Munchausen Syndrome

People with Munchausen Syndrome may pretend to have either a psychological or a physical illness – or both. For example, they might claim that they are hallucinating, experiencing dizziness and hearing voices that are not really there, or they might say that they are experiencing physical symptoms such as pain, nausea, or other forms of malaise. They may have real symptoms, but exaggerate the severity of them. They may try to create symptoms by, for example, taking emetics to induce vomiting, or other forms of medication that may bring on symptoms such as fever. They may know how to tamper with urine samples or temperature-measuring devices to provide false data about their health. People with Factitious Disorder are often quite well-informed about illness, and will choose to fake symptoms that are challenging to disprove, such as fainting, pretending to have seizures, or claiming to have severe headache. They may also engage in self-harm, such as deliberately eating contaminated food, rubbing a dirty substance into a wound to induce infection, or using a tourniquet or rubber band to cut off circulation to a limb, in order to create convincing symptoms of illness. Sometimes they may engage in behaviours so extreme that they actually run the risk of making themselves seriously ill to the point of death, in order to achieve the symptoms they seek and the notice they desire. Typically, relapses following improvements in their symptoms occur when no medical professionals are present, such as shortly after discharge from hospital.

While people with Factitious Disorder clearly crave attention, the condition goes far beyond attention-seeking. People with this condition may feign illness so convincingly that they are admitted to hospital for exploratory surgery, or for surgery to treat non-existent conditions, and often tell elaborate fictious stories about previous alleged periods of illness and the treatments they received. In fact, people with experience of working in healthcare settings are more likely to have Factitious Disorder than others.

Despite their cunning and manipulative behaviours, people with Munchausen Syndrome are not in complete control of their actions. While they know that they are not really ill, and are very aware of the things they do to induce or feign symptoms, they typically do not understand why they feel compelled to do these things. They may reject the idea that they have a problem or, conversely, go through periods of deep shame that eventually give way to another round of compulsive behaviours. Living with the condition is difficult: at minimum it causes problems in the person’s important relationships by eroding trust. Many people with Munchausen Syndrome have poor coping skills and also struggle to form and maintain relationships.

When their medical caregivers start to realise that they are not really ill, people with the condition will frequently leave the hospital and move to another area to start the process all over again. Sometimes they will present to a new doctor or hospital with a bogus name and identity, to avoid being recognised as someone who previously wasted medical time with a fake disorder.

People with Factitious Disorder may pretend to have either a psychological or a physical illness – or both. For example, they might claim that they are hallucinating, experiencing dizziness and hearing voices that are not really there, or they might say that they are experiencing physical symptoms such as pain, nausea, or other forms of malaise. They may have real symptoms, but exaggerate the severity of them. They may try to create symptoms by, for example, taking emetics to induce vomiting, or other forms of medication that may bring on symptoms such as fever. They may know how to tamper with urine samples or temperature-measuring devices to provide false data about their health. People with Factitious Disorder are often quite well-informed about illness, and will choose to fake symptoms that are challenging to disprove, such as fainting, pretending to have seizures, or claiming to have severe headache. They may also engage in self-harm, such as deliberately eating contaminated food, rubbing a dirty substance into a wound to induce infection, or using a tourniquet or rubber band to cut off circulation to a limb, in order to create convincing symptoms of illness. Sometimes they may engage in behaviours so extreme that they actually run the risk of making themselves seriously ill to the point of death, in order to achieve the symptoms they seek and the notice they desire. Typically, relapses following improvements in their symptoms occur when no medical professionals are present, such as shortly after discharge from hospital.

While people with Munchausen Syndrome clearly crave attention, the condition goes far beyond attention-seeking. People with this condition may feign illness so convincingly that they are admitted to hospital for exploratory surgery, or for surgery to treat non-existent conditions, and often tell elaborate fictious stories about previous alleged periods of illness and the treatments they received. In fact, people with experience of working in healthcare settings are more likely to have Factitious Disorder than others.

Despite their cunning and manipulative behaviours, people with Factitious Disorder are not in complete control of their actions. While they know that they are not really ill, and are very aware of the things they do to induce or feign symptoms, they typically do not understand why they feel compelled to do these things. They may reject the idea that they have a problem or, conversely, go through periods of deep shame that eventually give way to another round of compulsive behaviours. Living with the condition is difficult: at minimum it causes problems in the person’s important relationships by eroding trust. Many people with Factitious Disorder have poor coping skills and also struggle to form and maintain relationships.

When their medical caregivers start to realise that they are not really ill, people with the condition will frequently leave the hospital and move to another area to start the process all over again. Sometimes they will present to a new doctor or hospital with a bogus name and identity, to avoid being recognised as someone who previously wasted medical time with a fake disorder.

To date, it remains quite unclear why this condition develops in certain people, but it may often be linked to the individual’s past. If they experienced illness in childhood, they may associate this period in their lives with the positive attention they received from their parents or other adults in their lives. In some cases, people with Factitious Disorder may have been neglected or otherwise mistreated by their parents; possibly their only happy memories of childhood come from the times when they were ill. Others may have lost a parent or other loved one to illness, and the trauma they experienced resulted in the compulsive desire to return to the medical environment in which this original trauma occurred.

