Munchausen syndrome

Munchausen syndrome, also known as factitious disorder, is a rare mental health condition in which a person fakes illness. They may lie about symptoms, make themselves appear sick, or deliberately make themselves unwell. It is most often seen in young adults and is considered a form of self-harm.

A person with Munchausen syndrome can be very convincing, which sometimes leads doctors to provide unnecessary treatment such as medication or surgery. Importantly, the person does not pretend to be ill for practical gain, such as obtaining prescription drugs or money. Instead, they are driven by complex psychological reasons, including a strong need for attention and sympathy.

Signs and symptoms#

Many people with Munchausen syndrome have experienced trauma in childhood, and they gain intense satisfaction from the attention that comes with playing the role of a sick patient.

Signs that may suggest Munchausen syndrome include:

• a long and dramatic medical history involving many tests, procedures and operations
• an odd collection of seemingly unrelated symptoms
• a lack of clear results despite intense medical investigation
• new symptoms that appear after tests come back negative
• failure to improve despite treatment, including relapsing for unknown reasons
• extensive knowledge of many different illnesses
• frequent visits to many different doctors and emergency departments
• requests for invasive procedures or surgery

A person with Munchausen syndrome may convince doctors in many ways. For example, they may:

• pretend to be in pain or exaggerate symptoms
• fake symptoms, including psychological symptoms
• poison or infect themselves with chemicals or unclean substances
• tamper with diagnostic tests, such as contaminating a urine sample with sugar or blood
• interfere with a medical condition so recovery is not possible, for example by repeatedly opening or contaminating a wound, or by not taking prescribed medication
• ignore a genuine medical problem until it becomes serious

Complications#

A person with Munchausen syndrome is at risk of many complications, including:

• side effects from prescription medicines, including overdose
• complications from poisoning or self-harm
• complications from medical procedures or surgery
• death from self-harm or from the effects of medical intervention

Risk factors#

Some people may have a higher risk of developing Munchausen syndrome than others. Risk factors may include:

• chronic illness of a significant family member during the person’s childhood
• self-esteem or identity problems
• relationship difficulties
• difficulty distinguishing reality from fantasy
• an ability to lie and manipulate
• a history of mental health problems such as depression, hallucinations or post-traumatic stress disorder (PTSD)

Diagnosis#

Diagnosis is difficult because a range of legitimate physical and mental illnesses must be ruled out first. To complicate matters, a person with Munchausen syndrome tends to seek help from many different health care providers to avoid tipping off any single doctor.

When a diagnosis is made, it may depend on clues such as:

• the person’s symptoms do not make sense when compared with their test results
• the person is unusually eager to undergo invasive procedures and operations
• the person does not respond to treatment in a predictable way
• other people in the person’s life do not confirm the reported symptoms

Treatment#

Treatment aims to manage rather than cure the condition, and is rarely fully successful. Recovery tends to be slow or non-existent. Treatment options may include:

• medications to treat associated mental health conditions such as depression or anxiety
• cognitive behaviour therapy (CBT)

Unfortunately, a person with Munchausen syndrome may misuse prescription drugs to provoke symptoms and prompt further medical intervention. It is also unlikely that someone would admit to falsifying symptoms, which makes progress difficult, and some people flatly refuse psychiatric help.

Avoiding unnecessary tests and surgery is important to reduce the risk of complications. This can be helped by encouraging the person to see only one primary care doctor, although they are likely to move on to other doctors and start again.

Munchausen syndrome by proxy#

Munchausen syndrome by proxy was the term once used for a rare but serious form of abuse in which a person fakes or produces symptoms in someone else, usually their child. It is now more often described as fabricated or induced illness by carers, to distinguish it from Munchausen syndrome, and it is considered a form of child or victim abuse rather than a mental health condition.

In these cases, a carer may deliberately poison or harm a child to bring about unnecessary tests and procedures. One reported form involves apnoea, where the child stops breathing and is then revived, taken to hospital, and found on testing to have nothing wrong. Sometimes the child does not survive. This form of abuse is very rare. The perpetrator is most often the mother, which is thought to reflect the high number of women who take on the role of primary caregiver.

Key points#

• A person with Munchausen syndrome may lie about symptoms, make themselves appear sick, or deliberately make themselves unwell.
• Some people have a higher risk of developing Munchausen syndrome than others.
• Diagnosis is difficult because a range of legitimate physical and mental illnesses must be ruled out first.
• The person does not respond to treatment in a predictable way.
• Other people in the person’s life often do not confirm the reported symptoms.

Where to get help#