Today’s discussion of Munchausen Syndrome is Part One of a two part series on this rather disturbing, and often life-threatening, condition.

Munchausen syndrome (also known as ‘hospital addiction syndrome’ or ‘hospital hopper syndrome’) — named for Baron von Munchausen, an 18th century German officer who was known for embellishing the stories of his life and experiences — is a very serious mental disorder in which an individual with a deep need for attention or sympathy repeatedly acts as if he or she has a physical or mental disorder when, in truth, he or she has caused the symptoms.  Munchausen syndrome belongs to a group of psychiatric conditions called factitious disorders which is a group of conditions in which people purposely exaggerate, invent or even cause disease symptoms.  Many will create symptoms by injecting themselves with foreign substances (such as toxins) or taking unnecessary medications, or secretly harm themselves in order to construct signs of illness.

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 financial gain.  People with Munchausen syndrome exaggerate or create symptoms of illness in themselves to gain  treatment, attention, exploration, sympathy, and comfort from medical personnel; sympathy and special attention typically reserved for people who are truly ill.  In some extreme cases, people suffering from this disorder are highly knowledgeable about the practice of medicine and are able to produce symptoms that result in lengthy and costly medical analysis, prolonged hospital stays and unnecessary surgical procedures.  The role of “patient” is a familiar and comforting.  Munchausen syndrome is a mental illness associated with severe deep emotional needs, and is the most severe and chronic physical form of factitious disorder.  It can increase the risk of suicide, dramatically interfere with work and family relationships, and even lead to death.

There are many forms this disorder can take including feigning: cancer, cardiac disease, skin disorders, infections, bleeding disorders, metabolic disorders, chronic diarrhea, and many more.  It is extremely difficult to determine how prevalent Munchausen syndrome is because most of those afflicted with the disorder are very skillful in hiding their behaviors.  Some will even adopt an assumed name, or travel out of the area in order to avoid detection of the health community.  More males than females are diagnosed with Munchausen, and it appears to be more common among young or middle-aged adults.   However, it can occur at any age.

Munchausen syndrome is not the same as hypochondria, which is a condition in which people actually believe that they are sick.  It is also different than malingering, in which people pretend to be sick for financial gain or to get out of work.  Those with Munchausen syndrome know they are healthy, but have a bizarre need to be sick.

To help determine if someone has Munchausen syndrome, health care providers conduct a detailed interview, comprehensive physical examination, and also run tests for possible physical problems.   Since people with Munchausen syndrome go to great lengths to avoid discovery of their deception, it may be extremely difficult to notice that their symptoms are actually part of a serious mental disorder.

Symptoms of Munchausen syndrome include:

• Symptoms that exactly fit the textbook description of an illness but cannot be controlled with treatments.
• Unclear or inconsistent symptoms.
• An extensive understanding of illnesses, medical terminology and hospital procedures.
• An eagerness to undergo frequent testing, procedures or risky operations no matter how uncomfortable or painful they are.
• Extraordinary stories about many medical problems.
• Seeking treatment from many different doctors or hospitals.
• Frequent hospitalizations.
• Having few visitors when hospitalized.
• Arguing with hospital staff.
• Conditions that worsen for no apparent reason.
• An inconsistent medical history.
• Eagerness to travel to different doctors and hospitals.
• Unwillingness to allow health professionals to talk to family or friends.

Diagnosing Munchausen syndrome can be extremely challenging.  People with Munchausen syndrome are very skilled at faking many different diseases and conditions, and may have very real and even life-threatening medical illnesses, although they may be self-inflicted.

People suffering from Munchausen syndrome create symptoms or cause illness in a variety of ways including:

• Faking complaints and symptoms – They may feign symptoms, such as abdominal pain, seizures, headaches, or heart conditions.
• Self-injurious behaviors – They may intentionally injure or make themselves sick by injecting themselves with bacteria, other contaminated food sources, gasoline or even feces. They may take medications to mimic diseases, such as blood thinners, chemotherapy medications and diabetes medications.  They may cut or burn themselves.
• Preventing healing – They may intentionally interfere with the process of wound healing by reopening cuts or removing sutures prematurely.
• Making up medical histories – They may provide health care providers, families, or friends a false medical history.
• Tampering with medical tests – They may manipulate medical instruments to intentionally alter results, such as heating up a thermometer, or may tamper with laboratory tests by doing such things as contaminating their urine.

Psychiatrists are not certain as to the exact causes of Munchausen syndrome, but believe the risk factors include:

• A history of sexual, physical or emotional abuse.
• A serious illness during childhood that allowed them to be cared for and nurtured.
• A relative who had a serious illness.
• An unfulfilled desire to be a doctor or other health professional.
• The loss of a loved one through death, illness or abandonment early in life.
• A poor sense of identity or self-esteem.

• Work in the health care field.

Munchausen syndrome is indeed a mysterious and difficult disorder to treat.  However, medical support is vital in preventing serious injury and even death caused by the self-inflicted harm common to this disorder.  Although there are no standard therapies for the treatment of Munchausen syndrome, treatment often focuses on managing the condition, rather than trying to cure it.  Because people with this disorder desire to be in the patient role they are most often unwilling to seek appropriate psychiatric treatment.  However, if the patient is approached in a gentle, supportive and face-saving way, they may just agree to be treated by a mental health specialist.  Trying to reduce the patient’s care through only one physician, or two working closely together (psychiatrist and primary care physician), is also strongly suggested.

The goal of treatment is to alter the patient’s thinking and behavior, and reduce their misuse of medical and other health care resources. This is most often accomplished through the use of psychotherapy, in particular Cognitive-Behavioral Therapy (CBT).  Although there are no medicines specifically identified to treat factitious disorders themselves they may be used to treat other mental disorders that may also be present such as depression or anxiety.  Specifically, serotonin reuptake inhibitors (SSRIs) have shown to be helpful in treating depression and anxiety, and low dose antipsychotics may be helpful in the more serious cases of Munchausen syndrome.  In severe cases, temporary psychiatric hospitalization may be necessary.

People with Munchausen syndrome have such deeply seeded emotional issues they are actually willing to risk their lives to be viewed as sick.  As a result, these individuals face many possible complications including:

• Severe health problems from surgery or other procedures
• Loss of organs or limbs from unnecessary surgery
• Injury or death from self-inflicted medical conditions
• Financial problems
• Significant problems in daily life, relationships and work
• Alcohol or substance abuse

Although some sufferers of Munchausen syndrome will experience only one or two symptom-plagued episodes, for the vast majority it takes a chronic course that is extremely difficult to treat.  As a result, even with treatment, it is more realistic to work toward managing the disorder rather than trying to cure it.
If you believe a friend or loved one may be afflicted with this dangerous factitious disorder, gently encourage them, and/or through their primary care physician, to undergo a comprehensive evaluation by an experienced Psychiatrist sooner rather than later.  There are many highly qualified and capable Psychiatrists and Cognitive-Behavioral therapists within the Tri-Counties area that can effectively assist those suffering from this disorder.

In Part Two of this two part series to run next Saturday I will be discussing a variant of this disorder, known as Munchausen Syndrome by Proxy (MSBP), in which caregivers deliberately exaggerate, fabricate, and often actually induce physical or psychological problems in others, usually their own children.  It is a very serious and difficult to identify form of child abuse.