What is Munchausen Syndrome?

Munchausen’s syndrome (or Munchausen syndrome) was named in 1951 by Richard Asher after Karl Friedrich Hieronymus, Baron Munchausen (1720-1797), whose name had become legendary as the narrator of false and ridiculously exaggerated exploits.

Munchausen syndrome, also known as Factitious Disorder, is a serious mental disorder in which someone deceives others by appearing sick, by purposely getting sick or by self-injury. Syndrome sufferers are thought to experience an adrenaline rush from being cared for and being the centre of attention, with some even resorting to injecting themselves with faeces or rubbing chemicals on their skin to create symptoms.

Those who suffer from Munchausen syndrome are believed primarily to get emotional rewards from the care and attention of medical professionals, family, friends, and/or the community at large.

People with Munchausen syndrome can be very manipulative and, in the most serious cases, may undergo painful and sometimes life-threatening surgery, even though they know it is unnecessary. Most individuals with Munchausen syndrome are a physical danger to themselves.

Munchausen syndrome is considered rare, and it is not known how many people have the disorder, as some people use fake names when seeking medical treatments and care to avoid detection, some may visit a variety of different hospitals and doctors throughout the country, and some are simply never identified. This makes it really difficult to get a reliable estimate of the numbers of people affected with the disorder.

According to the official statistics, of the 95 patients who were officially diagnosed with Munchausen syndrome after hospital stays over a twelve-month period, 59 were women and 36 were men, with an average age of 39 years.

It has, however, been estimated that syndrome sufferers are likely to cost the NHS between £800 to £900 a day each; this equates to £1.7 million a year according to NHS Digital Statistics. Some syndrome sufferers can run up bills for the NHS of up to £40,000 if they go from hospital to hospital and demand countless tests to discover what is causing their “symptoms”.

Munchausen syndrome is different to hypochondria (health anxiety) or malingering. Hypochondria is a psychiatric disorder where a person has a fear of illness. They interpret normal body functions as signs of major illness. Even after an examination refutes their beliefs, a hypochondriac will likely still believe they are sick. Malingering is faking illness to gain a material benefit, for example to avoid work or to get compensation.

There is also a new phenomenon, Munchausen’s by internet, where a person joins an internet support group for people with a serious health condition such as cancer or HIV, and they then claim to have the condition themselves. These actions can have a negative impact on support groups and online communities.

How to deal with someone with Munchausen Syndrome?

Because people with Munchausen syndrome become experts at faking symptoms and diseases or inflicting real injuries upon themselves, it can be hard for healthcare professionals, let alone loved ones, to know if the illnesses are real or not.

If you think someone close, a friend or relative, may be exaggerating or faking health problems, it may help to attempt a gentle conversation about your concerns, but try to avoid anger, judgement or confrontation. Also try to reinforce and encourage more healthy, productive activities rather than focusing on their dysfunctional beliefs and behaviours. Offer support and caring and, if possible, help in finding treatment.

If your loved one causes self-inflicted injury or attempts suicide, call 999 or 112 for emergency medical help or, if you can safely do so, take them to a hospital A & E or an NHS walk-in centre immediately.

Is Munchausen Syndrome hereditary?

Munchausen syndrome is not genetic or hereditary, so if the disorder runs in a family it is not due to genes, but may more likely be due to the upbringing or the environment a child has experienced. Additionally, if a person closely associated with a family member has or has had the disorder, the individual may for various reasons adopt the behaviours themselves.

What are the signs and symptoms of Munchausen Syndrome?

Signs that a person may have Munchausen syndrome can include:

• Making frequent visits to surgeries, hospitals or other medical facilities in different areas, or repeatedly moving care to another medical facility, especially when a doctor determines there are no apparent medical issues.
• Claiming to have a history of complex and serious medical conditions, or giving inconsistent, selective or misleading information about their symptoms and health history.
• Telling unbelievable and often very elaborate stories about their past, particularly when these stories include details of medical conditions, illnesses or injuries suffered.
• Having symptoms that don’t match with test results or disputing test results that find no presence of an illness or disease.
• Having symptoms that are not responsive to treatment and the individual even escalates, relapses or comes up with new complaints in order to keep receiving care.
• During consultations the individual makes statements to strengthen their case that contradict the records or are clearly exaggerating symptoms as they consistently exceed the norms for the condition.
• Being willing to undergo often painful or dangerous tests and procedures.
• Consistent evidence from laboratory or other tests that disproves the information supplied by the individual or there are a notable number of tests, consultations and treatment efforts that are mysteriously ineffective.
• Reporting symptoms that are vague and inconsistent symptoms that consistently exceed the norms for the disease and/or the patient is clearly exaggerating symptoms.
• Having very good medical knowledge, or having medical information through exposure to a model of the illness they are falsifying, for example as a result of having a friend or relative with a similar medical condition or access to online medical information.
• Accurately predicting physical deteriorations.
• Refusing to allow medical professionals currently treating them to speak to any other professionals about their care, including previous doctors, particularly if previous health professionals may have noted the possibility of deception.
• Focusing on self-perceived “victimisation” by medical professionals and others involved in their care.
• Vigorously opposing psychiatric assessment and treatment.
• Not following medical treatment recommendations or is disruptive when being treated.

