Münchausen syndrome


Münchausen syndrome
Factitious disorders
Classification and external resources
ICD-10 F68.1
ICD-9 301.51
DiseasesDB 8459 33167
eMedicine med/3543 emerg/322 emerg/830
MeSH D009110

Münchausen syndrome is a term for psychiatric disorders known as factitious disorders wherein those affected feign disease, illness, or psychological trauma to draw attention or sympathy to themselves. It is also sometimes known as hospital addiction syndrome or hospital hopper syndrome. Nurses and Doctors sometimes refer to them as frequent flyers, because they return to the hospital just as frequent flyers return to the airport. However, there is discussion to reclassify them as somatoform disorder in the DSM-5 as it is unclear whether or not people are conscious of drawing attention to themselves.[1]

Münchausen syndrome is related to Münchausen syndrome by proxy (MSbP/MSP), which refers to the abuse of another being, typically a child, in order to seek attention or sympathy for the abuser.

Contents

Description

In Münchausen syndrome, the affected person exaggerates or creates symptoms of illnesses in themselves to gain investigation, treatment, attention, sympathy, and comfort from medical personnel. In some extreme cases, people suffering from Münchausen's syndrome are highly knowledgeable about the practice of medicine and are able to produce symptoms that result in lengthy and costly medical analysis, prolonged hospital stay and unnecessary operations. The role of "patient" is a familiar and comforting one, and it fills a psychological need in people with Münchausen's. It is distinct from hypochondriasis in that patients with Münchausen syndrome are aware that they are exaggerating, whereas sufferers of hypochondriasis believe they actually have a disease. Risk factors for developing Münchausen syndrome include childhood traumas, and growing up with caretakers who, through illness or emotional problems, were unavailable. Arrhythmogenic Münchausen syndrome describes individuals who simulate or stimulate cardiac arrhythmias to gain medical attention.[2]

A similar behavior called Münchausen syndrome by proxy has been documented in the parent or guardian of a child. The adult ensures that his or her child will experience some medical affliction, therefore compelling the child to suffer treatment for a significant portion of their youth in hospitals. Furthermore, a disease may actually be initiated in the child by the parent or guardian. This condition is considered distinct from Münchausen syndrome. In fact, there is growing consensus in the pediatric community that this disorder should be renamed "medical abuse" to highlight the real harm caused by the deception and to make it less likely that a perpetrator can use a psychiatric defense when real harm is done.[3] Parents who perpetrate this abuse are often affected by concomitant psychiatric problems like depression, spouse abuse, psychopathy, or psychosis. In rare cases, multiple children in one family may be affected either directly as victims or as witnesses who are threatened to keep them silent.

Origin of the name

The syndrome name derives from Baron Münchhausen (Karl Friedrich Hieronymus Freiherr von Münchhausen, 1720–1797) who purportedly told many fantastic and impossible stories about himself, which Rudolf Raspe later published as The Surprising Adventures of Baron Münchhausen.

In 1951, Richard Asher was the first to describe a pattern of self-harm, where individuals fabricated histories, signs, and symptoms of illness. Remembering Baron Münchhausen, Asher named this condition Münchausen's Syndrome in his article in The Lancet in February 1951,[4] quoted in his obituary in the British Medical Journal:

"Here is described a common syndrome which most doctors have seen, but about which little has been written. Like the famous Baron von Munchausen, the persons affected have always travelled widely; and their stories, like those attributed to him, are both dramatic and untruthful. Accordingly the syndrome is respectfully dedicated to the Baron, and named after him."
British Medical JournalR.A.J. Asher, M.D., F.R.C.P.[5]

Originally, this term was used for all factitious disorders. Now, however, there is considered to be a wide range of factitious disorders, and the diagnosis of "Münchausen syndrome" is reserved for the most severe form, where the simulation of disease is the central activity of the affected person's life.

Treatment and prognosis

Medical professionals or doctors suspecting Münchausen's in a patient should first rule out the possibility that the patient does indeed have a disease state but in an early stage and not yet clinically detectable. Providers need to acknowledge that there is uncertainty in treating suspected Münchausen patients so that real diseases are not under-treated.[6] Then they should take a careful patient history and seek medical records, to look for early deprivation, childhood abuse, or mental illness. If a patient is at risk to himself or herself, inpatient psychiatric hospitalization should be initiated.[7]

Medical providers or doctors should consider working with mental health specialists to help treat the underlying mood or disorder as well as to avoid countertransference.[8] Therapeutic and medical treatment should center on the underlying psychiatric disorder: a mood disorder, an anxiety disorder, or borderline personality disorder. The patient's prognosis depends upon the category under which the underlying disorder falls; depression and anxiety, for example, generally respond well to medication and/or cognitive behavioral therapy, whereas borderline personality disorder, like all personality disorders, is presumed to be pervasive and more stable over time,[9] thus offers the worst or best prognosis.

Illnesses and conditions commonly feigned by Münchausen patients

Patients may have multiple scars on abdomen due to repeated "emergency" operations. [10]

Many of these conditions do not have clearly observable or diagnostic symptoms.

