- Münchausen syndrome
For feigned mental illness, see Malingering.
Factitious disorders Classification and external resources ICD-10 F68.1 ICD-9 301.51 DiseasesDB 8459 33167 eMedicine med/3543 emerg/322 emerg/830 MeSH D009110
Münchausen syndrome is a term for psychiatric disorders known as factitious disorders wherein those affected feign disease, illness, or psychological trauma to draw attention or sympathy to themselves. It is also sometimes known as hospital addiction syndrome or hospital hopper syndrome. Nurses and Doctors sometimes refer to them as frequent flyers, because they return to the hospital just as frequent flyers return to the airport. However, there is discussion to reclassify them as somatoform disorder in the DSM-5 as it is unclear whether or not people are conscious of drawing attention to themselves.
Münchausen syndrome is related to Münchausen syndrome by proxy (MSbP/MSP), which refers to the abuse of another being, typically a child, in order to seek attention or sympathy for the abuser.
In Münchausen syndrome, the affected person exaggerates or creates symptoms of illnesses in themselves to gain investigation, treatment, attention, sympathy, and comfort from medical personnel. In some extreme cases, people suffering from Münchausen's syndrome are highly knowledgeable about the practice of medicine and are able to produce symptoms that result in lengthy and costly medical analysis, prolonged hospital stay and unnecessary operations. The role of "patient" is a familiar and comforting one, and it fills a psychological need in people with Münchausen's. It is distinct from hypochondriasis in that patients with Münchausen syndrome are aware that they are exaggerating, whereas sufferers of hypochondriasis believe they actually have a disease. Risk factors for developing Münchausen syndrome include childhood traumas, and growing up with caretakers who, through illness or emotional problems, were unavailable. Arrhythmogenic Münchausen syndrome describes individuals who simulate or stimulate cardiac arrhythmias to gain medical attention.
A similar behavior called Münchausen syndrome by proxy has been documented in the parent or guardian of a child. The adult ensures that his or her child will experience some medical affliction, therefore compelling the child to suffer treatment for a significant portion of their youth in hospitals. Furthermore, a disease may actually be initiated in the child by the parent or guardian. This condition is considered distinct from Münchausen syndrome. In fact, there is growing consensus in the pediatric community that this disorder should be renamed "medical abuse" to highlight the real harm caused by the deception and to make it less likely that a perpetrator can use a psychiatric defense when real harm is done. Parents who perpetrate this abuse are often affected by concomitant psychiatric problems like depression, spouse abuse, psychopathy, or psychosis. In rare cases, multiple children in one family may be affected either directly as victims or as witnesses who are threatened to keep them silent.
Origin of the name
The syndrome name derives from Baron Münchhausen (Karl Friedrich Hieronymus Freiherr von Münchhausen, 1720–1797) who purportedly told many fantastic and impossible stories about himself, which Rudolf Raspe later published as The Surprising Adventures of Baron Münchhausen.
In 1951, Richard Asher was the first to describe a pattern of self-harm, where individuals fabricated histories, signs, and symptoms of illness. Remembering Baron Münchhausen, Asher named this condition Münchausen's Syndrome in his article in The Lancet in February 1951, quoted in his obituary in the British Medical Journal:"Here is described a common syndrome which most doctors have seen, but about which little has been written. Like the famous Baron von Munchausen, the persons affected have always travelled widely; and their stories, like those attributed to him, are both dramatic and untruthful. Accordingly the syndrome is respectfully dedicated to the Baron, and named after him."—British Medical Journal, R.A.J. Asher, M.D., F.R.C.P.
Originally, this term was used for all factitious disorders. Now, however, there is considered to be a wide range of factitious disorders, and the diagnosis of "Münchausen syndrome" is reserved for the most severe form, where the simulation of disease is the central activity of the affected person's life.
Treatment and prognosis
Medical professionals or doctors suspecting Münchausen's in a patient should first rule out the possibility that the patient does indeed have a disease state but in an early stage and not yet clinically detectable. 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.
Medical providers or doctors should consider working with mental health specialists to help treat the underlying mood or disorder as well as to avoid countertransference. 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.
