Munchausen's syndrome

Munchausen's syndrome is a psychological and behavioural condition where someone pretends to be ill or induces symptoms of illness in themselves.

Information written and reviewed by Certified Doctors.

Contents

Introduction

Munchausen's syndrome is a psychological and behavioural condition where someone pretends to be ill or induces symptoms of illness in themselves.

Munchausen's syndrome is also sometimes known as factitious disorder.

In people with Munchausen's syndrome:

  • they intentionally produce or pretend to have physical or psychological symptoms of illness
  • their main intention is to assume the ‘sick role’; have people care for them and be the centre of attention
  • there is no practical benefit for them in pretending to be sick – for example, claiming incapacity benefit

Munchausen's syndrome is named after a German aristocrat, Baron Munchausen, who became famous for telling wild, unbelievable tales about his exploits and past.

Types of behaviour

People with Munchausen's syndrome can show different types of behaviour including:

  • pretending to have psychological symptoms – for example, claiming to hear voices or claiming to see things that are not really there
  • pretending to have physical symptoms – for example, claiming to have chest pain or stomach ache
  • actively seeking to make themselves ill – such as deliberately infecting a wound by rubbing dirt into it

Some people with Munchausen's syndrome may spend years travelling from hospital to hospital feigning a wide range of illnesses. When it is discovered they are lying, they may suddenly leave hospital and move to another district.

People with Munchausen's 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.

Read more about the symptoms of Munchausen’s syndrome.

What causes Munchausen's syndrome?

Munchausen’s syndrome is a complex and poorly understood condition and it is still unclear why people with the condition behave in the way they do.

Some experts have argued that Munchausen’s syndrome is a type of personality disorder. Personality disorders are a type of mental health condition where an individual has a distorted pattern of thoughts and beliefs about themselves and others. This leads them to behave in ways most people would regard as disturbed and abnormal.

Another theory is that the condition may be the result of parental neglect and abandonment, resulting in feelings of childhood trauma which causes them to fake illness.

Read more about the possible causes of Munchausen’s syndrome.

Treatment

Treating Munchausen’s syndrome can be challenging as most people with the condition refuse to admit they are faking illness.

For those who do admit their behaviour is abnormal, talking therapies such as cognitive behavioural therapy can sometimes be effective.

Read more about the treatment of Munchausen’s syndrome.

Who is affected

There appear to be two distinct groups of people affected by Munchausen's syndrome:

  • women who are 20 to 40 years of age, who often have a background in healthcare, such as working as a nurse or a medical technician
  • unmarried white men who are 30 to 50 years of age

It is unclear why this is the case.

It is not known exactly how common Munchausen's syndrome is. Some experts believe it is under-diagnosed because many people with the condition succeed in deceiving medical staff. It is also possible that cases of Munchausen's syndrome may be over-diagnosed because the same person could use different identities.

A large study carried out in a Canadian hospital estimated that out of 1,300 patients there were 10 who were faking symptoms of illness.

Symptoms

There are several warning signs someone may have Munchausen's syndrome.

Someone with the condition may:

  • make frequent visits to hospitals in different areas
  • claim to have a history of complex and serious medical conditions with little documentary evidence to support this (people often claim they have spent a long time out of the country)
  • have symptoms that do not correspond to test results
  • have symptoms that get worse for no apparent reason
  • have a very good medical knowledge
  • receive few or no hospital visitors (many people with Munchausen's syndrome adopt a solitary lifestyle and have little contact with friends or family)
  • be willing to undergo often painful or dangerous tests and procedures
  • report symptoms that are vague and inconsistent, or report a pattern of symptoms that are ‘textbook examples’ of certain conditions
  • tell highly unbelievable and often very elaborate stories about their past, such as claiming to be a decorated war hero or that their parents are fantastically rich and powerful

Patterns of behaviour

There are four main ways that people with Munchausen's syndrome fake or induce illnesses. These are outlined below.

  • Lying about symptoms. They often choose symptoms that are difficult to disprove, such as having a severe headache or pretending to have a seizure (fit) or to pass out.
  • Tampering with test results. For example, they may heat a thermometer to suggest a fever or add blood to a urine sample.
  • Self-infliction. They may cut or burn themselves, poison themselves with drugs or an overdose of medication, or eat food that has been contaminated with bacteria.
  • Aggravating pre-existing conditions. For example, they may rub dirt or dog faeces ('poo') into wounds to cause an infection or reopen previously healed wounds.

Munchausen's by internet

A relatively new condition has been labelled Munchausen's by internet. This is where a person joins an internet support group for people with a serious health condition, such as cystic fibrosis or leukaemia, and then claims to have the illness themselves.

While these actions may only be confined to the internet, they can have an incredibly destructive effect on support groups and online communities. People with genuine health conditions have reported feelings of betrayal and anger upon discovering they have been lied to.

One expert on Munchausen’s by internet has compiled a list of warning signs that indicate someone may be affected by the condition:

  • Their posts and messages seem to contain large chunks of information that appear to have been directly copied from health websites.
  • They report experiencing symptoms that appear much more severe than most people would experience.
  • They claim to have near-fatal bouts of illness followed by a miraculous recovery.
  • They make fantastic claims which they later contradict or which others disprove at a later date. For example, they may claim to be attending a certain hospital that does not actually exist.
  • They claim to have continual dramatic events in their life, such as loved ones dying or being the victim of a violent crime, particularly when other group members have become a focus of attention.
  • They feign an attitude of unconcern when they talk about serious problems, probably to attract attention and sympathy.
  • Other ‘people’ claim to post on their behalf, such as a parent or partner, but they use exactly the same pattern of writing.

