Factitious Disorder Imposed on Self (Munchausen Syndrome)

Factitious disorder imposed on self, commonly referred to as Munchausen syndrome, is a psychiatric condition where individuals feign or induce illness, injury, or psychological trauma in themselves to gain attention, sympathy, or reassurance. It fits within the subclass of factitious disorders characterised by predominantly physical symptoms. Individuals with this disorder often have a history of recurrent hospitalisation, extensive travel, and dramatic, improbable tales of past experiences. The disorder is named after the fictional character Baron Munchausen, known for his exaggerated tales.

Signs and Symptoms

In factitious disorder imposed on self, the affected person exaggerates or creates symptoms of illnesses in themselves to gain medical attention, treatment, and sympathy. This disorder often involves victim playing and attention seeking. People with Munchausen syndrome are sometimes highly knowledgeable about medical practices and can produce symptoms that result in extensive medical investigations, prolonged hospital stays, and unnecessary surgeries. The role of the patient fills a psychological need for them. This disorder is distinct from hypochondriasis, where individuals do not intentionally produce their symptoms, and from malingering, where symptoms are fabricated for material gain.

Possible risk factors include childhood traumas, emotionally unavailable parents, serious childhood illnesses, failed aspirations to work in the medical field, personality disorders, and low self-esteem. It is most common in mothers with these risk factors and those with a history of working in healthcare.

Related Behaviour

Factitious disorder imposed on another, also known as Munchausen by proxy, involves a caregiver inducing illness in another person, typically a child, to gain attention or sympathy. This is considered medical abuse and is distinct from Munchausen syndrome.

Diagnosis

Diagnosing factitious disorder is challenging due to the deceptive behaviours involved. Healthcare providers may refer the person to psychiatrists or psychologists for thorough evaluation. Diagnosis requires a clinical assessment, detailed history, physical examinations, laboratory tests, and psychological testing. Common diagnostic methods include blood tests, urine toxicology, CT scans, MRI, and psychological testing.

Laboratory and Diagnostic Confirmation

Common methods of imitation and laboratory confirmations include:

• Bartter syndrome: Surreptitious intake of diuretics or self-induced vomiting confirmed by urine chloride analysis.
• Catecholamine-secreting tumour: Injection of epinephrine confirmed by increased Chromogranin A.
• Cushing's syndrome: Surreptitious steroid administration confirmed by HPLC to differentiate endogenous and exogenous steroids.
• Hypoglycaemia: Exogenous insulin or insulin secretagogues confirmed by simultaneous blood analysis.

Common Indicators

Indicators of factitious disorder may include frequent hospitalizations, extensive knowledge of illnesses, frequent requests for medication, openness to surgery, few visitors during hospital stays, and exaggerated or fabricated stories about medical problems.

Treatment

Treating factitious disorder imposed on self is complex. Healthcare providers should first rule out other diseases and take a careful history. If the person is at risk, psychiatric hospitalisation may be initiated. Treatment often involves mental health specialists to address underlying mood or anxiety disorders. The prognosis depends on the underlying disorder; mood and anxiety disorders generally respond well to treatment, while personality disorders offer a worse prognosis.

History

The name "Munchausen syndrome" was coined by Richard Asher in 1951, inspired by the fictional character Baron Munchausen. Asher described the condition in an article in The Lancet, highlighting the dramatic and untruthful stories of affected individuals. The term sparked debate due to its literary allusion and perceived disrespect to patients. The DSM-5 now uses "factitious disorder imposed on self" and "factitious disorder imposed on another."

Munchausen by Internet

Munchausen by Internet is a manifestation of factitious disorder imposed on self, where individuals feign illnesses in online venues. It was named by psychiatrist Marc Feldman in 1998. The anonymity of the Internet makes it difficult to detect deception, leading to polarised online communities when fabrications are exposed.

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Self-assessment MCQs (single best answer)

What is another name for Factitious Disorder Imposed on Self?

Which of the following is NOT a common risk factor for developing Munchausen syndrome?

Factitious Disorder Imposed on Another is also known as:

Which of the following is a method used to confirm the surreptitious intake of diuretics?

Munchausen by Internet refers to:

Which of the following symptoms is NOT typically associated with Munchausen syndrome?

The term "Munchausen syndrome" was coined by:

Which diagnostic method is used to differentiate endogenous and exogenous steroids in suspected cases of surreptitious steroid administration?

What is the primary psychological need fulfilled by individuals with Munchausen syndrome?

Which of the following is a common indicator of factitious disorder imposed on self?