Munchausen syndrome is understood to be a mental disorder. In it, affected individuals invent diseases and ailments.
What is Munchausen syndrome?
The so-called Munchausen syndrome belongs to the artificial disorders. It is also known as luminary killer syndrome. A typical feature of the mental disorder is the deliberate invention of illnesses and physical ailments. These are dramatically, but quite plausibly, presented by those affected. Munchausen by proxy syndrome is considered a special form. Here, the damage is not inflicted on the patient himself, but on a proxy. This usually involves close relatives such as the patient’s own children. The term Munchausen syndrome was first used in 1951 by the English psychiatrist Richard Asher (1912-1969). It was named after the famous lying baron Munchausen, who repeatedly captivated his listeners with his tall tales.
Causes
Medical experts attribute the development of Munchausen syndrome to violent traumatic experiences in the childhood of the affected person. Thus, some patients were the victims of physical violence or sexual abuse. But neglect can also play a significant role. Thus, many affected persons suffer from a lack of attention or feel that they are not paid enough attention. A typical feature of Munchausen syndrome is the frequent visits of patients to doctors’ offices or hospitals. While normal patients do not like to visit these institutions, people with Munchausen syndrome go there quite happily. In this way, they intend to compensate for the attention they have not received so far. They are not interested in financial benefits or sick leave. Rather, through the numerous examinations, they experience a form of attention that they enjoy. Older people who lack family or social contacts are particularly affected by Munchausen syndrome. Instead, they perceive the doctor or nursing staff as helpers. In the process, those affected sometimes get so carried away with their medical histories that they even end up in the hospital.
Symptoms, complaints and signs
The main symptom of Munchausen syndrome is the invention of tall tales about one’s own state of health. In this process, patients visit a doctor and describe to him complaints from which they do not suffer at all or hardly at all. It is not uncommon for truth and untruth to be mixed together. In addition, social contacts are often broken off. Doctors and clinics are also repeatedly exchanged. Not infrequently, excessive travel follows. In this process, the patient has a constant desire to see a doctor and take on the role of the sick person. In some cases, patients go so far as to inflict physical harm on themselves. This includes inflicting abrasions or cuts, injecting infectious substances, and injecting insulin to cause hypoglycemia. It also involves feigning pain and demanding surgical procedures that are not necessary. In Munchausen by proxy syndrome, it is not the sufferer himself who suffers these injuries, but a proxy like a child. In most cases, the perpetrators are the mothers who falsify their children’s measurements, give them medications such as laxatives, or mix sugar into a urine sample so that the doctor will believe it is a disease. In extreme cases, the child even has bones broken, which is a serious form of child abuse. Problematically, some people who suffer from Munchausen by proxy syndrome work in medical professions themselves, making it easier for them to fake illness.
Diagnosis and course of the disease
Diagnosing Munchausen syndrome is not easy. Because sufferers are deceptive in presenting their complaints, it is difficult to impute intent. The constant complaining of symptoms is considered to be an indication of the mental disorders. Often there are deviations and always new versions. If, however, the doctor cannot discover a basis for the symptoms presented, those affected usually quickly change him or her and start their game all over again. Another indication is the avoidance of meetings with relatives or friends in a hospital. Often, no reference persons are given at all.In some cases, Munchausen’s syndrome can have severe consequences for those affected. Among other things, there is a risk of unnecessary surgical interventions, which in turn cause damage to health. Self-injury to one’s own body also sometimes results in considerable impairment. Finally, there is the threat of social problems if the hoax is ultimately uncovered. As a rule, Munchausen syndrome takes a chronic course.
Complications
People with Munchausen syndrome are difficult to treat. They are not afraid to harm themselves when feigning illness. They prefer to attend emergency consultations at the hospital and recite their symptoms, knowing that emergency physicians will have to examine them in more detail because of their extensively recited complaints and will therefore admit them as inpatients first. In most cases, the sufferers have studied medical literature extensively and provide the explanation for their complaints at the same time. In order to achieve hospitalization, they are very creative in feigning symptoms of illness and will stop at nothing. They cauterize their skin with acid, cause bruises themselves, artificially induce fever, inhibit blood clotting with medication, and even inject themselves with insulin to simulate hypoglycemia. Most of the time, they are successful in the short term, but doctors quickly see through this strategy and try to initiate psychotherapeutic treatment. But these people are not amenable to that. They don’t want to be treated and cured, but they want attention, which they won’t get if they are cured. They know this and that is why they often change doctors. Their self-harming behavior can take on dangerous proportions when they manipulate sepsis, for example. People with Munchausen syndrome are also at increased risk for suicide.
When should you see a doctor?