Illnesses and conditions commonly feigned by Münchausen patients
- Acid reflux
- Anxiety disorder
- Back pain
- Bipolar disorder (manic depression)
- Breathing difficulty
- Myalgic encephalomyelitis
- Kidney disease
- Post-traumatic stress disorder
- Sexual abuse
- Spousal abuse
- Suicidal ideation or suicide attempt
Patients may have multiple scars on abdomen due to repeated "emergency" operations. 
Many of these conditions do not have clearly observable or diagnostic symptoms.
- Münchausen syndrome by proxy, also known as Fabricated or induced illness
- Münchausen by Internet
- Victim playing
- Attention seeking
- Histrionic personality disorder
- Psychosomatic illness
- ^ Krahn LE, Bostwick JM, Stonnington CM (2008). "Looking toward DSM-V: should factitious disorder become a subtype of somatoform disorder?". Psychosomatics 49 (4): 277–82. doi:10.1176/appi.psy.49.4.277. PMID 18621932.
- ^ a b Vaglio JC, Schoenhard JA, Saavedra PJ, Williams SR, Raj SR (2010). "Arrhythmogenic Munchausen syndrome culminating in caffeine-induced ventricular tachycardia". J Electrocardiol 44 (2): 229–31. doi:10.1016/j.jelectrocard.2010.08.006. PMID 20888004.
- ^ Pediatrics 2007 May 05;119:1026-1030
- ^ Lancet 1951 Feb 10;1(6650):339-41 doi:10.1016/S0140-6736(51)92313-6
- ^ "R. A. J. Asher (Obituary notice)". British Medical Journal 2 (5653): 388. 1969-05-10. doi:10.1136/bmj.2.665.388. http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1983233&pageindex=2#page. Retrieved 2008-03-20
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- ^ Johnson BR, Harrison JA. Suspected Münchausen syndrome and civil commitment. J Am Acad Psychiatry Law. 2000; 28:74-76.
- ^ Elder W, Coletsos IC, Bursztajn HJ. Factitious Disorder/Munchhausen Syndrome. The 5-Minute Clinical Consult. 18th Edition. 2010. Editor. Domino, F.J. Wolters Kluwer/Lippincott. Philadelphia.
- ^ Davidson, G. et al. (2008). Abnormal Psychology - 3rd Canadian Edition. Mississauga: John Wiley & Sons Canada, Ltd.. pp. 412. ISBN 978-0-470-84072-6.
- ^ AJ Giannini,HR Black. Psychiatric, Psychogenic and Somatopsychic Disorders Handbook. New Hyde Park ,NY. Medical Examination Publishing, 1978,pp.194-195. ISBN 0-87488-596-5
- Feldman, Marc (2004). Playing sick?: untangling the web of Münchausen syndrome, Münchausen by proxy, malingering & factitious disorder. Philadelphia: Brunner-Routledge. ISBN 0-415-94934-3.
- Fisher JA (2006). "Playing patient, playing doctor: Münchausen syndrome, clinical S/M, and ruptures of medical power". The Journal of medical humanities 27 (3): 135–49. doi:10.1007/s10912-006-9014-9. PMID 16817003.
- Fisher JA (2006). "Investigating the Barons: narrative and nomenclature in Münchausen syndrome". Perspect. Biol. Med. 49 (2): 250–62. doi:10.1353/pbm.2006.0024. PMID 16702708.
- Friedel,Robert O., MD Borderline Personality Disorder Demystified, Pg 9-10, Münchausen syndrome, Münchausen syndrome by Proxy. ISBN 1-56924-456-1
- Davidson, G. et al. (2008). Abnormal Psychology - 3rd Canadian Edition. Mississauga: John Wiley & Sons Canada, Ltd.. pp. 412. ISBN 978-0-470-84072-6.
- Prasad, Ashoka; Oswald, A. G. "Munchausen's syndrome:an annotation"
- Dr. Marc Feldman's Münchausen Syndrome, Malingering, Factitious Disorder, & Münchausen by Proxy Page - Page offering information on Münchausen and its many other names. Offers information on Dr. Feldman's books and his email address for interested parties.
- Article in Discover magazine, July 1993, by Abigail Zuger
- The Medea of the modern times
- Sick note: Faking illness online - on "Münchausen by internet". The Guardian, 26 February 2011
- Forensic psychology
- Factitious disorders
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