Understanding Munchausen Syndrome
Factitious Disorder Basics
Mental health professionals use the term factitious disorder to describe any one of several conditions that center on exaggeration or falsification of an illness. In some cases, people with a factitious disorder attempt to exaggerate or falsify mental health-related symptoms such as delusions or hallucinations. In other cases, affected individuals attempt to exaggerate or falsify one or more of a broad range of physical complaints. People with a factitious disorder may also exaggerate or falsify both mental and physical symptoms. In addition, some affected individuals have unusual symptoms that fall into an unofficial category called factitious disorder not otherwise specified; the most famous example in this category is a condition called Munchausen syndrome by proxy.
Munchausen Syndrome Basics
Munchausen syndrome gets its name from the legendary tall tales of an 18th century German nobleman named Baron von Munchausen. In psychiatric terms, it qualifies as a form of factitious disorder centered on physical complaints. Unlike people with the condition formerly known as hypochondria (now broken down into two separate conditions, called somatic symptom disorder and illness anxiety disorder), people with the syndrome don’t actually believe that something is wrong with them. Instead, they fervently wish that they did have some form of illness. No one really knows for sure how many people have Munchausen syndrome, the Cleveland Clinic reports. In part, this lack of knowledge stems from the dishonesty regularly practiced by people affected by the syndrome; it also stems partly from the tendency of Munchausen’s patients to use multiple hospitals and doctors, and a subsequent overcounting of actual cases. Men apparently develop the condition much more frequently than women.
The Mayo Clinic lists potential symptoms of Munchausen syndrome that include physical complaints that are poorly defined or shift over time, elaborate storytelling regarding the origin of various complaints or ailments, frequent trips to the hospital, use of multiple hospitals or doctors during treatment, an unusually high degree of knowledge about the details of various medical conditions, an excited response to potentially dangerous medical procedures, and frequent conflict with medical personnel over the nature or course of an ailment. Additional potential symptoms include a negative or poorly defined self-identity, evidence of multiple previous surgical procedures (scars, etc.), and the production of new physical complaints when testing eliminates the possible causes of current complaints.
There is no known universal underlying cause for the onset of Munchausen syndrome. However, both physical events and mental problems in a person’s life may contribute to any given case of the condition. Examples of physical events that may play a role in the syndrome’s origin include repeated hospital trips during childhood, exposure to household or family neglect during childhood, and exposure to physical abuse during childhood. Mental problems that may play a role in Munchausen syndrome include any one of a range of conditions that mental health professionals refer to collectively as personality disorders (e.g., borderline personality disorder, antisocial personality disorder or narcissistic personality disorder).
The main treatment for Munchausen syndrome is psychotherapy, not medication. Common forms of psychotherapy used for this purpose include cognitive behavioral therapy—an approach that centers on teaching a Munchausen’s patient new reactions to emotional stress—and family therapy, an approach that teaches family members of a Munchausen’s patient ways to avoid contributing to or enabling that patient’s damaging behaviors. Doctors sometimes combine psychotherapeutic treatment for the syndrome with medications designed to address coexisting problems such as personality disorders, anxiety disorders, or depressive disorders.
Considerations and Outcomes
One of the main problems involved in treating Munchausen syndrome is properly identifying affected individuals, who tend to go to great lengths to hide their true condition beneath exaggerated or falsified medical claims. A second critical problem centers on the reluctance of identified Munchausen’s patients to participate in treatments that will improve their actual mental health problem, rather than treatments that prolong their factitious behaviors. For these and other reasons, people affected by the syndrome typically have relatively poor long-term mental health outlooks. When doctors successfully treat Munchausen syndrome, they usually limit its effects instead of eliminating it altogether.