Munchausen syndrome is a disorder in which a person simulates, exaggerates or artificially causes symptoms of the disease in order to undergo a medical examination, treatment, hospitalization, surgery. The reasons for this behavior are not fully understood. The generally accepted explanation of the causes of Munchausen disorder is that the simulation of the disease allows people with this problem to receive attention, care, sympathy, and psychological support, the need for which is frustrated. The term “Munchausen syndrome” was proposed by Richard Asher, who in 1951 first described the behavior of patients who tend to invent or cause painful symptoms. The disorder is understood as an extreme and long-lasting form of a simulative disorder in which the simulation of disease is central to a person’s life.
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There are two major types of Munchausen syndrome. First, the actual Munchausen illness, or a simulated disorder, when a person causes some physical symptoms in himself and enters the clinic with them. Second, the so-called delegated Munchausen syndrome, or proxy Munchausen. The patient does not cause symptoms in himself/herself, but in some other person who is dependent on him/her and is actually in a helpless state (Baig, Levin, Lichtenthal, Boland, & Breitbart, 2015). Usually, these are mothers, women who intentionally cause symptoms in a child, come to a doctor with him/her, and doctors try to help, understand what happened and examine the child. In this situation, a sick woman receives care and attention; there is some decrease in the stress level. It is known that the delegated form of Munchausen syndrome occurs mainly in women, and the usual way, when a person himself/herself causes illness, is equally present in both men and women. There is even evidence that this is more common in men (Fraher, 2014). It is important to understand that the disorder can be gender specific.
Patients with Munchausen syndrome deny the artificial nature of their symptoms, even if they show evidence of a simulation. In case of refusal of treatment by one specialist, a patient with Munchausen disorder turns to another. The actions by which the features of the disease are created can cause irreparable harm to health and constitute a danger to its life and adversely affect mental development and health. Munchausen’s syndrome is complicated to recognize, so its prevalence cannot be accurately determined. There are isolated cases of observations in various fields of medicine (Amladi & DePry, 2017). The causes of the disease are more profound than the simple desire to attract attention, but they are not well understood, because this is not the most common mental disorder. Patients come into the view of professional psychiatrists and psychologists far from always (Fraher, 2014). Now it is believed that this is a syndrome that can occur in various mental illnesses, primarily in the case of personality disorders and in mild forms of schizophrenia and slow-moving schizophrenia.
The diagnosis and disorder type identification are critically important. According to the diagnostic criteria, in order to diagnose Munchausen syndrome, a person should not have acute psychosis and acute schizophrenia, because then it is a manifestation of other diseases (Gomila et al., 2016). However, if these diseases are not observed, and there are some criteria according to which various injuries are caused to oneself, or various somatic symptoms are caused, at the same time the doctor has suggestions that the patient does this in order to gain attention, then he/she has put the diagnosis of Munchausen syndrome. There is a hypothesis that in childhood the patients had some psychological trauma. They were deprived of care and love and at a particular moment unconsciously discovered that they could only get attention, which these individuals are denied, in a medical care situation (Gomila et al., 2016). Thus, they semi-consciously or unconsciously begin to perform these procedures with themselves: they can use some medication that causes side effects of them, they can create themselves some injury. All this leads them to the hospital, where doctors and medical staff immediately begin to care for the patient, to give him a lot of attention, to figure out what these strange symptoms, which, generally speaking, should not be characteristic of this patient.
Munchausen syndrome is intermediate between these two concepts. On the one hand, the symptoms that are observed in these people are real; that is, some physiological changes on the part of the body are real. On the other hand, they are caused by this patient intentionally, but, unlike simulation, without any specific motive and purpose of obtaining material gain or evading any social demands (Gomila et al., 2016). Thus, Munchausen syndrome is a simulated disorder, and it manifests itself in the fact that the patient deliberately does some injury to himself, consciously causes the symptoms of the somatic circle, that is, the disease properties are associated with the suffering of the body. However, it is done not to avoid punishment or to evade social demands, but for other reasons (Gomila et al., 2016). Therefore, this is the most interesting thing in Munchausen syndrome, because, according to the existing observations, the main reason is the motive for receiving attention and extra care about oneself.
