Munchausen's syndrome

Symptoms and types of behaviour

Any practical benefit in pretending to be sick – for example, claiming incapacity benefit – isn't the reason for the behaviour of someone with Munchausen's syndrome.

People with Munchausen's syndrome can behave in a number of different ways, including:

• pretending to have psychological symptoms – for example, claiming to hear voices or claiming to see things that aren't really there
• pretending to have physical symptoms – for example, claiming to have chest pain or a stomach ache
• actively trying to get ill – such as deliberately infecting a wound by rubbing dirt into it

People with Munchausen's syndrome can be very manipulative. In the most serious cases, they may undergo painful and sometimes life-threatening surgery, even though they know it's unnecessary.

• Signs and symptoms of Munchausen's syndrome

Causes of Munchausen's syndrome

Munchausen's syndrome is complex and poorly understood. Many people refuse psychiatric treatment or psychological profiling. It's unclear why people with the syndrome behave in the way they do.

Based on the available research and case studies, several factors have been identified as possible causes of Munchausen's syndrome. These include:

• emotional trauma or illness during childhood – this often resulted in extensive medical attention
• a personality disorder – a mental health condition that causes patterns of abnormal thinking and behaviour
• a grudge against authority figures or healthcare professionals

Childhood trauma

Munchausen's syndrome may be caused by parental neglect and abandonment, or other childhood trauma.

As a result of this trauma, a person may have unresolved issues with their parents that cause them to fake illness. They may do this because they:

• have a compulsion to punish themselves (masochism) by making themselves ill because they feel unworthy
• need to feel important and be the centre of attention
• need to pass responsibility for their wellbeing and care on to other people

There's also some evidence to suggest people who've had extensive medical procedures, or received lengthy medical attention during childhood or adolescence, are more likely to develop Munchausen's syndrome when they're older.

This may be because they associate their childhood memories with a sense of being cared for. As they get older, they try to get the same feelings of reassurance by pretending to be ill.

Personality disorders

Some examples of the different personality disorders thought to be linked with Munchausen's syndrome include:

• antisocial personality disorder – a person may take pleasure in manipulating and deceiving doctors, giving them a sense of power and control
• borderline personality disorder – where a person struggles to control their feelings and often swings between positive and negative views of others
• narcissistic personality disorder – where a person often swings between seeing themselves as special and fearing they're worthless

It could be the person has an unstable sense of their own identity and also has difficulties establishing meaningful relationships with others.

Playing the "sick role" allows them to adopt an identity that brings unconditional support and acceptance from others with it. Admission to hospital also gives the person a clearly defined place in a social network.

Diagnosing Munchausen's syndrome

Diagnosing Munchausen's syndrome can be challenging for medical professionals.

People with the syndrome are often very convincing and skilled at manipulating and exploiting a doctor's concern for their patients, and their natural interest in investigating unusual medical conditions.

Investigating claims

If a healthcare professional suspects a person may have Munchausen's syndrome, they'll look at the person's health records. This is to check for inconsistencies between their claimed and actual medical history. They may also contact the person's family and friends to find out whether their claims about their past are true.

Healthcare professionals can also run tests to check for evidence of self-inflicted illness or tampering with clinical tests. For example, the person's blood can be checked for traces of medication they shouldn't be taking but which could explain their symptoms.

Doctors will also want to rule out other possible motivations for their behaviour, such as faking illness for financial gain or because they want access to strong painkillers.

Munchausen's syndrome can usually be confidently diagnosed if:

• there's clear evidence of fabricating or inducing symptoms
• the person's prime motivation is to be seen as sick
• there's no other likely reason or explanation for their behaviour

Treating Munchausen's syndrome

Treating Munchausen's syndrome can be difficult. This is because most people refuse to admit they have a problem and won't co-operate with suggested treatment plans.

Some experts recommend that healthcare professionals should adopt a gentle non-confrontational approach, suggesting the person has complex health needs and may benefit from a referral to a psychiatrist.

Others argue that a person with Munchausen's syndrome should be confronted directly and asked why they've lied and whether they have stress and anxiety.

One of the biggest ironies about Munchausen's syndrome is that people who have it are genuinely mentally ill, but will often only admit to having a physical illness.

If a person admits to their behaviour, they can be referred to specialist psychiatric services for further treatment. If they don't admit to lying, most experts agree the doctor in charge of their care should minimise medical contact with them.

This is because the doctor-patient relationship is based on trust. If there's evidence the patient can no longer be trusted, the doctor is unable to continue treating them.

Psychiatric treatment and CBT

It may be possible to help control the symptoms of Munchausen's syndrome if the person admits they have a problem and co-operates with treatment.

There's no standard treatment for Munchausen's syndrome, but a combination of psychoanalysis and cognitive behavioural therapy (CBT) has shown some success in helping people control their symptoms.

Psychoanalysis is a type of psychotherapy which attempts to uncover and resolve these unconscious beliefs and motivations which can cause many psychological conditions.

CBT helps a person identify unhelpful and unrealistic beliefs and behavioural patterns. A specially trained therapist teaches the person ways of replacing unrealistic beliefs with more realistic and balanced ones.

Family therapy

People with Munchausen's syndrome still in close contact with their family may also benefit from having family therapy.

The person with the syndrome and their close family members discuss how it's affected the family and the positive changes that can be made.

Who's affected

From the available case studies, there appear to be two distinct groups of people affected by Munchausen's syndrome. They are:

• women who are 20 to 40 years of age, often with a background in healthcare, such as working as a nurse or medical technician
• unmarried white men who are 30 to 50 years of age 

It's unclear why these two groups tend to be affected by Munchausen's syndrome. It's also not known how common the syndrome is.

Fabricated or induced illness

Fabricated or induced illness, also known as Munchausen's by proxy, is a variant of Munchausen's syndrome.

This is where a person fabricates or induces illness in a person under their care. Most cases involve a mother and her child.

More useful links

• Munchausen's syndrome
• How to use your health services
• Mind
• Royal College of Psychiatrists