Moreover, Factitious Disorder often occurs with comorbidities, including:

• narcissistic personality disorder, when the person views themselves as special and unique, while also requiring huge amounts of validation, because of their deeply-held fears that others may see them as of low worth;
• a mood disorder or an anxiety disorder;
• antisocial personality disorders, manifested here when the person affected achieves a sense of being in control from fooling and manipulating medical caregivers;
• borderline personality disorders, when they find it difficult to control their emotions and often switch rapidly between viewing others positively or negatively.

In countries like Britain, with nationalised health systems, or in those where people depend heavily on private insurance companies, such as the United States, frequently patients with Factitious Disorder are experienced as extremely frustrating by medical caregivers and administrative staff. Invasive medical testing and hospital stays are generally very expensive, and it is infuriating when resources are diverted to those who do not really need medical attention. In these contexts, patients with Munchausen disorder may be confronted in a very robust manner, which is understandable but can actually be counterproductive in terms of addressing the problem and bringing their condition under control.

It is important to note that people with Factitious Disorder seek affirmation of their imagined or self-induced conditions because of their deeply-felt need for attention, and not with the intention of defrauding their employer or the state by feigning illness for financial gain (a crime known as malingering). While this does not, of course, mean that their endless demands for attention and medical care in the absence of real illness should be entertained, it is clear that they need psychiatric and/or psychological support, and that it will be more useful – and ultimately less costly – to provide them with interventions that will help.

It is also essential to recognise that people with Factitious Disorder can, like everyone else, also become sick with real illnesses, particularly as they age and become more frail. At this point, their long history of presenting with fake or self-induced symptoms becomes a significant risk to their health, well-being, and effective medical care, as doctors will be understandably sceptical of new claims of illness. Thus, opportunities to effectively treat real illnesses can be lost.

The greatest challenge in treating Factitious Disorder is getting the person affected to admit that they have a problem. As the core symptom of the condition is their insistence that they truly are ill, they will typically reject any suggestion that they have the condition, and will simply not cooperate with any proposed treatment plans.

Opinions vary as to how to approach these extremely challenging patients. Some believe that the best method is to refer to them to a psychiatrist, while initially avoiding confronting them regarding their behaviour, and in particular not suggesting that the symptoms they are claiming to experience are not real. Others, conversely, suggest that an assertive approach is the most appropriate, as it may force them to confront reality.

Either way, it is not possible to effectively treat the person with Factitious Disorder until they have admitted to their behaviour and accepted that they have a problem. If and when that occurs, there are ways to treat the condition and minimise its impact on their lives – and on the lives of their loved ones.

A useful approach can be a combination of cognitive behavioural therapy (CBT) and psychoanalysis.

A course of CBT will help the patient to recognise recurring unhelpful beliefs and behaviours, and to learn how to think differently about themselves, and how to replace unhelpful behaviours with more useful ones.

Meanwhile, in psychoanalysis, the patient and his or her therapist can explore the origins of the behaviour, which may lie in childhood experiences such as trauma, prolonged illness, inattentive or abusive parents or – frequently – a combination of the above.

Both approaches should also bear in mind the patient’s comorbidities, such as narcissistic personality disorder, and work with them to bring these under control.

Family therapy may also help, as often the family and other loved ones of the patient have become inadvertently complicit in supporting the patient in making false claims of illness by giving them the attention they crave, and may also be vulnerable to developing a disorder themselves.

It is likely that patients with Factitious Disorder will have to learn how to live with the condition by managing the symptoms and becoming aware of the factors that trigger them, as it may not be possible to completely eliminate the desire to present with illness. However, with a willingness to admit that there is a problem, and to engage with therapy, for most people the condition can be kept under control. For most patients, relapse may remain a possibility, and therefore it is recommended that they maintain a line of communication with their therapist, so that a return to therapy when they feel they are at risk is recommended.

Factitious Disorder by Proxy, also known as Munchausen Syndrome by Proxy, is a related condition that is diagnosed when someone feigns illness in another – typically a child – or does things to create symptoms in the child even when no illness is present. While Factitious Disorder tends to be more common in men, Factitious Disorder by Proxy is more common among women, typically mothers.

If you would like to talk to someone about Factitious Disorder/Munchausen Syndrome, please get in touch with the Private Therapy Clinic on Whatsapp message at: +447511116565 email, chat bot or book online to arrange an appointment.

Feldman, Marc (2004). Playing sick?: Untangling the Web of Munchausen syndrome, Munchausen by Proxy, Malingering & Factitious disorder. Philadelphia: Brunner-Routledge.

Feldman MD (July 2000). “Munchausen by Internet: Detecting Factitious Illness and Crisis on the Internet”. South. Med. J. 93 (7): 669–72. Retrieved from Link

Kinns H, Housley D, Freedman DB (May 2013). “Munchausen Syndrome and Factitious Disorder: the Role of the Laboratory in its Detection and Diagnosis”. Annals of Clinical Biochemistry, 50 (Pt 3): 194–203. Retrieved from Link

Repper J (February 1995). “Münchausen Syndrome by Proxy in Health Care Workers”. Journal of Advanced Nursing. Hoboken, New Jersey: John Wiley and Sons. 21 (2): 299–304. Retrieved from Link