Münchausen syndrome

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For feigned illness, see Malingering.
Factitious disorders
Classification and external resources
ICD-10 F68.1
ICD-9 301.51
DiseasesDB 8459 33167
eMedicine med/3543 emerg/322 emerg/830
MeSH D009110

Münchausen syndrome is a psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention, sympathy, or reassurance to themselves. It is also sometimes known as hospital addiction syndrome, thick chart syndrome, or hospital hopper syndrome. True Münchausen syndrome fits within the subclass of factitious disorder with predominantly physical signs and symptoms, but they also have a history of recurrent hospitalization, travelling, and dramatic, untrue, and extremely improbable tales of their past experiences.[1] There is discussion to reclassify them as somatoform disorders in the DSM-5 as it is unclear whether or not people are conscious of drawing attention to themselves.[2] In the current iteration, the term "somatoform disorder" (as used in the DSM-IV-TR and other literature) is no longer in use; that particular section of the DSM-V has been renamed "Somatic Symptom and Related Disorders". Officially, Münchausen syndrome has been renamed "Factitious Disorder", with specificity either as "Imposed on Self" or "Imposed on Another" (formerly "by Proxy").

Münchausen syndrome is related to Münchausen syndrome by proxy (MSbP/MSP), which refers to the abuse of another person, typically a child, in order to seek attention or sympathy for the abuser. It is an obsessive want to create symptoms for the victim in order to obtain repeated medication or even operations.

Description[edit]

In Münchausen syndrome, the affected person exaggerates or creates symptoms of illnesses in themselves to gain investigation, treatment, attention, sympathy, and comfort from medical personnel. In some extreme cases, people suffering from Münchausen's syndrome are highly knowledgeable about the practice of medicine and are able to produce symptoms that result in lengthy and costly medical analysis, prolonged hospital stay and unnecessary operations. The role of "patient" is a familiar and comforting one, and it fills a psychological need in people with this syndrome. This disorder is distinct from hypochondriasis and other somatoform disorders in that those with the latter do not intentionally produce their somatic symptoms.[3]

Risk factors for developing Münchausen syndrome include childhood traumas, growing up with parents/caretakers who were emotionally unavailable due to illness or emotional problems, a serious illness as a child, failed aspirations to work in the medical field, personality disorders, and a low self-esteem. Münchausen syndrome is more common in men and seen in young or middle-aged adults. Those with a history of working in healthcare are also at greater risk of developing it.[4]

Arrhythmogenic Münchausen syndrome describes individuals who simulate or stimulate cardiac arrhythmias to gain medical attention.[5] The syndrome differs from malingering, in which a patient fabricates symptoms for an apparent purpose, such as financial compensation, absence from work, or access to drugs.

A similar behavior called Münchausen syndrome by proxy has been documented in the parent or guardian of a child. The adult ensures that his or her child will experience some medical affliction, therefore compelling the child to suffer treatment for a significant portion of their youth in hospitals. Furthermore, a disease may actually be initiated in the child by the parent or guardian. This condition is considered distinct from Münchausen syndrome. In fact, there is growing consensus in the pediatric community that this disorder should be renamed "medical abuse" to highlight the real harm caused by the deception and to make it less likely that a perpetrator can use a psychiatric defense when real harm is done.[6]

Origin of the name[edit]

The syndrome name derives from Baron Münchhausen (Karl Friedrich Hieronymus Freiherr von Münchhausen, 1720–1797), a German nobleman working in the Russian army, who purportedly told many fantastic and impossible stories about himself, which Rudolf Raspe later published as The Surprising Adventures of Baron Münchhausen.

In 1951, Richard Asher was the first to describe a pattern of self-harm, wherein individuals fabricated histories, signs, and symptoms of illness. Remembering Baron Münchhausen, Asher named this condition Münchausen's Syndrome in his article in The Lancet in February 1951,[7] quoted in his obituary in the British Medical Journal:

"Here is described a common syndrome which most doctors have seen, but about which little has been written. Like the famous Baron von Munchausen, the persons affected have always travelled widely; and their stories, like those attributed to him, are both dramatic and untruthful. Accordingly the syndrome is respectfully dedicated to the Baron, and named after him."

British Medical JournalR.A.J. Asher, M.D., F.R.C.P.[8]

Originally, this term was used for all factitious disorders. Now, however, there is considered to be a wide range of factitious disorders, and the diagnosis of "Münchausen syndrome" is reserved for the most severe form, where the simulation of disease is the central activity of the affected person's life.

Treatment and prognosis[edit]

Medical professionals or doctors suspecting Münchausen's in a patient should first rule out the possibility that the patient has an early stage disease that is not yet clinically detectable. Providers need to acknowledge that there is uncertainty in treating suspected Münchausen patients so that real diseases are not under-treated.[9] Then they should take a careful patient history and seek medical records, to look for early deprivation, childhood abuse, or mental illness. If a patient is at risk to himself or herself, inpatient psychiatric hospitalization should be initiated.[10]

Medical providers or doctors should consider working with mental health specialists to help treat the underlying mood or disorder as well as to avoid countertransference.[11] Therapeutic and medical treatment should center on the underlying psychiatric disorder: a mood disorder, an anxiety disorder, or borderline personality disorder. The patient's prognosis depends upon the category under which the underlying disorder falls; depression and anxiety, for example, generally respond well to medication and/or cognitive behavioral therapy, whereas borderline personality disorder, like all personality disorders, is presumed to be pervasive and more stable over time,[12] thus offers the worst or best prognosis.