Some people are not able to understand that they are sick. Their self-damaging behavior, aimed at causing symptoms, does not reflect well enough. For them, it is a habit, impulsive obsessive actions. Even the part that they realize can very quickly be forced out into the unconscious because it causes shame feelings in the patient when the person realizes that he/she is capable of doing such things. Therefore, patients usually weakly reflect what is happening to them. The syndrome progresses in such a way that patients are increasingly admitted to hospitals (Yates & Bass, 2017). If it is a delegated form of a simulated disorder, then at a certain point a medicine has a request to law enforcement agencies because the child suffers and there is evidence that they are harmed.
If this is an independent simulated disorder that occurs in one person, then at best he/she will be referred to a psychiatrist in a relatively compulsory manner, and the psychiatrist will communicate with him. In the worst case, an individual can get some serious injuries and even die from what the person does with himself (Yates & Bass, 2017). Therefore, medicine takes careful attention if it detects that self-destructive actions are characteristic of a particular patient; that is, it can cause itself harm and is potentially dangerous for itself. Early prevention of this disease is almost impossible.
In psychiatric clinics, such patients are sporadic and treatment may be different, for example, psychopharmacotherapy. There is a point of view in the literature that selective serotonin reuptake inhibitors are sufficiently effective for stopping these conditions (Kuhne et al., 2019). Therefore, there are methods of treatment with the help of psychotherapy, starting with family psychotherapy and ending with psychotherapy aimed at solving the problem, that is, when the psychotherapist tries to find ways of receiving care, attention, and love with the patient in some other ways that are not associated with self-destruction and auto-aggression. However, it works only if the patient is set up to solve this problem, if he/she realizes that the issue is precisely in the disease and that he, the patient, suffers from it.
Munchausen syndrome is a mental disorder from a group of simulative or simulated disorders. However, in order to more clearly understand what it is, it is necessary to immediately differentiate it from the simulation and the so-called somatoform disorders (Baig et al., 2015). A simulation is an imitation of a disease for a specific purpose and with a particular motive: avoiding punishment, evading service, work, or for some other mercenary purposes (Amladi & DePry, 2017). Somatoform disorder is a mental problem, and, as the name implies, it is somatic in form. In the DSM-5 classification, it is called “a mental disorder in the form of somatization.” That is, the patient has some somatic symptoms, but for them, there is no sufficient explanation from the physiology and anatomy of his/her body.
In conclusion, Munchausen syndrome is an imitation of the disease, and it is not a somatoform disorder, but somewhat resembles it because the underlying somatic illness is a mental problem. The key difference is that in Munchausen disorder, people deliberately fake symptoms of physical illness. They constantly simulate various diseases and often move from hospital to hospital in search of treatment. Munchausen syndrome, of course, is a more complex condition than simple dishonesty and simulation. This disease occurs in the presence of severe emotional disturbances. People suffering from this disorder are usually quite intelligent and resourceful; they not only know how to simulate the symptoms of the disease but also have information about diagnostic methods. They can “manage” their treatment and approve the doctor in the opinion that they need intensive examination and treatment, including sometimes serious operations. They deceive consciously, but their motivations and the need for attention are largely subconscious.
Amladi, A. K., & DePry, D. R. (2017). A 90-year-old man with factious disorder: Separating fact from fiction. The International Journal of Psychiatry in Medicine, 53(4), 310-316.
Baig, M. R., Levin, T. T., Lichtenthal, W. G., Boland, P. J., & Breitbart, W. S. (2015). Factitious disorder (Munchausen’s syndrome) in oncology: case report and literature review. Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 25(6), 707-711.
Fraher, A. L. (2014). A toxic triangle of destructive leadership at Bristol Royal Infirmary: A study of organizational Munchausen syndrome by proxy. Leadership, 12(1), 34-52.
Gomila, I., Lopez-Corominas, V., Pellegrini, M., Quesada, L., Miravet, E., Pichini, S., & Barcelo, B. (2016). Alimemazine poisoning as evidence of Munchausen syndrome by proxy: A pediatric case report. Forensic Science International, 266(4), 18-22.
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Kuhne, A. C. A., Pitta, A. C., Galassi, S. C., Goncalves, A. M. F., Cardoso, A. C. A., Paz, J. A., … Silva, C. A. (2019). Munchausen by proxy syndrome mimicking childhood-onset systemic lupus erythematosus. Lupus, 28(2), 249-252.
Yates, G., & Bass, C. (2017). The perpetrators of medical child abuse (Munchausen Syndrome by Proxy) – A systematic review of 796 cases. Child Abuse & Neglect,72(1), 45-53.