Munchausen syndrome is a difficult mental illness to diagnose. In addition, the affected person lacks insight into the illness. Often in these cases, the help and cooperation of family members, friends or people from the social environment is needed. Since the sufferers permanently undergo changing medical treatment and feign illnesses or injuries, it is often not possible for the attending physicians to take the necessary steps. Due to the obligation of secrecy and a non-existent exchange between medical practices, connections remain hidden and make it difficult to diagnose the illness. A doctor should be consulted by relatives as soon as they notice that the person concerned regularly lies or causes damage to his or her own health. If a third person is harmed by the sufferer, immediate action must be taken. Because sufferers are good at planning and concealing their schemes, irregularities often go unnoticed for years or decades. If a regular change in doctors or members of the social environment is noticed, there is cause for concern. This process is a sign of a disorder, it should be followed up carefully and inconspicuously. Frequently, incidental findings take place or people from the environment, who, however, do not maintain intimate contact with the affected person, can provide the decisive clues.
Treatment and therapy
Although the complaints of people suffering from Munchausen syndrome are only invented, they still require extensive therapy. However, their actual condition is not treated during doctor visits. It is a major problem that patients often resist therapy because they do not see its necessity. For this reason, a very cautious approach must be taken by the doctor. In addition, cooperation with a psychiatrist is usually required, in the context of which inpatient therapy takes place. If this succeeds in establishing a relationship of trust with the patient, psychotherapy can then be carried out. In the course of treatment, several inpatient and outpatient phases alternate. It is also important to reliably exclude actual organic diseases. Not infrequently, therapy is also required for the physical damage that the affected person has inflicted on himself. In order to monitor the course of therapy, the patient is closely observed and must fill out various questionnaires.Some patients also have other mental illnesses such as a personality disorder, which also requires special therapy. The administration of psychotropic drugs and the use of relaxation methods can also be helpful.
Outlook and prognosis
The prognosis in Munchausen syndrome is generally considered poor. This is due to the fact that sufferers with this perceptual shift do not show any insight at all when confronted with their condition. It is true that medical help is often sought. However, this applies at best to (alleged) suffering and to get attention. Psychotherapeutic approaches push sufferers from the role of the demanding to the role of the needy. This then meets with rejection in most cases. In addition, affected persons frequently change doctors, which can even considerably delay the time of a suspected diagnosis by the attending physician. If it comes then so far that a treating physician confronts the patient with a possible Munchausen syndrome, this changes usually the physician. Furthermore, with Munchausen’s syndrome there is the possibility of actual damage caused by actually superfluous medication or even surgery. These are interwoven into the behavior of the affected person and additionally underpin the self-image of the role as patient. The prospect of freeing a sufferer from his Munchausen syndrome is therefore very slim. It is in rare cases that relatives or medical personnel can convince the sufferer of his suffering or explain to him that he needed psychotherapeutic treatment.
Prevention
Preventive measures against Munchausen syndrome are not known.
Follow-up care
As a rule, only limited measures of aftercare are available to those affected by Munchausen syndrome. In this regard, affected persons are primarily dependent on an early diagnosis of this disease so that a further worsening of the symptoms can be prevented. Therefore, especially the patient’s relatives should point out the symptoms to the patient, in some cases even a forced admission to a closed clinic may be necessary. Those affected are dependent on the lasting support of their own family. In this context, especially loving and intensive conversations with one’s own family have a very positive effect on the further course of the disease. The symptoms can also be alleviated with the help of relaxation exercises. Many of the exercises can also be repeated at home, so that the treatment of Munchausen’s syndrome is accelerated. Likewise, the triggers for this syndrome should be prevented and limited as much as possible. In many cases, contact with other people affected by the syndrome is also useful. It is not uncommon for an exchange of information to occur, which can make the daily life of the affected person easier. As a rule, this disease does not reduce the life expectancy of the patient.
This is what you can do yourself
People suffering from Munchausen syndrome require extensive therapy. Treatment focuses on helping the affected person with everyday life. Friends and family members can help by showing understanding and repeatedly pointing out to the affected person in a matter-of-fact manner the obviously imaginary complaints. In cooperation with a psychiatrist, further measures can be taken to alleviate the symptoms. In the long term, relief can only be achieved through a comprehensive therapy concept consisting of psychological discussions, relaxation exercises and drug treatment. Above all, regular relaxation is important to counteract stress and other typical triggers. People who suffer from Munchausen syndrome as a result of a traumatic experience must also work through the causes in the long term. This can be done by attending support groups and therapy sessions, but also by keeping a diary or talking to a close confidant. A lack of attention is a frequent trigger for acute symptoms, which is why relatives and friends should spend a lot of time with the sufferer. If the symptoms are severe, temporary placement in a psychiatric hospital may be appropriate. Due to the many possible symptoms and manifestations of Munchausen syndrome, only a specialist can answer which measures should be taken in detail.