Symptoms of Munchausen syndrome can range from mild, that is a slight exaggeration of medical symptoms, to severe where the person may make up medical symptoms or even tamper with medical tests to convince others that treatment, such as high-risk surgery, is needed.

There are four main ways that people with Munchausen’s syndrome fake or induce illnesses:

• Lying about symptoms – Choosing symptoms that are difficult to disprove. This can include having a severe headache or back pain, pretending to have a seizure or to pass out.
• Tampering with test results – Heating a thermometer to suggest a fever or adding blood to a urine sample.
• Self-infliction – Cutting or burning themselves, self-poisoning or eating food contaminated with bacteria.
• Aggravating pre-existing conditions – Rubbing something into a wound to cause an infection or reopening healed wounds.

The symptoms involve mimicking or producing illness or injury or exaggerating symptoms or impairment to deceive others. People with the disorder go to great lengths to hide their deception, so it may be difficult to recognise that their symptoms are actually part of a serious mental health disorder. They continue with the deception, even without receiving any visible benefit or reward or when faced with objective evidence that doesn’t support their claims.

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

• Side effects from prescription medicines, including overdose or allergic reactions.
• Complications from poisoning or self-harm practices.
• Complications from medical procedures or surgeries.
• Death from self-harm or complications of medical interventions.

What causes Munchausen Syndrome?

Some people may have a higher risk of developing Munchausen syndrome than others; often people with Munchausen syndrome have experienced a childhood trauma such as child abuse or neglect.

Risk factors for developing the syndrome may include but are not limited to:

• Chronic illness during childhood; the individual may have received a lot of attention because of their illness and now associates needing to have an illness when they need to obtain the same feelings of reassurance, care and being the centre of attention.
• Chronic illness of a significant family member when the person was a child; they equate the attention given to that person with needing to have an illness to be cared for.
• Loss of a loved one through death, illness or abandonment.
• The need to blame personal failures on external factors, such as illness.
• Self-esteem or identity problems.
• Relationship problems.
• Difficulty distinguishing reality from fantasy.
• Desire to be associated with doctors or with medical professionals and establishments.
• Ability to lie and manipulate.
• A history of mental problems such as depression, hallucinations or post-traumatic stress disorder (PTSD).

How to know if you have Munchausen Syndrome?

Often someone who has Munchausen syndrome will be aware that they don’t have the illness they are presenting or that they are making the symptoms of an illness or condition worse, but they might not know why they are making it seem as if they are physically unwell. You should see your doctor if you are spending a lot of time thinking about being ill, worrying that you have the symptoms of an illness or you are trying to make it look like you have an illness you don’t actually have.

There is no known way to prevent Munchausen syndrome, so seeking advice as soon as you become aware that you may have the symptoms of the syndrome is vital to help avoid unnecessary and potentially dangerous tests and treatment and for getting the support and treatment that you may need for the syndrome.

Other sources of advice include:

• MIND 0300 123 3393.
• Rethink Mental Illness 0800 801 0525.

The difference between Munchausen Syndrome and Munchausen Syndrome by Proxy

Munchausen syndrome by proxy is also known as Factitious Disorder Imposed on Another or Fabricated or Induced Illness (FII). This is when someone falsely claims that another person has physical or psychological signs or symptoms of illness, or causes injury or disease in another person with the intention of deceiving others.

People with this disorder present another person as sick, injured or having problems functioning, claiming that medical attention is needed. Usually this involves a parent harming a child but it can also involve a caregiver and a vulnerable adult such as a person with a disability or dementia. This is a form of abuse that can put a child or vulnerable adult in serious danger of injury or unnecessary medical care and may be considered child or victim abuse, rather than a mental health condition.

The Royal College of Paediatrics and Child Health (RCPCH) launched new guidance about fabricated or induced illness (FII) in children. The new guidance provides procedures for safeguarding children who present with FII and best practice advice in the medical management of these cases to minimise harm to children.

The guidance describes alerting signs that are not evidence of FII but are indications of possible FII. It makes clear that the focus must always be on the health and safety of the child and that, where these signs are associated with possible harm, they may amount to a safeguarding concern.

Since a parent or caregiver with Munchausen syndrome by proxy often appears to be caring and attentive, doctors usually don’t suspect any wrongdoing. Diagnosis can also be difficult due to the person’s ability to manipulate doctors and induce symptoms in the child or vulnerable adult.

