Factitious disorder imposed on self

Factitious disorder imposed on self
Specialty	Psychiatry, psychology

This article is about the self-inflicted factitious disorder. For the type of abuse commonly known as Munchausen Syndrome by Proxy, see Fabricated or Induced Illness.

Munchausen syndrome is a psychiatric disorder in which those affected feign disease, illness, or psychological trauma in order to draw attention or sympathy to themselves. It is in a class of disorders known as factitious disorders which involve "illnesses" whose symptoms are either self-induced or falsified by the patient. It is also sometimes known as Hospital addiction syndrome.

Munchausen syndrome

In Munchausen syndrome, the affected person exaggerates or creates symptoms of illnesses in themselves in order to gain investigation, treatment, attention, sympathy, and comfort from medical personnel. The role of "patient" is a familiar and comforting one, and it fills a psychological need in people with Munchausen's. It is distinct from hypochondria in that the patient is aware that he is exaggerating, while sufferers of hypochondria actually believe they have a disease.

There is some controversy on the exact causes of the syndrome, but an increased occurrence has been reported in healthcare professionals and close family members of people with a chronic illness such as manic depression.

Individuals with the Munchausen pattern of behaviour may be admitted to many hospitals under many medical teams.

Origin of the name

The name derives from one Baron Münchhausen (Karl Friedrich Hieronymus Freiherr von Münchhausen, 1720-1797), to whom were ascribed a series of fantastically impossible tales written by Rudolf Raspe.

In 1951, Sir Richard Asher (father of Jane Asher and Peter Asher) was the first to describe a pattern of self-harm, where individuals fabricated histories, signs, and symptoms of illness. Remembering Baron Munchausen, Asher named this condition Munchausen's Syndrome. 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 "Munchausen syndrome" is reserved for the most severe form, where the simulation of disease is the central activity of the affected person's life.

Comparison to Fabricated or Induced Illness (FII)

Fabricated or Induced Illness (FII) is the formal name of a type of abuse in which a caregiver feigns or induces an illness in a person under their care, in order to attract attention, sympathy, or to fill other emotional needs. It is informally known as Munchausen Syndrome by Proxy (MSbP), due to its similarity to Munchausen syndrome, in which a person feigns or induces illness in themselves for similar emotional reasons. While a person can be said to be "suffering" from Munchausen syndrome, it is incorrect to state that a caretaking person who perpetrates abuse is "suffering" from Munchausen Syndrome by Proxy.

The two terms are frequently confused. One recognizable instance is in a song by rap artist Eminem, titled "Cleaning Out My Closet". The line from the song is:

"... victim of Munchausen's syndrome/My whole life I was made to believe I was sick when I wasn't"

The circumstance Eminem describes is not the illness Munchausen syndrome, but the type of abuse informally called Munchausen Syndrome by Proxy.

Illnesses and Conditions that are feigned by Munchausen sufferers

• Lupus
• Electrolyte disturbance
• Dissociative identity disorder
• Post-traumatic stress disorder
• Kidney Disease
• Heart disease
• Arthritis
• Sexual abuse

Munchausen Syndrome in popular culture

• On April 19 1983, the NBC television series St. Elsewhere aired the episode "Baron Von Munchausen" in which a patient is eventually diagnosed with Munchausen syndrome.[1] This 1983 reference was probably the first time that Munchausen syndrome was referred to in an American network dramatic series. In the 1990s and later, almost every major medical drama on television has referred to either Munchausen syndrome or Munchausen syndrome by proxy.
• In the film The Sixth Sense, the ghost of dead girl leads the main character (played by Haley Joel Osment) to a video tape. The tape reveals that her mother had been poisoning her with cleaning fluid in her food (making her a victim of "Munchausen by proxy"). This tape is played at the funeral gathering, to the shocked horror of the girl's father. This action saves the dead girl's sister from sharing the same fate (overheard conversation at the funeral mentions that "now their other daughter is sick").
• First airing October 11, 2005, an episode of FX's Nip/Tuck features a patient with Munchausen syndrome. She cuts herself to mimic the injuries left by the show's infamous face-slasher The Carver (and later actually becomes one of his victims).
• An episode of ABC-TV's Grey's Anatomy first airing October 16, 2005, features a patient diagnosed with Munchausen syndrome. She is portrayed taking Amitriptyline, an antidepressant that turned her urine blue.
• An episode of FOX's House, M.D. first aired on December 13, 2005, featured a patient played by Cynthia Nixon who admitted to Munchausen syndrome after being tricked into taking Rifampin, an antibiotic that turned her tears orange, but who was later additionally diagnosed with a bacterial infection.
• An episode of NBC's Law & Order: Special Victims Unit (S07E15), first aired on Tuesday February 7, 2006, featured a woman, played by Rebecca DeMornay, who had Munchausen syndrome.
• In an episode of the British series Doctors (TV series) first aired on Wednesday 15th November 2006, a woman is diagnosed with Munchausen syndrome after repeatedly faking illness in the form of stomach pain. She cuts herself to put blood in her urine, and has surgical scars on her stomach from previous medical investigations. She then pretends to attempt suicide when in actual fact she only took four tablets.
• In the Seinfeld episode The Scofflaw, a character played by Jon Lovitz fakes cancer for the attention (and subsequently, gifts such as a toupee).
• In the Lifetime movie, Glass House: The Good Mother it tells about a mother who has munchausen syndrome and who poisons her kids. The kids get rescued, though.

See also

• Fabricated or Induced Illness, also known as Munchausen Syndrome by Proxy
• Psychosomatic illness
• Mythomania

External links

• Dr. Marc Feldman's Munchausen Syndrome, Malingering, Factitious Disorder, & Munchausen by Proxy Page - Page offering information on Munchausen and its many other names. Offers information on Dr. Feldman's books and his email address for interested parties.
• Article in Discover magazine, July 1993, by Abigail Zuger

References

• Feldman M.D. 2004. Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder. New York: Brunner-Routledge.
• Fisher, Jill A. 2006. Playing Patient, Playing Doctor: Munchausen Syndrome, Clinical S/M, and Ruptures of Medical Power. Journal of Medical Humanities 27 (3): 135-149.
• Fisher, Jill A. 2006. Investigating the Barons: Narrative & Nomenclature in Munchausen Syndrome. Perspectives in Biology and Medicine 49 (2): 250-262.