Munchausen Syndrome (Factitious disorder imposed on self)

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.

How is factitious disorder imposed on self (Munchausen syndrome) diagnosed?

Diagnosing is very difficult because of the dishonesty and multiple health care providers involved. Healthcare providers must rule out any possible physical and mental illnesses, and often use a variety of diagnostic tests and procedures before considering this diagnosis.

If your healthcare provider finds your symptoms medically unexplainable, he or she might refer you to a psychiatrist or psychologist — mental health professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use a thorough medical history, physical history, laboratory imagery and psychological assessment tools to evaluate. Your healthcare provider bases his or her diagnosis on the exclusion of actual physical or other psychiatric disorders and his or her observations of your attitude and behavior. However, personality concerns are prominent and can make it that much more confusing to sort out what’s real and what isn’t. If you are hospitalized, you may work with a variety of healthcare providers to help determine a comprehensive care plan.

Your healthcare provider then determines if your symptoms compare to the criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is the standard reference book for recognized mental illnesses in the United States.

How is Munchausen syndrome treated?

If you have this syndrome, you actively seek treatment for various disorders, and you’re also often unwilling to admit to and seek treatment for the syndrome itself. This makes treating this syndrome very challenging, and the outlook for recovery poor. If caretakers can protect you from self-harm and educate you about the consequences that can occur, it may be helpful. Trying to reduce your care through only one physician, or two working closely together (psychiatrist and internist, for example), is also suggested.

When treatment is sought, the first goal is to modify your behavior and reduce your misuse or overuse of medical resources. Once this goal is met, treatment aims to work out any underlying psychological issues that might be causing your behavior or help you find solutions to other social needs.

The primary treatment for Munchausen syndrome is psychotherapy (a type of counseling). Treatment will focus on changing your thinking and behavior (cognitive-behavioral therapy). Family therapy also might be helpful in teaching your family members more about Munchausen Syndrome. Group therapy may reduce feelings of isolation or feelings that no one cares for you. There are no antidepressant or antipsychotic medications known to be helpful.

What medicines may help with Munchausen syndrome?

There are no medicines to treat factitious disorders themselves. Medicine might be used, however, to treat a related disorder — such as depression or anxiety. The use of medicines must be carefully monitored due to the risk that the drugs might never be picked up from the pharmacy or might be used in a harmful way.

What are the complications of Munchausen syndrome?

You’re at risk for health problems (or even death) associated with hurting yourself or otherwise causing symptoms. In addition, you might suffer from reactions or health problems associated with multiple tests, procedures and treatments and are at high risk for substance abuse and suicide attempts.

How long does it take to recover from Munchausen syndrome?

Munchausen syndrome doesn’t have a clear cure. If you have the syndrome, it’s likely that you’ll have to manage it the rest of your life, with support from your healthcare providers.

Can Munchausen syndrome be prevented?

There is no known way to prevent this disorder. However, it might be helpful to begin treatment as soon as you begin to have symptoms.

What is the prognosis (outlook) for people with Munchausen syndrome?

You might suffer only a single episode of symptoms. In most cases, however, the disorder is a recurring condition that can be very difficult to treat. You might deny faking the symptoms and will not seek or follow treatment. Even with treatment, it is more realistic to work toward managing the disorder rather than to try curing it. Avoiding unnecessary, inappropriate admissions to the hospital, testing, or treatment is important.

How do I take care of myself?

Do exactly what your healthcare providers recommend. Attend your appointments and take your medications. Be honest with your healthcare providers regarding any appointments and/or hospitalizations you may have had.

How can my family and friends help?

Educate your family and friends about Munchausen syndrome and explain your symptoms. Ask them to keep you accountable as you recover. It might be helpful to have them dispense your medication and make sure that you attend your healthcare appointments.

When should I see my healthcare provider?

If you have Munchausen syndrome symptoms then you should see your healthcare provider about it as soon as possible. The sooner you get help, the less likely you are to cause harm to yourself.

What questions should I ask my healthcare provider?

• Do I have a related mental illness such as depression or a personality disorder?
• Can you recommend a psychiatrist?
• Can you recommend a therapist?
• What medications should I take?
• What treatment is best for me?
• How often should I return to see you for treatment?

A note from Cleveland Clinic

If you have Munchausen syndrome then you likely have a deep need for attention – perhaps attention you never got as a child – a need to feel important and a goal to find a place where you “belong.”

Munchausen syndrome is a dangerous disease because of the risk of self-harm. People have injured themselves in an attempt to get attention and sympathy. This is behavior that needs immediate treatment. Do your best to have insight into your own actions and don’t lie to your family and healthcare providers regarding your behaviors. Get help. Your healthcare providers want what’s best for you.

If you’re harming yourself, or having thoughts about harming yourself, you should immediately contact a healthcare provider.