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    Munchausen Syndrome (Factitious Disorder): Causes, Symptoms And Treatment

    Factitious disorder, previously termed as Munchausen Syndrome, is a mental condition in which a person acts and deceives other people by appearing to be sick. The person does not have any malingering motive but deliberately shows that they have a severe illness by exaggerating symptoms to gain the image of a patient [1] , [2] .

    It can be imposed by one person on another, that is, a caretaker or a parent can fabricate illness and disabilities to their ward. The condition can be easily understood by the real-life case of Gypsy Rose Blanchard, who was forced to act as a patient by her mother, Dee Dee Blanchard. The intriguing case had received global attention and is used as the prime example of the varying degrees of factitious disorder [3] .

    Munchausen

    [Source: Verywell Mind]

    An individual with factitious disorder goes to the extent of forging symptoms by tainting urine samples and medical tests so as to convince others. The symptoms of the condition can range from mild to severe, with some going to the extent of receiving high-risk surgeries [4] . Factitious disorder should not be confused with malingering motives which are fabricated with the aim of gaining practical benefits such as winning a lawsuit or taking a break from work [5] .

    Individuals with the mental condition do not shy away from taking up various risks so as to obtain the sympathy and special attention. In most cases, it is associated with other mental conditions such as personality disorders and emotional difficulties [6] .

    Factitious disorders are in a way similar to that of somatoform disorders. There is a lack of accurate statistics regarding the number of people who suffer from the disorder as dishonesty is the central trait with the condition. However, factitious disorders are commonly found in men than in women and factitious disorder by proxy tends to be more common in women than in men [7] .

    Types Of Munchausen Syndrome

    The mental condition is categorised into four different types [8] , [9] , [10] .

    1. Factitious disorder with mostly psychological symptoms

    Individuals who fall under this type tend to mimic behavioural patterns of a mental disorder such as schizophrenia. The individual can appear confused, make absurd statements and report hallucinations, such as hearing voices. Ganser syndrome, also termed as prison psychosis falls under this category and the individuals tend to have episodes of abnormal behaviour that are usually displayed by individuals with real mental disorders.

    2. Factitious disorder with mostly physical symptoms

    Individuals under this category tend to claim that they have symptoms pertaining to physical illness such as chest pain, stomach problems, or fever.

    3. Factitious disorder with both psychological and physical symptoms

    Individuals who fall under this category tend to display symptoms of both physical and mental illness.

    4. Factitious disorder not otherwise specified

    People who fall under this category do not fabricate the symptoms of severe illness on themselves but on others. The disorder is termed as factitious disorder by proxy and also, Munchausen syndrome by proxy. It is mostly reported in mothers, with some rare cases in fathers too who harm their children to receive attention.

    Symptoms Of Munchausen Syndrome

    The possible warning signs of the mental disorder include the following [11] , [12] :

    • Vague or inconsistent symptoms that are not controllable, become more severe or change once treatment has begun
    • Extensive knowledge of medical terms and diseases
    • Inconsistent medical history
    • Predictable relapses when there is an improvement in the condition
    • Presence of many surgical scars
    • The appearance of new or additional symptoms following negative test results
    • Symptoms arise only when the patient is alone and not during an observation
    • Eagerness to have medical tests, operations, or other procedures
    • History of seeking treatment at various hospitals, and clinics, most likely in different cities
    • Reluctance in allowing healthcare professionals to meet with or talk to family members, friends, and prior healthcare providers
    • Refusal to undergo a psychiatric or psychological evaluation
    • Sabotaging discharge plans or becoming increasingly ill when the individual is about to be discharged

    Individuals with factitious disorder are experts at faking illness and can go to severe extends to develop signs and symptoms of diseases. The individuals can make up symptoms through various ways [13] :

    • By exaggerating existing symptoms
    • Making up histories
    • Faking symptoms
    • Causing self-harm
    • Tampering with test results and medical instruments

    Causes Of Munchausen Syndrome

    Although the specific cause behind the disorder is not known, it is asserted to be a combination of psychological factors and stressful life experiences. It can also be due to an underlying personality disorder [14] . The need to get sympathy and attention is one of the other major reasons why individuals tend to develop the syndrome [15] .

    Risk Factors Of Munchausen Syndrome

    Certain factors can increase an individual's tendency to develop factitious disorder [16] .

    Munchausen
    • Loss of a loved one through death, abandonment or illness
    • Childhood trauma caused by emotional, physical or sexual abuse
    • Any serious illness during childhood
    • Personality disorders
    • Past experiences during sickness and the desire to get that attention again
    • Depression
    • Lack of self-esteem and identity
    • A desire to be correlated with hospitals or doctors

    Complications Of Munchausen Syndrome

    Individuals who have factitious syndrome are willing to go to the far extends in faking their condition. As this is a result of possible psychological problems, they are increasingly prone to various complications [17] .

    • Problems in daily life, relationships and work
    • Severe health problems from unnecessary surgery or other procedures
    • Injury or death from self-inflicted medical conditions
    • Loss of organs or limbs from unnecessary surgery
    • Alcohol or other substance abuse

    Diagnosis Of Munchausen Syndrome

    Examining the condition is extremely difficult. Individuals with the factitious syndrome are experts at making up symptoms of different diseases and condition. So, the doctors tend to carry out the following steps to see the severity of the condition [18] , [19] .

