So far we have covered relatively common mental health disorders. This time we will look at something rarer. A diagnosis that is a challenge for doctors and the patient’s relatives – Munchausen syndrome.
This term was first described by Richard Asher in 1951. Baron Munchausen (Karl Friedrich Hieronymus, Baron von Münchhausen, 1720-1797) was famous for his exaggerated, unreal adventures and novels were written about him. In the 20th century, this surname had already become a signifier of false, exaggerated adventures.
Unlike hypochondria and somatoform disorders, in Munchausen syndrome the patient pretends to be ill or deliberately causes the symptoms of the illness.
It is further divided into:
- Munchausen syndrome – an individual deliberately invents or causes health disorders;
- Intermediate Munchausen syndrome – when an individual deliberately creates or causes health disorders for a person under his care (most often his offspring);
- in recent years, a new phenomenon characteristic of the digital age has been mentioned – Munchausen’s syndrome on the Internet, when an individual joins peer groups in the Internet environment for people with certain diagnoses, pretending that he also suffers from such a disease.
When would Munchausen syndrome be suspected?!
The most important thing, when suspecting such a diagnosis, the patient should be thoroughly examined to rule out any other illness. Below, we will summarize several characteristic features characteristic of this syndrome:
- false complaints about symptoms – for example, choosing symptoms that are difficult to refute (severe headaches, seizures or unconsciousness);
- distorting test results – for example, heating a thermometer, adding blood to a urinalysis;
- self-harm (or harm to the person cared for) – for example, cutting or burning, intentional poisoning with medication or contamination of food with bacteria;
- aggravation of pre-existing disorders – for example, intentionally contaminating a wound or opening a healed wound.
Additional symptoms:
- frequent visits to medical facilities of various profiles;
- claims to have had complex and serious medical conditions for which there is no or little evidence, these people often claim that they have spent a long time outside the country, have been in medical facilities in other countries;
- symptoms that do not correspond to the results of examinations;
- symptoms that worsen for no known reason;
- very good medical knowledge;
- there are few or no visitors in the hospital – often people with Munchausen syndrome live in seclusion;
- are willing and willing to undergo frequent painful or even dangerous tests and procedures;
- complains of vague, contradictory symptoms or, on the contrary, the complaints are as precise as “textbook examples”;
- tell often very complicated, even unbelievable, stories about their past, for example, claiming to be decorated war veterans or of high birth or from a very wealthy family.
There are no exact data on the prevalence of these disorders, but it is possible that the mildest cases go unnoticed. These patients travel from hospital to hospital with various, changing complaints and are quite manipulative with those around them. In more severe cases, the patient may even endanger his or her health.
How does Munchausen syndrome occur?
No unequivocal cause has been discovered for the development of these disorders, but studies have cited childhood abuse or indifference in the family as important causes. As a result, a mechanism is formed, how an individual “learns” to get the necessary attention and care, hiding under it low self-esteem and self-doubt, the need to transfer care and responsibility for oneself to others. This syndrome can also develop in personality disorders such as:
- antisocial personality disorder – the person manipulates and deceives the medical staff, enjoying a sense of power and control;
- borderline personality disorder – the person struggles to control his feelings and often oscillates between a positive and negative opinion of others;
- narcissistic personality disorder – when a person often oscillates between the belief that he is more special than others and fears that he is worthless.
These patients often have unstable self-confidence and difficulties in forming relationships with others. The “sick role” allows them to accept themselves, receive unconditional support and sympathy from others. Being in a medical institution gives a person a clearly defined place in society.
Treatment of Munchausen syndrome.
Ironically, people with Munchausen syndrome in most cases do not want to accept the fact that they have a mental disorder, even though the syndrome itself involves seeking medical help. As we have already described, perhaps due to the existing psychiatric stigma, it is easier for people to “accept” physical illness than mental illness. Taking into account the reasons for the syndrome described above, it would be recommended for such patients to receive psychotherapeutic help in order to solve past problems that have affected this person’s thinking, the way relationships are formed with others, and understanding of their personality. It is not excluded that this syndrome can be part of a more complex mosaic of mental disorders, and making sure that, for example, depression or panic disorder in such a patient is not just part of the show. Drug therapy can also be used, but care must be taken, remembering that these people have a tendency to abuse drugs.
Authors of the article: resident doctor in psychiatry, Juta Jaudzema doctor psychiatrist Pēteris Zālītis
Literature
https://www.webmd.com/mental-health/munchausen-syndrome#3
https://aifs.gov.au/cfca/publications/new-name-munchausen-syndrome-proxy-defining-fabric#whatis
https://www.nhs.uk/conditions/munchausens-syndrome/symptoms/
Jyoti Prakash et al “Munchausen syndrome: Playing sick or sick player”
https://www.ncbi.nlm.nih.gov/pubmed/12422889