What is Munchausen syndrome (factitious disorder imposed on self)?

Munchausen syndrome (also known as factitious disorder imposed on self) is a mental health disorder where you falsify, exaggerate, or induce physical, emotional or cognitive disorders.

People with factitious disorders act this way because of an inner need to be seen as ill or injured, not to achieve a concrete benefit, such as getting medications or financial gain. This is distinguishable from malingering which is where someone exaggerates or fakes an illness to, for example, get out of work.

If you have Munchausen syndrome, you may undergo painful or risky medical tests and operations in order to get the sympathy and special attention given to people who are truly ill. You may secretly injure yourself to cause signs of illness. You may add blood to your urine, or use a rubber band to cut off circulation to a limb. Some people will cut or burn themselves, poison themselves, reopen wounds, rub feces or dirt into a wound to cause infection, or eat food contaminated with bacteria.

Munchausen Syndrome is named after Baron von Munchausen, an 18th century German officer who was known for embellishing the stories of his life and experiences. Most symptoms in people with this disorder are related to physical illness — symptoms such as chest pain, stomach problems, or fever — rather than those of a mental disorder. While some symptoms are self-imposed, others are exaggerated. For example, you may embellish symptoms about vision loss, seizures, joint pain, headaches, weakness, vomiting and diarrhea.

How common is Munchausen syndrome? Who is likely to get Munchausen syndrome?

Obtaining accurate statistics is difficult because of the dishonesty. In addition, people with this disorder tend to seek treatment at many different healthcare facilities, which causes misleading statistics. However, in a National Hospital Discharge Survey in 2013 there were 6.8 cases of a factitious disorder per 100,000 patients. It is unclear how many of those patients had Munchausen syndrome, specifically.

Researchers have noted that females who work in the healthcare community are most likely to have Munchausen syndrome. You’re at risk if you have borderline or histrionic personality traits or disorders.

What is the difference between Munchausen syndrome and Munchausen syndrome by proxy?

Munchausen syndrome by proxy (also known as factitious disorder imposed on another) is where you act like the person you’re caring for (a child, a disabled individual, or an older person, for example) has a physical or mental illness while the person is not actually sick. This is a form of child or elder abuse.

Munchausen syndrome is pretending you have an illness. By proxy is pretending your dependent has an illness.

What is Munchausen syndrome by internet?

The online community has groups for people with physical and mental/emotional health issues. They’re meant to be a safe place where people who have a disorder can come together and discuss their difficulties, share tips and provide support. Examples of support groups include those for leukemia patients, cancer patients and cystic fibrosis patients.

Sometimes people join the groups and pretend to be sick. If you have Munchausen syndrome by internet, you might do the following:

  • Say you have symptoms that are far more severe than anyone else’s.
  • Claim to have nearly died and had a miraculous recovery.
  • Paste information copied from a health website into your posts.
  • Contradict yourself.
  • Lie about what hospital you attend, what medicines you take, etc.
  • Claim to have something dramatic going on in your life, repeatedly. You may lie about being the victim of crime, or a loved one’s death, etc.
  • Try to get the focus back on you when someone else in the group is getting attention.
  • Pretend to be blasé or nonchalant (unconcerned or carefree) about your symptoms.
  • Pretend to be someone else posting on your behalf. You might claim to be a partner, parent or friend reporting on your symptoms.

If you do this and get caught, this can have a negative impact on the community. The members feel betrayed and angry and may leave the group, losing out on the support that they need.

What causes Munchausen syndrome?

The exact cause is not known, but researchers believe psychological factors play a role in the development of this syndrome. Some theories suggest that a history of abuse or neglect as a child, or a history of frequent illnesses requiring hospitalization, might be factors associated with the development of this syndrome. Other triggers might be experiencing the death of a loved one at a young age and abandonment. Researchers are also studying the possible link with personality disorders, which are common in these individuals.

Is Munchausen syndrome hereditary?

Research does not show a link between Munchausen syndrome and genetics.

What are the symptoms of Munchausen syndrome?

If you have Munchausen syndrome, then you deliberately produce or exaggerate symptoms in several ways. You may lie about or fake symptoms, hurt yourself to bring on the symptoms, or alter diagnostic tests (such as contaminating a urine sample). Possible warning signs of Munchausen syndrome include the following:

  • Dramatic but inconsistent medical history. Unclear symptoms that are not controllable and that become more severe or change once treatment has begun.
  • Problems with identity and self-esteem.
  • Predictable relapses following improvement in the condition.
  • Extensive knowledge of hospitals and/or medical terminology, as well as the textbook descriptions of illnesses. Medical knowledge may be quite extensive from many hospitalizations, or from a prior job.
  • Presence of multiple surgical scars.
  • Appearance of new or additional symptoms following negative test results.
  • Presence of symptoms only when the patient is alone or not being observed (e.g. seizures or passing out).
  • Willingness or eagerness to have medical tests, operations, or other procedures. More comfortable being in the hospital than you might think.
  • History of seeking treatment at numerous hospitals, clinics and doctors' offices, possibly even in different cities.
  • Reluctance by the patient to allow healthcare professionals to meet with or talk to family, friends, or prior healthcare providers.

Some individuals may put blood in their urine, inject themselves with feces, rub dirt into their IV lines, or put tight rubber bands around an arm or leg. They may pretend to swallow their medications but store them in their cheeks and spit them out later. Deliberate dehydration has also been observed.

Last reviewed by a Cleveland Clinic medical professional on 11/23/2020.

References

  • Merck Manual. Factitious Disorder Imposed on Self. Accessed 11/19/2020.
  • Jaghab K, Skodnek K, Padder TA. Munchausen’s syndrome and other factitious disorders in children. Psychiatry. 2006 Mar;3(3):46-55. Accessed 11/19/2020.
  • Yaacob BMJ. Munchausen syndrome by proxy. The Malaysian Journal of Medical Sciences. 1999 Jul;6(2):30-31. Accessed 11/19/2020.
  • NHS. Munchausen’s Syndrome. Accessed 11/19/2020.
  • Weber B, Gokarakonda SB, Doyle MQ. Munchausen Syndrome. Treasure Island (FL): StatPearls Publishing; 2020 Jan. Accessed 11/19/2020.

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