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Fake’s progress: A beginner’s guide to Münchausen syndrome

One of the most interesting psychological disorders is Münchausen Syndrome (MS) and is sometimes referred to more colloquially as ‘hospital addiction syndrome’, ‘hospital hopper syndrome’ and ‘thick chart syndrome’. MS is currently classified in the most recent International Classification of Diseases under ‘other disorders of adult personality’. The primary characteristic of people suffering from MS is that they deliberately pretend to be ill in the absence of external incentives (such as criminal prosecution or financial gain). MS has been called a factitious disorder because sufferers feign illness, pretend to have a disease, and/or fake psychological trauma typically to gain attention and/or sympathy from other people. Doctors often nickname such people as ‘frequent flyers’. The name of the syndrome was coined in 1951 by Dr. Richard Asher (in a paper he published in The Lancet about people who fabricated illnesses) and derives from German Karl Friedrich Hieronymus Freiherr von Münchhausen (aka Baron Münchausen), a renowned eighteenth century nobleman, who was reported as telling many fantastical and impossible stories about himself.

A related condition is Münchausen Syndrome by Proxy refers to the abuse of someone else (quite often a child son or daughter), also as a way of seeking attention and/or sympathy for the sufferer. Some members of the medical community believe that this related MS condition should simply be re-named ‘medical abuse’). There are also some specific sub-types of MS. For instance, a 2011 paper in the Journal of Electrocardiology, by Dr. Joseph Vaglio reported a female case of Arrhythmogenic Münchausen Syndrome who intentionally simulated and stimulated irregular cardiac activity to gain medical attention by drinking (and overdosing) on caffeine.

According to Dr. A.J. Giannini and Dr. H.R. Black in the Psychiatric, Psychogenic and Somatopsychic Disorders Handbook, one of the most common signs among MS sufferers is that they may have multiple scars on their abdomen because of repeated exploratory or emergency operations. Other ‘warning signs’ listed on the Web MD website of MS include: (i) dramatic but inconsistent medical history, (ii) predictable relapses following improvement in the condition, (iii) detailed knowledge of hospitals and/or medical terminology, (iv) appearance of new or additional symptoms following negative test results, (v) willingness or eagerness to have medical procedures, (vi) history of seeking treatment at numerous hospitals, clinics, and doctors offices, possibly even in different cities, and (vii) problems with identity and self-esteem.

There has been a debate about whether MS should have been re-classified in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. For instance, in a 2008 issue of the journal Psychosomatics, Dr. Lois Krahn and her colleagues argued that MS should be classed as a somatoform disorder because MS sufferers may not be conscious that they are drawing attention to themselves. [According to Wikipedia, a somatoform disorder “is a mental disorder characterized by symptoms that suggest physical illness or injury – symptoms that cannot be explained fully by a general medical condition or by the direct effect of a substance, and are not attributable to another mental disorder”]. More specifically, Krahn and her colleagues noted:

Factitious and somatoform-disorder patients are alike in that they both organize their lives around seeking medical services in spite of having primarily a psychiatric condition. In DSM–IV, the key difference is that factitious-disorder patients feign illness, and somatoform disorder patients actually believe they are ill. Although patients may not be conscious of their motivation or even their behaviors, deliberately embellishing history or inducing symptoms exemplifies behaviors designed to enhance a self-concept of being ill. For DSM–V, we propose reclassifying factitious disorder as a subtype within the somatoform-spectrum disorders or the proposed physical-symptom disorder, premised on our belief that deliberate deceptions serve primarily to portray to treaters the sense of being ill”.

This appears to be part of the same debate that says MS is distinct from hypochondriasis in that MS patients are said to be aware that they are exaggerating their illness or disease, whereas hypochondriasis sufferers actually believe they have an illness or disease. Another way of looking at it is that MS sufferers want to be a patient whereas those with hypochondriasis don’t. One of the more unusual consequences of MS is that the affected individual will often undergo unnecessary medical procedures, treatments and/or exploratory operations to prolong hospital stay and gain sympathy and attention from those around them including the medical and nursing staff. It is also known that some MS patients have very good medical knowledge and use this as a way of creating and/or producing symptoms of known medical conditions.

Some of the reported risk factors for individuals that develop MS include (i) a history of childhood traumas and (ii) emotional deprivation (e.g., having parents or guardians that were emotionally unavailable due to illness and/or emotional problems while the individual was a child). In relation to treatment and prognosis, the Wikipedia entry on MS asserts:

“Providers need to acknowledge that there is uncertainty in treating suspected Münchausen patients so that real diseases are not under-treated. 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…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, thus offers the worst or best prognosis”.

Unfortunately there are no reliable statistics regarding the number of people who suffer from MS. Research suggests that both males and females are affected in roughly equal numbers and that the mean age of presentation is 36-years old. This is certainly one behaviour that we could do with more empirical research.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Asher, R. (1951). Munchausen’s syndrome. The Lancet, 1, 339–341.

Bhugra D. (1988). Psychiatric Munchausen’s syndrome. Literature review with case reports. Acta Psychiatrica Scandinavica, 77, 497–503.

Feldman, M.D., Hamilton, J.C & Deemer, H.N. (2001). Factitious Disorder. In K.A. Phillips (Eds.), Somatoform and Factitious Disorders. Washington D.C.: American Psychiatric Association.

Giannini A.J. & HR Black, H.R. (1978). Psychiatric, Psychogenic and Somatopsychic Disorders Handbook (pp.194-195). New Hyde Park, NY. Medical Examination Publishing.

Krahn, L.E., Bostwick, J.M. & Stonnington, C.M. (2008). Looking toward DSM-V: Should factitious disorder become a subtype of somatoform disorder? Psychosomatics, 49, 277–282.

Vaglio, J. C., Schoenhard, J. A., Saavedra, P. J., Williams, S. R., & Raj, S. R. (2011). Arrhythmogenic Munchausen syndrome culminating in caffeine-induced ventricular tachycardia. Journal of Electrocardiology, 44, 229-231.

Wikipedia (2013). Münchausen syndrome. Located at:ünchausen_syndrome