Munchhausen Syndrome

Munchhausen Syndrome:  Repeated fabrication of physical
illness – usually acute, dramatic and convincing – by a person who wanders from hospital to
hospital to hospital and doctor to doctor for treatment.  Patient
actually may have ingested or injected substances (poison) so they can
seek medical attention.

Munchhausen syndrome patients may simulate many physical disorders,
such as; Myocardial infarction, acute abdominal conditions and fever of
unknown origin.  Their abdomen may be criss-crossed with scars from
multiple abdominal surgeries.  The patient may have had a limb or
a digit amputated.  many have lengthy surgical histories.  These
patients eventually become the responsibility of the medical community
– doctors, hospitals and surgical clinics.  However, this illness
is primarily psychiatric.  It is far more complex than simply dishonest
simulation of symptoms.  It is associated with severe emotional difficulties. 

Patients may have prominent histrionic personality features; they are usual
intelligent and resourceful.  They know how to simulate disease and
are sophisticated regarding medical practices.  They differ from malingerers
because although their deceits and simulations are conscious, their motivations
for forging illness and quest for attention are largely unconscious. 
Commonly there is and early history of emotional and or physical abuse. 
They appear to have problems with their identity, intense feelings, inadequate
impulse control, a deficient sense of reality, brief psychotic episodes
and unstable personal relationships.  Their need to be taken care
of conflicts with their lack of trust of any authority figures, whom they
manipulate and continuously provoke or test. 

Patients with Munchhausen
syndrome and psychotic psychopathology as part of a character logic disorder
are rarely treated successfully.  Acceding to their manipulations
relieves their tension, but their provocation’s escalate, ultimately surpassing
what physicians are willing or able to do.  Confrontation or refusal
to meet treatment demands results in angry reactions, and patients generally
move to another hospital or doctor.  Psychiatric treatment is usually
refused or circumvented; but consultation and follow up care may be accepted.
at least to help relieve a crisis.  Management is generally limited
to recognizing the disorder early and avoiding risky procedures and excessive
or unwarranted use of drugs.

Munchhausen Syndrome By Proxy:  or MSBP is a bizarre
variant in which a child is used as a surrogate patient .  The parent
falsifies history and may injure the child to simulate a disease. 
The parent seeks medical care for the child and always appears to be deeply
concerned and overly protective.  The child is often seriously ill,
and requires frequent hospitalization and may even die.   
MSBP is very hard to detect.  MSBP victims may undergo numerous lab
tests, multi medication trials, and surgical procedures that aren’t really

Munchhausen syndrome by proxy parent or caregiver has a need to feel
“special”  or heroic to stimulate attention from people, such as family,
friends, community, and medical professions.  Often using their child
as the victim, and the child has been under medical care most of their
young life.

When MSBP is suspected, health care professionals/providers are required
by law to report their concerns to law enforcement and social service agencies.

Munchhausen’s syndrome was named for the fictitious Baron Munchhausen
– who told many ‘tall tales’.