Disease: Munchausen Syndrome

    Munchausen syndrome facts

    • Munchausen syndrome is a mental disorder that is characterized by the sufferer causing or pretending to have physical or psychological symptoms in his or herself.
    • Adults aged 20-40 years are the most likely groups to develop Munchausen syndrome. Women with some knowledge or training in health care and men with little familial attachment are particularly vulnerable to this disorder.
    • Munchausen syndrome is often either preceded by or coexists with Munchausen syndrome by proxy.
    • It is estimated that Munchausen syndrome occurs in a small portion of the United States population, with higher tendencies to occur in subpopulations like people who have been diagnosed as having psychosis or fever of unknown origin.
    • Munchausen syndrome has been described since at least biblical times. It was named for Baron Karl Friedrich von Munchausen, an 18th-century man who joined the Russian military and was known to tell fantastic tales about the battles he participated in.
    • Munchausen syndrome by proxy (MSBP) is a fabrication of illness by a third person that allows the third person, usually the victim's mother, to assume the caregiver's role.
    • Although there is no specific cause for Munchausen syndrome, risk factors for the disorder tend to be psychological as in having borderline or antisocial personality traits or a grudge against the medical profession and social, like having a personal or familial history of serious illness or a history of neglect, abuse, or other maltreatment.
    • Due to the chronic nature of the illness, as well as the tendency of sufferers to flee treatment, the treatment of Munchausen syndrome is difficult. No single approach is consistently effective in managing this illness.
    • Prevention or early treatment of the factors that place people at risk for developing Munchausen syndrome are important aspects of decreasing the likelihood that the disorder will develop. Once symptoms of the disorder are determined, the earlier it is addressed, the better the likely outcome.

    What is Munchausen syndrome?

    Munchausen syndrome is a mental disorder that is characterized by the sufferer causing or pretending to have physical or psychological symptoms in his or herself. It is thought to be motivated only by a desire to be seen as ill rather than by avoiding responsibility, financial gain, improving his or her physical condition, or some other benefit, as is true in malingering. Research outcomes differ in terms of identifying groups that are susceptible to developing the disorder. Some statistics indicate that women with health training may be more vulnerable to developing Munchausen syndrome, particularly when it presents with physical symptoms. However, it is thought by other investigators that men and women experience Munchausen syndrome in equal frequency. Still other studies describe middle-aged men who are unmarried and estranged from their families as being the most susceptible to developing this illness. While the disorder may occur at any age, it seems to most often develop in late adolescence or early adulthood and is either preceded by or coexists with Munchausen syndrome by proxy. Munchausen syndrome is also referred to as factitious disorder.

    It is estimated that Munchausen syndrome occurs in a small percentage of the United States population. How common it is can be significantly higher in certain subpopulations. For example, some cases of fever of unknown origin are the result of this disorder. Some people who were previously diagnosed as having psychosis were found to have Munchausen syndrome.

    Even before it was given its current name, this illness has been described since at least biblical times. For example, sufferers of this attention-seeking syndrome during the Middle Ages have been known to scrape off their skin and put leeches in their own mouths in order to induce bleeding. This disorder was named for Baron Karl Friedrich von Munchausen. Baron von Munchausen lived from 1720 to 1797, was born in Germany, joined the Russian military, and was known to tell fantastic tales about the battles he participated in against the Ottoman Turks. For example, he apparently told stories about riding cannonballs and traveling to the moon.

    In contrast to Munchausen syndrome, Munchausen syndrome by proxy (MSBP) is a fabrication of illness by a third person that allows the third person, usually a caretaker, to assume the sick role. The caretaker usually involved in the development of MSBP is the victim's mother. Although both Munchausen syndrome and somatoform disorders can be characterized by physical complaints, Munchausen syndrome is different in that the complaints are consciously invented or caused by the sufferer him or herself. For example, in somatization disorder, conversion disorder, and hypochondria, the individual is convinced that they really suffer from physical symptoms, have a deficit in movement or sensory function, or are seriously ill, respectively.

