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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 in order to draw attention or sympathy to themselves. It is also sometimes known as hospital addiction syndrome or hospital hopper syndrome.

Münchausen syndrome is related to Münchausen syndrome by proxy (MSbP/MSP), which refers to the abuse of another being (typically a child) as a result of having a psychological disorder.

Contents

Description

In Münchausen syndrome, the affected person exaggerates or creates symptoms of illnesses in themselves in order to gain investigation, treatment, attention, sympathy, and comfort from medical personnel. In some extremes, people suffering from Münchausen's Syndrome are highly knowledgeable about the practice of medicine, and are able to produce symptoms that result in multiple unnecessary operations. For example, they may inject a vein with infected material, causing widespread infection of unknown origin, and as a result cause lengthy and costly medical analysis and prolonged hospital stay. 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.

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[1]. Parents who perpetrate this abuse are often affected by concomitant psychiatric problems like depression, spouse abuse, sociopathy, 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 adventures 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,[2] 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 JournalR.A.J. Asher, M.D., F.R.C.P.[3]

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

Risk factors for developing Münchausen syndrome include childhood traumas, and growing up with caretakers who, through illness or emotional problems, were unavailable.

Medical professionals suspecting Münchausen's in a patient should first rule out the possibility that the patient does indeed have a disease state, but it is 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.[4] Then they should take a careful patient history, and seek medical records, to look for early deprivation, childhood abuse, mental illness.

Medical providers should consider working with mental health specialists to help treat the underlying mood or disorder as well as to avoid countertransference.[5] 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 [6], thus offers the worst prognosis.

If a patient is at risk to himself or herself, inpatient psychiatric hospitalization should be initiated.[7]

Illnesses and conditions commonly feigned by Münchausen patients

Patients may have multiple scars on abdomen due to repeated "emergency" operations.

Note that many of these conditions do not have clearly observable or diagnostic symptoms.

See also

References

  1. ^ Pediatrics 2007 May 05;119:1026-1030
  2. ^ Lancet 1951 Feb 10;1(6650):339-41 doi:10.1016/S0140-6736(51)92313-6
  3. ^ "R. A. J. Asher (Obituary notice)", British Medical Journal 2(5653): 388, 1969-05-10, http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1983233&pageindex=2#page, retrieved 2008-03-20  
  4. ^ Bursztajn, H, Feinbloom RI, Hamm RM, Brodsky A. Medical Choices, medical chances: How patients, families and physicians can cope with uncertainty. New York. Delacourte/Lawrence. 1981.
  5. ^ 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.
  6. ^ Davidson, G. et al. Abnormal Psychology. 2008
  7. ^ Johnson BR, Harrison JA. Suspected Münchausen syndrome and civil commitment. J Am Acad Psychiatry Law. 2000; 28:74-76.
  • 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.  
  • Ashoka Prasad,A.G.Oswald:Munchausen's syndrome:an annotation[1]

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