See also

Notes

  1. ^ Krahn LE, Bostwick JM, Stonnington CM (2008). "Looking toward DSM-V: should factitious disorder become a subtype of somatoform disorder?". Psychosomatics 49 (4): 277–82. doi:10.1176/appi.psy.49.4.277. PMID 18621932. 
  2. ^ a b Vaglio JC, Schoenhard JA, Saavedra PJ, Williams SR, Raj SR (2010). "Arrhythmogenic Munchausen syndrome culminating in caffeine-induced ventricular tachycardia". J Electrocardiol 44 (2): 229–31. doi:10.1016/j.jelectrocard.2010.08.006. PMID 20888004. 
  3. ^ Pediatrics 2007 May 05;119:1026-1030
  4. ^ Lancet 1951 Feb 10;1(6650):339-41 doi:10.1016/S0140-6736(51)92313-6
  5. ^ "R. A. J. Asher (Obituary notice)". British Medical Journal 2 (5653): 388. 1969-05-10. doi:10.1136/bmj.2.665.388. http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1983233&pageindex=2#page. Retrieved 2008-03-20 
  6. ^ Bursztajn, H, Feinbloom RI, Hamm RM, Brodsky A. Medical Choices, medical chances: How patients, families and physicians can cope with uncertainty. New York. Delacourte/Lawrence. 1981.
  7. ^ Johnson BR, Harrison JA. Suspected Münchausen syndrome and civil commitment. J Am Acad Psychiatry Law. 2000; 28:74-76.
  8. ^ Elder W, Coletsos IC, Bursztajn HJ. Factitious Disorder/Munchhausen Syndrome. The 5-Minute Clinical Consult. 18th Edition. 2010. Editor. Domino, F.J. Wolters Kluwer/Lippincott. Philadelphia.
  9. ^ Davidson, G. et al. (2008). Abnormal Psychology - 3rd Canadian Edition. Mississauga: John Wiley & Sons Canada, Ltd.. pp. 412. ISBN 978-0-470-84072-6. 
  10. ^ AJ Giannini,HR Black. Psychiatric, Psychogenic and Somatopsychic Disorders Handbook. New Hyde Park ,NY. Medical Examination Publishing, 1978,pp.194-195. ISBN 0-87488-596-5

References

  • Feldman, Marc (2004). Playing sick?: untangling the web of Münchausen syndrome, Münchausen by proxy, malingering & factitious disorder. Philadelphia: Brunner-Routledge. ISBN 0-415-94934-3. 
  • Fisher JA (2006). "Playing patient, playing doctor: Münchausen syndrome, clinical S/M, and ruptures of medical power". The Journal of medical humanities 27 (3): 135–49. doi:10.1007/s10912-006-9014-9. PMID 16817003. 
  • Fisher JA (2006). "Investigating the Barons: narrative and nomenclature in Münchausen syndrome". Perspect. Biol. Med. 49 (2): 250–62. doi:10.1353/pbm.2006.0024. PMID 16702708. 
  • Friedel,Robert O., MD Borderline Personality Disorder Demystified, Pg 9-10, Münchausen syndrome, Münchausen syndrome by Proxy. ISBN 1-56924-456-1
  • Davidson, G. et al. (2008). Abnormal Psychology - 3rd Canadian Edition. Mississauga: John Wiley & Sons Canada, Ltd.. pp. 412. ISBN 978-0-470-84072-6. 
  • Prasad, Ashoka; Oswald, A. G. "Munchausen's syndrome:an annotation"

External links


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Look at other dictionaries:

  • Munchausen syndrome — Infobox Disease Name = Munchausen syndrome Caption = DiseasesDB = 8459 DiseasesDB mult = DiseasesDB2|33167 ICD10 = ICD10|F|68|1|f|60 ICD9 = ICD9|301.51 ICDO = OMIM = MedlinePlus = eMedicineSubj = med eMedicineTopic = 3543 eMedicine mult =… …   Wikipedia

  • Munchausen syndrome — noun syndrome consisting of feigning acute and dramatic illness for which no clinical evidence is ever found • Syn: ↑Munchausen s syndrome • Hypernyms: ↑syndrome * * * ˈmənˌchau̇zən , ˈmünˌ , ŋˌkau̇ , ŋˌḵau̇ , ˌ ̷ ̷ ˈ ̷ ̷  ̷ ̷ noun or munchausen …   Useful english dictionary

  • Munchausen syndrome — (This is an alternate entry to Munchhausen syndrome with two h s in Munchhausen. Whole medical reports have been written about the Munchausen syndrome incorrectly written with one h.) Recurrent feigning of catastrophic illnesses, a psychological… …   Medical dictionary

  • Munchausen Syndrome —    Deliberately simulating medical or surgical illness in order to be admitted to hospital for an operation is a form of malingering, unlike involuntary addiction to surgery. (See HYSTERIA: Karl Menninger describes polysurgical addiction [1934].) …   Historical dictionary of Psychiatry

  • Münchausen syndrome — (This is an alternate entry to Munchhausen syndrome. Münchhausen has an umlaut over the u but it is sometimes written as Munchhausen without the umlaut in English.) A recurrent feigning of catastrophic illnesses, a psychological disorder that is… …   Medical dictionary

  • Munchausen syndrome — /ˈmʊntʃhaʊzən ˌsɪndroʊm/ (say moonchhowzuhn .sindrohm), /ˈmʌntʃ / (say munch ) noun a syndrome in which a person pretends to be ill in order to be admitted to hospital or to obtain extensive medical investigations and treatment. Also, Munchausen… …   Australian English dictionary

  • Munchausen syndrome — noun Etymology: Baron K. F. H. von Münchhausen died 1797 German soldier and proverbial teller of exaggerated tales Date: 1951 a psychological disorder characterized by the feigning of the symptoms of a disease or injury in order to undergo… …   New Collegiate Dictionary

  • Munchausen syndrome — Psychiatry. a factitious disorder in which otherwise healthy individuals seek to hospitalize themselves with feigned or self induced pathology in order to receive surgical or other medical treatment. [1950 55; named after Baron von MÜNCHHAUSEN,… …   Universalium

  • Münchausen syndrome — noun A psychiatric disorder in which those affected feign illness or psychological trauma in order to garner attention or sympathy …   Wiktionary

  • Munchausen syndrome — disorder in which an individual pretends to have certain symptoms in order to be admitted into a hospital or undergo various medical tests …   English contemporary dictionary