    What causes Munchausen syndrome?

    Although there is no specific cause for Munchausen syndrome, like most other mental disorders, it is understood to be the result of a combination of biological vulnerabilities, ways of thinking, and social stressors (biopsychosocial model). Little is known about the specific biological vulnerabilities from which individuals with Munchausen syndrome are more likely to suffer. Psychologically, sufferers of this mental illness tend to have an increased need for control, an imbalance in the level of self-esteem (either low or excessively high), and a vulnerability to suffering from depression, anxiety, or substance abuse. Personality traits of individuals who have a history of feigning or inducing symptoms in themselves include some that are in common with borderline personality disorder (for example, if the person is dissociative or has another disturbance in their identity/sense of self; unstable relationships, recurrent self-mutilation, and/or recurrent thoughts or attempts at suicide) or antisocial personality disorder (for example, a tendency to lie, disregard the safety of themselves or others, and to have little empathy for others). Risk factors for people with Munchausen syndrome include enduring a major negative event (trauma) during their own childhood (such as a serious illness of themselves, a close family member or friend), having a grudge against the medical profession or having been themselves the victim of neglect, physical or sexual abuse, or other forms of maltreatment during childhood.

    What are Munchausen syndrome symptoms and signs?

    The specific signs and symptoms of Munchausen syndrome can be extremely varied, from heart symptoms like fainting and chest pain, to ear problems seen by specialists in that area, to overtly psychiatric symptoms like hallucinations. Although the specific symptoms that the individual complains of are nearly limitless, sufferers may have in common a tendency to seek care from multiple care providers and hospitals, seem excessively pleased to be subjected to multiple tests and procedures, have symptoms that are vague and/or inconsistent with test results, have an illogical course to their illness, usually worsening, an unwillingness to allow current health care professionals to talk to family members or previous care providers, and an excessive desire to receive medications. Interestingly, the symptoms of Munchausen syndrome are very similar in children and adolescents as they are in adults.

    How is Munchausen syndrome diagnosed?

    As occurs with some psychiatric diagnoses, there is ongoing debate about how to best understand and diagnose Munchausen syndrome. The diagnosis as indicated by the widely accepted criteria set by the Diagnostic and Statistical Manual of Mental Disorders (DSM) requires that the sufferer exhibit the following:

    • Purposeful production or pretending to have physical or mental health signs or symptoms
    • Being able to assume the role of a sick person is the motivation for the behavior
    • Other motivators for the behavior (for example, financial gain, avoiding legal consequences, or improving physical well-being) are not present.

    There are three types of Munchausen syndrome: primarily mental health signs and symptoms, primarily physical signs and symptoms, and a combination of physical and mental health signs and symptoms.

    There is no specific definitive test, like a blood test, that can accurately assess that a person has Munchausen syndrome. Therefore, practitioners conduct a mental health interview that looks for the presence of the symptoms previously described. As with any mental health assessment, the professional will usually work toward ruling out other mental disorders and ensuring that the individual is not suffering from a primary medical problem or from medical issues that may cause emotional symptoms. He or she will often inquire about when the person has most recently had a physical examination, comprehensive blood work, and any other tests that a medical professional deems necessary to ensure that the individual is not suffering from a true medical condition instead of or in addition to potentially feigning or manufacturing symptoms. Also of significant importance is the practitioner reviewing any available previous medical records and talking to other people who may be in the person's life (for example, current or previous treating professionals, the spouse, or other family members) in order to explore the possibility that there is a pattern of the individual making up or inducing illness in previous instances.

    What is the treatment for Munchausen syndrome?