Patients may have multiple scars on abdomen due to repeated "emergency" operations.[13]

There are several symptoms that together point to Münchausen syndrome. Some are frequent hospitalizations, knowledge of several illnesses, frequently requesting medication such as pain killers, openness to extensive surgery, little to no visitors during hospitalizations, exaggerated or fabricated stories about several medical problems, and more. Münchausen syndrome should not be confused with hypochondria as patients with Münchausen syndrome do not really believe they are sick, they only want to be sick and thus fabricate the symptoms of an illness. It is also not the same as pretending to be sick for personal benefit such as being excused from work or school.[4]

There are several ways in which the patients fake their symptoms. Other than making up past medical histories and faking illnesses patients might inflict harm on themselves such as taking laxatives or blood thinners, ingesting or injecting themselves with bacteria, cutting or burning themselves, and disrupting their healing process such as reopening wounds. Many of these conditions do not have clearly observable or diagnostic symptoms and sometimes the syndrome will go undetected because patients will fabricate identities when visiting the hospital several times. Münchausen syndrome has several complications as these patients will go to great lengths to fake their illness. Severe health problems, serious injuries, loss of limbs or organs, and even death are possible complications.[4]

See also[edit]

Notes and references[edit]

  1. ^ Jerald Kay and Allan Tasman (2006). Essentials of psychiatry. John Wiley & Sons, Ltd. p. 680. ISBN 0-470-01854-2. 
  2. ^ Krahn LE, Bostwick JM, Stonnington CM (2008). "Looking toward DSM-5: should factitious disorder become a subtype of somatoform disorder?". Psychosomatics 49 (4): 277–82. doi:10.1176/appi.psy.49.4.277. PMID 18621932. 
  3. ^ Benjamin J. Sadock (Editor), Virginia A. Sadock (Editor) (January 15, 2000). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (2 Volume Set) (7th ed.). Lippincott Williams & Wilkins Publishers. p. 3172. ISBN 0683301284. 
  4. ^ a b c Staff, Mayo Clinic. "Munchausen Syndrome." Mayo Clinic. Mayo Foundation for Medical Education and Research, 13 May 2011. Web. 11 Apr. 2013.
  5. ^ Vaglio JC, Schoenhard JA, Saavedra PJ, Williams SR, Raj SR (2010). "Arrhythmogenic Munchausen syndrome culminating in caffeine-induced ventricular tachycardia". J Electrocardiol 44 (2): 229–31. doi:10.1016/j.jelectrocard.2010.08.006. PMID 20888004. 
  6. ^ Pediatrics 2007 May 05;119:1026-1030
  7. ^ Lancet 1951 Feb 10;1(6650):339-41 doi:10.1016/S0140-6736(51)92313-6
  8. ^ "R. A. J. Asher (Obituary notice)". British Medical Journal 2 (5653): 388. 1969-05-10. doi:10.1136/bmj.2.665.388. Retrieved 2008-03-20 
  9. ^ Bursztajn, H, Feinbloom RI, Hamm RM, Brodsky A. Medical Choices, medical chances: How patients, families and physicians can cope with uncertainty. New York. Delacourte/Lawrence. 1981.
  10. ^ Johnson BR, Harrison JA. Suspected Münchausen syndrome and civil commitment. J Am Acad Psychiatry Law. 2000; 28:74-76.
  11. ^ Elder W, Coletsos IC, Bursztajn HJ. Factitious Disorder/Munchhausen Syndrome. The 5-Minute Clinical Consult. 18th Edition. 2010. Editor. Domino, F.J. Wolters Kluwer/Lippincott. Philadelphia.
  12. ^ Davidson, G. et al. (2008). Abnormal Psychology - 3rd Canadian Edition. Mississauga: John Wiley & Sons Canada, Ltd. p. 412. ISBN 978-0-470-84072-6. 
  13. ^ AJ Giannini,HR Black. Psychiatric, Psychogenic and Somatopsychic Disorders Handbook. New Hyde Park ,NY. Medical Examination Publishing, 1978,pp.194-195. ISBN 0-87488-596-5

Bibliography[edit]

  • Feldman, Marc (2004). Playing sick?: untangling the web of Münchausen syndrome, Münchausen by proxy, malingering & factitious disorder. Philadelphia: Brunner-Routledge. ISBN 0-415-94934-3. 
  • Fisher JA (2006). "Playing patient, playing doctor: Münchausen syndrome, clinical S/M, and ruptures of medical power". The Journal of medical humanities 27 (3): 135–49. doi:10.1007/s10912-006-9014-9. PMID 16817003. 
  • Fisher JA (2006). "Investigating the Barons: narrative and nomenclature in Münchausen syndrome". Perspect. Biol. Med. 49 (2): 250–62. doi:10.1353/pbm.2006.0024. PMID 16702708. 
  • Friedel,Robert O., MD Borderline Personality Disorder Demystified, Pg 9-10, Münchausen syndrome, Münchausen syndrome by Proxy. ISBN 1-56924-456-1
  • Davidson, G. et al. (2008). Abnormal Psychology - 3rd Canadian Edition. Mississauga: John Wiley & Sons Canada, Ltd. p. 412. ISBN 978-0-470-84072-6. 
  • Prasad, Ashoka; Oswald, A. G. "Munchausen's syndrome:an annotation"
  • Leila Schneps and Coralie Colmez, Math on trial. How numbers get used and abused in the courtroom, Basic Books, 2013. ISBN 978-0-465-03292-1. (First chapter: "Math error number 1: multiplying non-independent probabilities. The case of Sally Clark: motherhood under attack").
  • Staff, Mayo Clinic. "Munchausen Syndrome." Mayo Clinic. Mayo Foundation for Medical Education and Research, 13 May 2011. Web. 11 Apr. 2013

External links[edit]