Munchausen syndrome is a psychiatric disorder that causes an individual to
self-inflict injury or illness or to fabricate symptoms of physical or
mental illness in order to receive medical care or
. In a variation of the disorder, Munchausen by proxy (MSBP), an
individual, typically a mother, intentionally causes or fabricates illness
in a child or other person under her care.
Munchausen syndrome takes its name from Baron Karl Friederich von
Munchausen, an eighteenth century German military man known for his tall
tales. The disorder first appeared in psychiatric literature in the early
1950s when it was used to describe patients who sought hospitalization by
inventing symptoms and complicated medical histories, and/or inducing
illness and injury in themselves. Categorized as a factitious disorder (a
disorder in which the physical or psychological symptoms are under
voluntary control), Munchausen syndrome seems to be motivated by a need to
assume the role of a patient. Unlike malingering, there does not seem to
be any clear secondary gain (e.g., money) in Munchausen syndrome.
Individuals with Munchausen by proxy syndrome use their child (or another
dependent person) to fulfill their need to step into the patient role. The
disorder most commonly victimizes children from birth to eight years old.
Parents or caregivers with MSBP may only exaggerate or fabricate their
child's symptoms, or they may deliberately induce symptoms through
various methods, including
, suffocation, starvation, or introducing bacteria into open
. They often display an extraordinary depth of medical knowledge and may
even be in the medical profession themselves.
Both Munchausen syndrome and Munchausen syndrome by proxy are thought to
be rare, but there are no solid statistics on the frequency of either
diagnosis. Data on Munchausen syndrome in children and adolescents
specifically are very limited. In 2000 one review found that among the 42
cases reported in the medical literature, 71 percent were female and the
mean age was 14 years of age. Children age 14 and younger were more likely
to admit to falsifying symptoms when confronted than those between the
ages of 15 and 18.
Munchausen syndrome by proxy is also hard to quantify due to the number of
undetected or undiagnosed cases. The incidence of the condition in the
United States is not known, but a 1996 study of children in Ireland and
the United Kingdom estimated that Munchausen syndrome by proxy occurred
annually in 0.5 of every 100,000 children under age 16, and in 2.8 of
every 100,000 children under the age of one.
Causes and symptoms
The exact cause of Munchausen syndrome is unknown. It has been theorized
that Munchausen patients are motivated by a desire to be cared for, a need
for attention, dependency, an ambivalence toward doctors, or a need to
suffer. Factors that may predispose an individual to Munchausen include a
serious illness in childhood or an existing personality disorder. Some
research indicates that children and adolescents who develop Munchausen
syndrome are more likely to have been previous victims of Munchausen
syndrome by proxy.
The Munchausen and Munchausen by proxy patient can appear to have a wide
array of physical or psychiatric symptoms, usually limited only by their
(or their caregiver's) medical knowledge. Many Munchausen patients
are very familiar with medical terminology and symptoms. Some common
complaints include fevers,
, abscesses, bleeding, and
. Common Munchausen by proxy symptoms include apnea (cessation of
, vomiting, and
. In both Munchausen and MSBP syndromes, the suspected illness does not
respond to a normal course of treatment, and
diagnostic tests turn up nothing out of the ordinary. Patients or parents
may push for invasive procedures and display an extraordinary depth of
knowledge of medical therapies.
Because Munchausen sufferers often go from doctor to doctor, gaining
admission into many hospitals along the way, diagnosis can be difficult.
They are typically detected rather than diagnosed. During a course of
treatment, they may be discovered by a hospital employee who encountered
them during a previous hospitalization. Their caregivers may also notice
that symptoms such as high fever occur only when the patient is left
unattended. Occasionally, medication used to induce symptoms is found with
the patient's belongings. When the patient is confronted, they
often react with outrage and check out of the hospital to seek treatment
at another facility with a new caregiver.
A diagnosis of Munchausen syndrome may be even more difficult in children
and adolescents. A physician may be able to recognize a pattern of
symptoms (e.g., those that occur only when the child is alone or that
begin only when the parent is present with the child) or the child may
admit to fabricating or self-inflicting symptoms upon questioning.
Surveillance video may record the child or the child's caregiver
There is no clearly effective treatment for Munchausen syndrome. Extensive
psychotherapy may be helpful with some Munchausen patients. If Munchausen
syndrome coexists with other mental disorders, such as a personality
disorder, the underlying disorder is typically treated first. Children who
develop the syndrome may respond more favorably to therapy than adults,
particularly if they are diagnosed at an early age.
Children who are victims of Munchausen syndrome by proxy are usually
removed from the offending caregiver immediately and placed in protective
custody. Therapy may also be beneficial to these children in recovering
from the emotional trauma of MSBP.
The infections and injuries Munchausen patients self-inflict can cause
serious illness. Patients often undergo countless unnecessary surgeries
throughout their lifetimes. In addition, because of their frequent
hospitalizations, they have difficulty holding down a job. Further, their
chronic health complaints may damage interpersonal relationships with
Children victimized by sufferers of MSBP are at a real risk for serious
injury and possible death. A UK study published in 1998 found that
although the majority of children with MSBP studied (90 percent) were
placed in child protection care at diagnosis, at two-year follow up the
number had fallen to 32 percent. A reported 17 percent of children who
were victims of MSBP and who were eventually returned to an abusive
caregiver suffered further abuse. Those who survive physically unscathed
may suffer developmental and emotional problems.
—The temporary absence of breathing. Sleep apnea consists of
repeated episodes of temporary suspension of breathing during sleep.
—A mental condition in which symptoms are deliberately
manufactured by patients in order to gain attention and sympathy.
Patients with factitious diseases do not fake symptoms for obvious
financial gain or to evade the legal system.
—Pretending to be sick in order to be relieved of an unwanted
duty or obtain some other obvious benefit.
Parents who suspect that their child may be deliberately hurting
themselves or falsifying symptoms should contact their pediatrician
immediately for assessment. Children who are thought to pose potentially
danger to themselves may require hospitalization, and a referral to a
child psychologist or therapist will be necessary. It is important to
remember that properly treating the condition requires addressing the
motives and emotions behind the disorder, not simply punishing the
Diagnostic and Statistical Manual of Mental Disorders
, 4th ed., text revision (DSM-IV-TR). Washington, DC: American Psychiatric
Press Inc., 2000.
Playing Sick?: Untangling the Web of
Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious
New York: Brunner-Routledge, 2004.
Mart, Eric G.
Munchausen's Syndrome by Proxy Reconsidered.
Manchester, NH: Bally Vaughn, 2002.
Libow, Judith. "Child and Adolescent Illness Falsification."
105, no. 2 (February 2000): 336.
Schreier, Herbert. "Munchausen by Proxy Defined."
110, no. 5 (November 2002): 985.
American Psychiatric Association.
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