Causes

There is little available evidence about possible causes of Munchausen's syndrome because many people with the condition refuse to co-operate with psychiatric treatment or psychological profiling.

Theories

There are two main theories about the root cause of Munchausen's syndrome. The condition may be the result of:

  • emotional trauma (deeply upsetting experiences) that occurred during a person’s childhood
  • a personality disorder: a mental health condition that causes patterns of abnormal thinking and behaviour

It could be the case that both theories are interrelated to some extent. A person with a traumatic childhood can often go on to develop a personality disorder in later life.

The two theories are discussed in more detail below.

Childhood trauma

Some experts have suggested that many cases of Munchausen's syndrome may be the result of parental neglect and abandonment, resulting in feelings of childhood trauma.

As a result of this trauma, a person may have unresolved issues with their parents that cause them to fake illness. They may do this for a number of reasons, for example because they have:

  • a compulsion to punish themselves (masochism) by making themselves ill because they feel unworthy
  • a need to feel important and be the centre of attention
  • a need to pass responsibility for their wellbeing and care onto other people

There is also some evidence to suggest that people who have had extensive medical procedures, or received prolonged medical attention during childhood or adolescence, are more likely to develop Munchausen's syndrome when they are older.

This may be because they associate their childhood memories with a sense of being cared for. As they get older they try to obtain the same feelings of reassurance by pretending to be ill.

Personality disorders

There is some evidence that many people with Munchausen's syndrome have a personality disorder.

Personality disorders are a type of mental health condition where an individual has a distorted pattern of thoughts and beliefs about themselves and others. This leads them to behave in ways most people would regard as disturbed and abnormal.

One theory is that there may be people with Munchausen's syndrome who have an antisocial personality disorder that causes them to take pleasure in manipulating and deceiving doctors. They may see doctors as authority figures and by tricking them it may give them a sense of power and control.

Another theory is that some people with Munchausen's syndrome have an extreme form of what are known as cluster B personality disorders. A person with a cluster B personality disorder struggles to regulate their feelings and often swings between positive and negative views of others. (The most common type of cluster B personality disorders is borderline personality disorder).

It could be that the person has an unstable sense of their own identity and also has difficulties establishing meaningful relationships with others. So playing the 'sick role' allows them to adopt an identity that brings with it unconditional support and acceptance from others. And admission to hospital gives that person a clearly defined place in a social network.

Diagnosis

Diagnosing Munchausen's syndrome can be challenging for medical professionals.

People with the condition are often accomplished liars and skilled at manipulating and exploiting a doctor's concern for their patient, and a doctor's natural interest in investigating unusual medical conditions.

Investigating claims

If a health professional suspects a person may have Munchausen's syndrome they will usually make a detailed study of that person's health records to look for inconsistencies between their claimed and actual medical history. They may also attempt to talk to their family and friends to see if their claims about their past are true.

Health professionals can also run a number of clinical tests to check for evidence of self-inflicted illness or tampering of clinical tests. For example, the person's blood can be checked for traces of medication that the person should not be taking, but which could explain their symptoms.

Doctors will also want to rule out other possible motivations for their behaviour, such as faking illness for financial gain, or because they want access to strong painkillers.

A diagnosis of Munchausen's syndrome can usually be confidently made if:

  • there is clear evidence of fabricating or inducing symptoms
  • the person's prime motivation is to be seen as sick
  • there is no other likely reason or explanation for their behaviour

Treatment

Treating Munchausensyndrome can be difficult because most people refuse to admit they have a problem and will not co-operate with suggested treatment plans.

Some experts suggest healthcare professionals adopt a gentle, non-confrontational approach, suggesting the person has complex health needs and may benefit from a referral to a psychiatrist.

Other experts argue that a person with Munchausen's syndrome should be confronted directly with a question about why they have lied and whether they suffer from stress and anxiety.

One of the biggest ironies surrounding Munchausen's syndrome is that people with the condition are genuinely mentally ill, but will often only admit to having a physical illness.

If a person admits to their behaviour, they can be referred to specialist psychiatric services for further treatment (see below).

If the person does not admit to lying, most experts agree 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 that the patient can no longer be trusted, the doctor is unable to continue treating them.

Psychiatric treatment

If someone admits they have a problem and co-operates with treatment, it may be possible to help them control the symptoms of Munchausen's syndrome.

There is no standard treatment for the condition, but a combination of psychoanalysis and cognitive behavioural therapy (CBT) has shown some success in helping people control their symptoms.

Psychoanalysis

Psychoanalysis is a type of psychotherapy based on the theories of Sigmund Freud. Freud suggested unconscious beliefs or motivations, often formed during early childhood, can be the cause of many psychological conditions. Psychoanalysis attempts to uncover and resolve these unconscious beliefs and motivations.

Read more about Psychotherapy.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) works by helping a person identify unhelpful and unrealistic beliefs and behavioural patterns they may have.

A specially trained therapist teaches the person ways of replacing unrealistic beliefs with more realistic and balanced ones.

Read more about CBT.

Family therapy

People with Munchausen's syndrome still in close contact with their family may also benefit from having family therapy. The person with Munchausen's syndrome and their close family members discuss how the condition has affected the family and the positive changes that can be made.

It can also teach family members ways to avoid ‘reinforcing’ the person’s abnormal behaviour. For example, recognising when the person is playing the 'sick role' and avoiding showing them concern or offering support.

Content supplied by NHS Choices