Introduction

Munchausen's syndrome is a rare psychological and behavioural condition in which somebody fabricates or induces symptoms of illness in themselves.

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

People with Munchausen's syndrome typically display a set pattern of behaviour. This pattern includes:

  • lying about their symptoms and typically also lying about other aspects of their life, such as their past or level of education
  • manipulating test results to suggest the presence of symptoms, such as adding blood to urine samples
  • actually inflicting symptoms on themselves, such as poisoning themselves with an overdose of medication, and
  • travelling from hospital to hospital in different parts of the country, and seeing many different doctors

Munchausen's syndrome differs from two, more common, types of feigned illness, hypochondria and malingering. People who have hypochondria actually believe they are ill, but do not manipulate test results. People who malinger pretend to be ill to gain some sort of benefit, such as avoiding military duty or trying to obtain compensation.

People with Munchausen's syndrome know they're making their symptoms up and can be highly manipulative, but their behaviour brings them no obvious benefit. Instead, they often undergo painful and sometimes life-threatening surgery, even though they know it is unnecessary.

How common is Munchausen's syndrome

It is hard to estimate how many people are affected by Munchausen's syndrome. They tend to be highly secretive and often use a number of false identities. Once their deception is uncovered they discharge themselves from hospital and move to another area.

The condition is thought to be most common in white men aged between 30 and 50. It is unclear why this is the case.

The causes of Munchausen's syndrome are largely unknown. Most people who have been diagnosed with the condition refuse to accept any sort of psychiatric treatment so little is known about their motives or thought processes.

There is a variant of Munchausen's syndrome, called Munchausen's syndrome by proxy, in which an individual fabricates or induces illness in a person under their care, typically a child.

Symptoms

Warning signs that somebody may have Munchausen's syndrome include:

  • frequent visits to hospitals in different areas
  • claiming to have a history of complex and serious medical conditions, yet there is little documentary evidence to support this; a common ruse is for people to claim they have spent a long time out of the country
  • symptoms that do not correspond to the results of tests
  • symptoms that get worse for no apparent reason
  • the person has a extremely good medical knowledge
  • the person receives very few, or no, visitors in hospital; many people with Munchausen's syndrome adopt a solitary lifestyle and have little contact with any friends of family
  • a willingness to undergo often painful or dangerous tests and procedures
  • if confronted about their behaviour, they can become aggressive and will try to leave the hospital

Patterns of behaviour in Munchausen's syndrome

There are four main ways in which people with Munchausen's syndrome can feign or induce illnesses, which are outlined below:

  • lying about symptoms - often they choose symptoms that are hard to disprove, such as having severe headaches or they may pretend to have a seizure or pass out
  • tampering with test results - such as heating thermometers to suggest fever or adding blood to urine samples
  • self-infliction - they may cut or burn themselves, poison themselves with drugs or an overdose of medication, or eat food that has been contaminated with bacteria
  • aggravate pre-existing conditions - such as rubbing dirt or dog faeces into wounds to cause an infection, or reopen previously healed wounds

Causes

As most people with Munchausen's syndrome refuse to co-operate with any sort of psychiatric treatment or psychological profiling, there is little available evidence on the possible causes of the condition.

There is a consensus of opinion that Munchausen's syndrome is a type of personality disorder. Personality disorders are a class of mental health conditions in which an individual has a distorted pattern of thoughts and beliefs about themselves and others which lead them to behave in ways most people would regard as disturbed and abnormal.

One theory is that people with Munchausen's syndrome have an anti-social personality disorder which causes them to take pleasure in manipulating and deceiving doctors. They may see a doctor as a figure of authority, so tricking these figures of authority, gives them a sense of power and control.

Another theory is that Munchausen's syndrome is an attempt to form relationships and become more socially acceptable. Many people with Munchausen's syndrome are 'loners', have little contact with their family, and have few friends. So they then take comfort in adopting the role of a patient, and find the doctor/patient relationship provides a much needed source of human contact and emotional warmth.

Many people with Munchausen's syndrome have claimed to have experienced physical and sexual abuse during childhood. Though due to their tendency to lie about their past, it is hard to say whether this is actually true in all cases.

Diagnosis

Diagnosing Munchausen's syndrome can be very challenging for medical professionals. People with the condition are often accomplished liars and are skilled at manipulating and exploiting a doctor's concern for their patient, and the doctor's natural curiosity in investigating unusual medical conditions.

If a health professional does suspect a person may have Munchausen's syndrome they will usually make a detailed study of that person's health records to look for any inconsistencies between their claimed and actual medical history. They may also attempt to talk to their family and friends to see if their claims about their past are true.

Health professionals can also run a number of clinical tests to check for evidence of self-inflicted illness or tampering of clinical test. For example, the person's blood can be checked for traces of medication that the person should not be taking, but which could explain their symptoms.

Doctors will also want to rule out other possible motivations for their behaviour, such as faking illness for financial gain, or because they want access to strong painkillers.

A diagnosis of Munchausen's syndrome can usually be confidently made if there is:

  • clear evidence of fabricating or inducing symptoms
  • the person prime motivation is to be seen as sick
  • there is no other likely reason or explanation for their behaviour

Treatment

As mentioned, treating Munchausen's syndrome can be very difficult as most people with the condition will refuse to admit they have a problem and will not co-operate with suggested treatment plans.

Because of this, some experts have suggested that health professionals adopt a gentle, non-confrontational approach. So rather than directly accuse a person of lying, they may gently suggest that they have complex health needs that may benefit from a referral to a psychiatrist. Still, even with this approach, many people refuse, or simply move to another area.

For people who do admit they have a problem, and co-operate with treatment, it may be possible to help them control the symptoms of Munchausen's syndrome.

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

Psychoanalysis is a type of psychotherapy that is based on the theories of Sigmund Freud. Freud suggested that unconscious beliefs or motivations, often formed during early childhood, can lay at the root of many psychological conditions. Psychoanalysis attempts to uncover and then resolve these unconscious beliefs and motivations.

CBT works by helping people to identify any unhelpful and unrealistic beliefs and behavioural patterns they may have. The therapist then shows them ways in which they can replace these beliefs with more realistic and balanced ones.