Professionals working with children or vulnerable adults who suspect FII is happening should liaise with social services and the police and must follow their local child or vulnerable adults safeguarding procedures.

Someone with Munchausen syndrome by proxy often:

• Has medical skills or experience.
• Seems devoted to their child or vulnerable adult in their care.
• Looks for sympathy and attention.
• Tries too hard to become close and friendly with medical staff.
• Needs to feel powerful and in control.
• Does not see their behaviour as harmful.

Behaviours and clues in Munchausen syndrome by proxy include a parent or other caregiver who:

• Persuades healthcare professionals that a child or vulnerable adult is ill when they are healthy.
• Exaggerates or lies about a child’s or vulnerable adult’s symptoms.
• Manipulates test results to suggest the presence of illness, for example by putting glucose in urine samples to suggest the child or vulnerable adult has diabetes.
• Deliberately induces symptoms of illness, for example by poisoning the child or vulnerable adult with unnecessary medicine or other substances.
• Is a caregiver to a child or vulnerable adult who has a repeated or unusual illness where no reason can be found for the illness and it doesn’t get better even with treatments that should help the condition. The symptoms only occur when the caregiver is with or has recently been with the child or vulnerable adult and the symptoms do get better or go away, however, when the caregiver is not there or is being closely watched.

Some parents or caregivers with Munchausen syndrome by proxy (FII) have unresolved psychological and behavioural problems, or may have experienced the death of another child or close family member. In rare cases it has been found that a parent or caregiver involved in FII may also be suffering from Munchausen syndrome. There have also been several reported cases where illness was fabricated or induced in another for financial reasons, for example to claim disability benefits or to access services such as care homes.

For victims of Munchausen syndrome by proxy, the first step is to protect the child or vulnerable adult by moving them into a place of safety. Then a doctor will monitor the child or vulnerable adult for symptoms. Most of the time, the child or vulnerable adult’s symptoms stop after they are moved away from the caregiver. Some children or vulnerable adults may need counselling or other help.

For anyone concerned about Munchausen syndrome by proxy or if you suspect that a child or vulnerable adult is a victim, don’t confront the suspected caregiver as it might make the problem worse.

Instead, think about these options:

• Keep a diary of the child or vulnerable adult’s symptoms and other related events.
• Talk with your doctor about your concerns.
• Report your concerns to your local child welfare agency. You can make a report anonymously without using your name. Additional advice helplines include:
  – The NSPCC‘s child protection helpline 0808 800 5000.
  – Age UK 0800 678 1602.
  – Dementia UK 0800 888 6678.

How is Munchausen Syndrome treated?

Munchausen syndrome is challenging to identify and hard to treat. This is because most people refuse to admit they have a problem and won’t co-operate with suggested treatment plans. However, medical and psychiatric help are critical for preventing serious injury and even death caused by the self-harm typical of this disorder.

As happens with some other psychiatric conditions, there is ongoing debate about how to best understand, diagnose and treat Munchausen syndrome. Some medical and mental health experts recommend that healthcare professionals should adopt a gentle non-confrontational approach to treating people with Munchausen syndrome, suggesting to the person that they have complex health needs and may benefit from a referral to a psychiatrist.

People with Munchausen syndrome may be well aware of the risk of injury or even death as a result of their self-harm or the treatment they seek, but they can’t control their behaviours and they are unlikely to seek help. Even when they are confronted with objective proof such as video evidence showing that they are causing their own illness, they often deny it and refuse psychiatric help.

There is 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.

People with Munchausen 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 has affected the family and the positive changes that can be made.

Munchausen syndrome sufferers who have no other psychiatric illness seem to have a better chance of full recovery than those who also suffer from another mental illness. However, when a person with another psychiatric disorder gets treatment for that problem, their symptoms of Munchausen syndrome often improve as well.

There are no medications to treat factitious disorders such as Munchausen syndrome themselves. Medication may be used, however, to treat any related illness, such as depression or anxiety. The use of medications must be carefully monitored in people with Munchausen syndrome due to the risk that the prescribed medication may be used in a harmful way by the sufferer.

In conclusion

Munchausen syndrome and Munchausen syndrome by proxy are not common conditions; however, it is usually up to others to recognise the behaviours and to try to get help to stop it before it escalates.

One of the biggest ironies about Munchausen 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, then they can be referred to specialist psychiatric services for further treatment.

If they do not admit to lying, most experts agree that the doctor in charge of their care should minimise medical contact with them. This is because the doctor-patient relationship is based on trust and if there is evidence the patient can no longer be trusted, such as someone with Munchausen syndrome, the doctor is unable to continue treating them. Unfortunately, the sufferer may only move on to another medical facility and the cycle continues.