Munchhausen syndrome is a mental disease, also called a factitive disorder, in which a person pretends to be sick, exaggerates or artificially induces symptoms of a disease in order to undergo medical examination, treatment, hospitalization, surgery and the like. In 1951, an English endocrinologist and hematologist Richard Asher proposed this name when he first described the behavior of patients inclined to invent or induce painful symptoms in oneself.
Who is Simulating and Why
The reasons for this behavior aren’t completely clear yet. The common explanation is that simulation allows patients to receive attention, care and psychological support when they have a high demand but are somehow deprived of them.
Munchausen syndrome is a borderline mental disorder. It resembles a somatoform disorder (when real pain is caused by psycho-traumatic factors) by the fact that complaints are based on a mental problem. The main difference is that patients with Munchausen syndrome imitate the symptoms intentionally. They constantly feign various illnesses and often go from one hospital to another in search of treatment.
Nevertheless, this syndrome cannot be reduced to a simple simulation. Most often, it is inherent in hysterical persons with increased emotionality. Their feelings are superficial and unstable, emotional reactions are aimed to manipulate others.
Instead of solving the existing problem, patients prefer to simulate illness and hide from the conflict. They receive attention, sympathy, and indulgence; others take over their duties, which suits the pretended sufferer.
Such patients are highly suggestible so they can imitate nearly anything. When they enter the hospital, they can copy the symptoms of other patients.
People with Munchhausen syndrome are usually quite smart and resourceful; they not only know how to feign symptoms, but also understand the diagnosis methods. They often manage to manipulate the doctor and convince him or her to appoint a thorough examination and treatment, which can include surgery. They are lying intentionally, but their motivation and need for attention are largely unconscious.
How to Recognize Munchhausen Syndrome?
A continuous flow of unrealistic health complaints, often with persistent demands for a surgery, is a key symptom of Munchhausen syndrome. Richard Asher identified three main varieties of the disorder:
1. Acute abdominal type is the most common one. There are external signs of acute abdominal pain and numerous scars from previous surgeries. Patients complain of severe pain and insist on an immediate surgical treatment. If a hospital refuses to provide the surgery, patients who were writhing with pain just a minute ago can leave immediately in order to enter another hospital the same day. Some can swallow spoons, forks, nails and other objects in order to get the surgery done.
2. Hemorrhagic type (hysterical bleeding). Patients occasionally have bleedings from different parts of the body. Sometimes they use animal blood or cut themselves, giving the impression of natural injuries. Such patients enter the hospital with complaints of severe life-threatening bleedings.
3. Neurological type. Patients imitate acute neurologic symptoms such as paralysis, fainting, convulsive seizure, severe headache, or unusual gait change. Such patients can demand a brain surgery.
For obvious reasons, people with Munchhausen syndrome are trying not to get into the same hospital twice. They enter various hospitals tens and sometimes hundreds of times.
Munchausen Syndrome by Proxy
Munchausen Syndrome by Proxy, MSBP, is a factitive disorder when parents or people who replace them deliberately cause a child or a vulnerable adult (for example, a disabled person) to seek medical help.
This behavior is shown mostly by women, in the majority of cases by mothers and wives. In different ways they cause symptoms of a disease in their victim. An imaginary or caused illness can be any, though the most frequent symptoms are bleeding, epileptic attack, diarrhea, vomiting, poisoning, infection, fever, and allergy.
Typical marks of MSBP-cases include:
• The symptoms disappear when the parent/caretaker is not in the near;
• The parent/caretaker shows dissatisfaction if the examination shows no disease;
• The parent refuses to leave the child even for a while under various excuses.
Usually a MSBP-person will cause harm in ways that do not leave evidence. Some of the common actions include:
• Obstructing breathing;
• Withholding food or drugs;
• Using drugs improperly (increasing the dose, injecting drugs when it it is not necessary);
• Delaying the necessary medical aid.
When the victim is on the brink of death, his tormentor can take rescue actions to be praised as a hero who saved the patient’s life. Mothers who cause illness in children often suffer from lack of communication and are unhappy in their marriage. Some also suffer from other mental disorders. The majority of them (up to 90%) were subject to physical or mental violence in childhood.
If a doctor detects the artificial nature of a child’s illness, the offenders will deny their guilt and refuse psychiatriс help even if there is strong evidence.
Munchausen Syndrome Treatment
People with Munchausen syndrome are mostly difficult patients. The diagnosis can be suspected, though it is impossible to establish it without a comprehensive examination and long-term follow-up. Treatment usually consists of mental health counseling, which aims to challenge and change the thinking and behavior of a patient. Therapy may also try to address any underlying issues that may be causing the disorder.