy

People with Munchausen's syndrome still in close contact with their family may also benefit from having family therapy. 

The person with Munchausen's syndrome and their close family members discuss how the condition has affected the family and the positive changes that can be made.

It can also teach family members ways to avoid reinforcing the person's abnormal behaviour. For example, this could involve recognising when the person is playing the "sick role" and avoiding showing them concern or offering support.