    Due to the chronic nature of the illness, as well as the tendency of sufferers to flee treatment, the treatment of Munchausen syndrome can be difficult. No single approach is consistently effective in managing this illness. Confronting victims of Munchausen syndrome does not seem to be an effective part of treatment of this illness. Rather, the sufferer is at even higher risk of prematurely ending medical care in response to being confronted, only to resume getting unnecessary tests and treatments from a new care provider. Therefore, maintaining the delicate balance between providing the sufferer of Munchausen syndrome with empathetic professional support with prevention of their receiving further unnecessary tests and procedures is key to caring from victims of this disorder. Specifically, showing empathy for the difficulties of what led to the development of the disorder while encouraging the victim to adapt new ways of managing their feelings are important aspects of addressing Munchausen syndrome. In addition to trying to develop and maintain a supportive relationship with the individual with this illness, many health care professionals will keep in close contact with the family of the sufferer in order to educate family members about the victim's behaviors and need for attention. The health care professional may also greatly assist in the person's recovery by maintaining frequent communication with other health care professionals as a means of educating those providers about this diagnosis and preventing the perpetuation of unnecessary tests and procedures.

    What is the prognosis for Munchausen syndrome?

    Munchausen syndrome can have significantly negative effects on the lives of individual sufferers and on the community at large. It is estimated that this disorder results in about $40 million per year in unnecessary tests and other medical resources. The chronic nature as well as the tendency to be at odds with the medical community puts individuals with this illness at risk of multiple recurrences of symptoms. Of related note is the associated high completed suicides at a rate of 30%-70%. Males tend to have worse outcomes than females.

    People with Munchausen syndrome who have no other psychiatric diagnosis seem to have a better chance of full recovery than those who also suffer from another mental illness. However, when a person with another psychiatric disorder gets treatment for that problem, their symptoms of Munchausen syndrome often improve as well.

    What causes Munchausen syndrome?

    Although there is no specific cause for Munchausen syndrome, like most other mental disorders, it is understood to be the result of a combination of biological vulnerabilities, ways of thinking, and social stressors (biopsychosocial model). Little is known about the specific biological vulnerabilities from which individuals with Munchausen syndrome are more likely to suffer. Psychologically, sufferers of this mental illness tend to have an increased need for control, an imbalance in the level of self-esteem (either low or excessively high), and a vulnerability to suffering from depression, anxiety, or substance abuse. Personality traits of individuals who have a history of feigning or inducing symptoms in themselves include some that are in common with borderline personality disorder (for example, if the person is dissociative or has another disturbance in their identity/sense of self; unstable relationships, recurrent self-mutilation, and/or recurrent thoughts or attempts at suicide) or antisocial personality disorder (for example, a tendency to lie, disregard the safety of themselves or others, and to have little empathy for others). Risk factors for people with Munchausen syndrome include enduring a major negative event (trauma) during their own childhood (such as a serious illness of themselves, a close family member or friend), having a grudge against the medical profession or having been themselves the victim of neglect, physical or sexual abuse, or other forms of maltreatment during childhood.

    What are Munchausen syndrome symptoms and signs?

    The specific signs and symptoms of Munchausen syndrome can be extremely varied, from heart symptoms like fainting and chest pain, to ear problems seen by specialists in that area, to overtly psychiatric symptoms like hallucinations. Although the specific symptoms that the individual complains of are nearly limitless, sufferers may have in common a tendency to seek care from multiple care providers and hospitals, seem excessively pleased to be subjected to multiple tests and procedures, have symptoms that are vague and/or inconsistent with test results, have an illogical course to their illness, usually worsening, an unwillingness to allow current health care professionals to talk to family members or previous care providers, and an excessive desire to receive medications. Interestingly, the symptoms of Munchausen syndrome are very similar in children and adolescents as they are in adults.

    How is Munchausen syndrome diagnosed?

    As occurs with some psychiatric diagnoses, there is ongoing debate about how to best understand and diagnose Munchausen syndrome. The diagnosis as indicated by the widely accepted criteria set by the Diagnostic and Statistical Manual of Mental Disorders (DSM) requires that the sufferer exhibit the following:

    • Purposeful production or pretending to have physical or mental health signs or symptoms
    • Being able to assume the role of a sick person is the motivation for the behavior
    • Other motivators for the behavior (for example, financial gain, avoiding legal consequences, or improving physical well-being) are not present.