    • Conduct a detailed interview
    • Require past medical records from the individual
    • Work with family members and friends for more information
    • Run tests required to address possible physical problems only
    • Use the criteria for factitious disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

    Treatment For Munchausen Syndrome

    The lack of standardised therapies for the condition makes it difficult. As people with the disorder desire to keep up their role as the sick one, they are most likely to be unwilling to seek or undergo any treatments. However, doctors assert that approaching the individuals in a gentle and non-judgemental manner may let them into considering undergoing treatment. By adopting the non-judgemental approach, the doctors may successfully influence the individual to undergo mental health treatment [20] .

    The other treatment options focus on managing the condition.

    • Having a primary care doctor to oversee medical care
    • Psychotherapy or talk therapy can help control stress and improve one's coping skills
    • Medication for treating associated mental health disorders such as anxiety or depression
    • In severe cases, the individual will have to be hospitalised in psychiatric care

    Home Remedies For Munchausen Syndrome

    Along with the professional help, following these steps can be helpful for an individual suffering from the disorder [20] .

    • Be aware of the risks of unnecessary surgeries and treatments.
    • Religiously follow the treatment plan.
    • Do not flee and resist the urge to find a new doctor.
    • Connect with someone whom you can confide in.
    View Article References
    1. [1] Bauer, M., & Boegner, F. (1996). Neurological symptoms in factitious disorder.Journal of Nervous and Mental Disease.
    2. [2] Fischer, C. A., Beckson, M., & Dietz, P. (2017). Factitious disorder in a patient claiming to be a sexually sadistic serial killer.Journal of forensic sciences,62(3), 822-826.
    3. [3] Yates, G. P., & Feldman, M. D. (2016). Factitious disorder: a systematic review of 455 cases in the professional literature.General Hospital Psychiatry,41, 20-28.
    4. [4] Yates, W. R. (2016). Other psychiatric syndromes: adjustment disorder, factitious disorder, illicit steroid abuse, cultural syndromes. InThe Medical Basis of Psychiatry(pp. 313-329). Springer, New York, NY.
    5. [5] Baig, M. R., Levin, T. T., Lichtenthal, W. G., Boland, P. J., & Breitbart, W. S. (2016). Factitious disorder (Munchausen's syndrome) in oncology: case report and literature review.Psycho‐Oncology,25(6), 707-711.
    6. [6] Rice, S., O'Brien, K., Chew, M., & Qudairat, E. (2018). Fabricated facial rash-an unusual presentation of factitious disorder.British dental journal,225(12), 1063-1066.
    7. [7] Jafferany, M., Khalid, Z., McDonald, K. A., & Shelley, A. J. (2018). Psychological Aspects of Factitious Disorder.The primary care companion for CNS disorders,20(1).
    8. [8] Naqvi, S., Khan, R. A., Rupareliya, C., Hanif, R., Ali, Z., & Farooq, F. (2017). Bleeding Diathesis or Fabrication: Munchausen Syndrome.Cureus,9(6).
    9. [9] Naqash, M., Naik, M., Bhat, T., Yusuf, I., Khan, A. W., & Suhaff, A. (2015). Recurrent hypoglycemia in a patient of neurofibromatosis type 1 and type 1 diabetes mellitus: Munchausen's syndrome mimicking Insulinoma.Journal of Mental Health and Human Behaviour,20(1), 32.
    10. [10] Majeed, M. A., & Clark, J. (2016). Munchausen’s syndrome: a near-fatal case.British Journal of Diabetes,16(1), 35-36.
    11. [11] Yates, G., & Bass, C. (2017). The perpetrators of medical child abuse (Munchausen syndrome by proxy)–a systematic review of 796 cases.Child abuse & neglect,72, 45-53.
    12. [12] Moreno-Ariño, M., & Bayer, A. (2016). Munchausen syndrome by proxy—illness fabricated by another in older people.
    13. [13] Zittel, S., Lohmann, K., Bauer, P., Klein, C., & Münchau, A. (2017). Munchausen syndrome by genetics: next-generation challenges for clinicians.Neurology,88(10), 1000-1001.
    14. [14] McFarlane, M., Eaden, J., Burch, N., & Disney, B. (2017). Factitious disorder: a rare cause of haematemesis.Clinical journal of gastroenterology,10(5), 447-451.
    15. [15] Baig, M. R., Levin, T. T., Lichtenthal, W. G., Boland, P. J., & Breitbart, W. S. (2016). Factitious disorder (Munchausen's syndrome) in oncology: case report and literature review.Psycho‐Oncology,25(6), 707-711.
    16. [16] Simonton, K., & Shah, K. N. (2016). Abuse and Factitious Disorders. InCase-Based Inpatient Pediatric Dermatology(pp. 191-204). Springer, Cham.
    17. [17] Erens, B. (2017). Symptom Exaggeration and the Risk of Violent Recidivism in Forensic Patients.Maastricht Student Journal of Psychology and Neuroscience,6(1).
    18. [18] Bursch, B., & Andermann, F. (2018). Factitious 20.Gates and Rowan's Nonepileptic Seizures, 211.
    19. [19] Bass, C., & Wade, D. T. (2019). Malingering and factitious disorder.Practical neurology,19(2), 96-105.
    20. [20] Lazzari, C., Shoka, A., Papanna, B., & Kulkarni, K. (2018). Current healthcare challenges in treating the borderline personality disorder “epidemic”.British Journal of Medical Practitioners,11(2), 4-7.

    Read more about: lie disorder mental health
    Story first published: Wednesday, April 10, 2019, 11:06 [IST]
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