Factitious disorder

Factitious disorder

Introduction

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

It is also sometimes known as factitious disorder.

People with the condition intentionally produce or pretend to have physical or psychological symptoms of illness.

Their main intention is to assume the “sick role” to have people care for them and be the centre of attention.

Any practical benefit for them in pretending to be sick – for example, claiming incapacity benefit – is not the reason for their behaviour.

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

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 a stomach ache
  • actively trying to get 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 area.

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. 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, where only real or imagined illness gives them feelings of care.

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?

From the available case studies, there appear to be two relatively distinct groups of people affected by Munchausen’s syndrome:

  • women aged 20 to 40 years old, 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 old

It is unclear why this is the case. It is also not known exactly how common Munchausen’s syndrome is.

Some experts believe it is underdiagnosed because many people with the condition succeed in deceiving medical staff. It is also possible cases may be overdiagnosed as 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 of Munchausen’s syndrome

Symptoms and signs of Munchausen’s syndrome may include pretending to be ill or self-harming to aggravate or induce illness.

There are four main ways people with Munchausen’s syndrome fake or induce illnesses, including:

  • lying about symptoms – for example, choosing 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, heating a thermometer to suggest a fever or adding blood to a urine sample
  • self-infliction – for example, cutting or burning themselves, poisoning themselves with drugs, or eating food contaminated with bacteria
  • aggravating pre-existing conditions – for example, rubbing faeces into wounds to cause an infection, or reopening previously healed wounds

Other signs

Some clues that a person may have Munchausen’s syndrome include:

  • making frequent visits to hospitals in different areas
  • claiming 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
  • having symptoms that do not correspond to test results
  • having symptoms that get worse for no apparent reason
  • having very good medical knowledge
  • receiving few or no hospital visitors – many people with Munchausen’s syndrome adopt a solitary lifestyle and have little contact with friends or family
  • being willing to undergo often painful or dangerous tests and procedures
  • reporting symptoms that are vague and inconsistent, or reporting a pattern of symptoms that are “textbook examples” of certain conditions
  • telling 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

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, including:

  • posts and messages that contain large chunks of information and appear to have been directly copied from health websites, such as NHS Choices
  • reports of experiencing symptoms that appear to be much more severe than most people would experience
  • making claims of near-fatal bouts of illness followed by a miraculous recovery
  • making fantastic claims that they later contradict or others disprove at a later date – for example, they may claim to be attending a certain hospital that does not actually exist
  • claiming 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
  • feigning an attitude of unconcern when they talk about serious problems, probably to attract attention and sympathy
  • other “people” claiming to post on their behalf, such as a parent or partner, but they use exactly the same pattern of writing

Causes of Munchausen’s syndrome

Diagnosing Munchausen’s syndrome

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

People with the condition are often very convincing 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 the person’s 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 they should not be taking but 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

Treating Munchausen’s syndrome