    There are three types of Munchausen syndrome: primarily mental health signs and symptoms, primarily physical signs and symptoms, and a combination of physical and mental health signs and symptoms.

    There is no specific definitive test, like a blood test, that can accurately assess that a person has Munchausen syndrome. Therefore, practitioners conduct a mental health interview that looks for the presence of the symptoms previously described. As with any mental health assessment, the professional will usually work toward ruling out other mental disorders and ensuring that the individual is not suffering from a primary medical problem or from medical issues that may cause emotional symptoms. He or she will often inquire about when the person has most recently had a physical examination, comprehensive blood work, and any other tests that a medical professional deems necessary to ensure that the individual is not suffering from a true medical condition instead of or in addition to potentially feigning or manufacturing symptoms. Also of significant importance is the practitioner reviewing any available previous medical records and talking to other people who may be in the person's life (for example, current or previous treating professionals, the spouse, or other family members) in order to explore the possibility that there is a pattern of the individual making up or inducing illness in previous instances.

    What is the treatment for Munchausen syndrome?

    Due to the chronic nature of the illness, as well as the tendency of sufferers to flee treatment, the treatment of Munchausen syndrome can be difficult. No single approach is consistently effective in managing this illness. Confronting victims of Munchausen syndrome does not seem to be an effective part of treatment of this illness. Rather, the sufferer is at even higher risk of prematurely ending medical care in response to being confronted, only to resume getting unnecessary tests and treatments from a new care provider. Therefore, maintaining the delicate balance between providing the sufferer of Munchausen syndrome with empathetic professional support with prevention of their receiving further unnecessary tests and procedures is key to caring from victims of this disorder. Specifically, showing empathy for the difficulties of what led to the development of the disorder while encouraging the victim to adapt new ways of managing their feelings are important aspects of addressing Munchausen syndrome. In addition to trying to develop and maintain a supportive relationship with the individual with this illness, many health care professionals will keep in close contact with the family of the sufferer in order to educate family members about the victim's behaviors and need for attention. The health care professional may also greatly assist in the person's recovery by maintaining frequent communication with other health care professionals as a means of educating those providers about this diagnosis and preventing the perpetuation of unnecessary tests and procedures.

    What is the prognosis for Munchausen syndrome?

    Munchausen syndrome can have significantly negative effects on the lives of individual sufferers and on the community at large. It is estimated that this disorder results in about $40 million per year in unnecessary tests and other medical resources. The chronic nature as well as the tendency to be at odds with the medical community puts individuals with this illness at risk of multiple recurrences of symptoms. Of related note is the associated high completed suicides at a rate of 30%-70%. Males tend to have worse outcomes than females.

    People with Munchausen syndrome who have no other psychiatric diagnosis seem to have a better chance of full recovery than those who also suffer from another mental illness. However, when a person with another psychiatric disorder gets treatment for that problem, their symptoms of Munchausen syndrome often improve as well.

    Source: http://www.rxlist.com

    The specific signs and symptoms of Munchausen syndrome can be extremely varied, from heart symptoms like fainting and chest pain, to ear problems seen by specialists in that area, to overtly psychiatric symptoms like hallucinations. Although the specific symptoms that the individual complains of are nearly limitless, sufferers may have in common a tendency to seek care from multiple care providers and hospitals, seem excessively pleased to be subjected to multiple tests and procedures, have symptoms that are vague and/or inconsistent with test results, have an illogical course to their illness, usually worsening, an unwillingness to allow current health care professionals to talk to family members or previous care providers, and an excessive desire to receive medications. Interestingly, the symptoms of Munchausen syndrome are very similar in children and adolescents as they are in adults.

    Source: http://www.rxlist.com

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