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Munchausen Syndrome

Munchausen syndrome

Definition

Munchausen syndrome is a psychiatric disorder that causes an individual to self-inflict injury or illness or to fabricate symptoms of physical or mental illness in order to receive medical care or hospitalization . In a variation of the disorder, Munchausen by proxy (MSBP), an individual, typically a mother, intentionally causes or fabricates illness in a child or other person under her care.

Description

Munchausen syndrome takes its name from Baron Karl Friederich von Munchausen, an eighteenth century German military man known for his tall tales. The disorder first appeared in psychiatric literature in the early 1950s when it was used to describe patients who sought hospitalization by inventing symptoms and complicated medical histories, and/or inducing illness and injury in themselves. Categorized as a factitious disorder (a disorder in which the physical or psychological symptoms are under voluntary control), Munchausen syndrome seems to be motivated by a need to assume the role of a patient. Unlike malingering, there does not seem to be any clear secondary gain (e.g., money) in Munchausen syndrome.

Individuals with Munchausen by proxy syndrome use their child (or another dependent person) to fulfill their need to step into the patient role. The disorder most commonly victimizes children from birth to eight years old. Parents or caregivers with MSBP may only exaggerate or fabricate their child's symptoms, or they may deliberately induce symptoms through various methods, including poisoning , suffocation, starvation, or introducing bacteria into open wounds . They often display an extraordinary depth of medical knowledge and may even be in the medical profession themselves.

Demographics

Both Munchausen syndrome and Munchausen syndrome by proxy are thought to be rare, but there are no solid statistics on the frequency of either diagnosis. Data on Munchausen syndrome in children and adolescents specifically are very limited. In 2000 one review found that among the 42 cases reported in the medical literature, 71 percent were female and the mean age was 14 years of age. Children age 14 and younger were more likely to admit to falsifying symptoms when confronted than those between the ages of 15 and 18.

Munchausen syndrome by proxy is also hard to quantify due to the number of undetected or undiagnosed cases. The incidence of the condition in the United States is not known, but a 1996 study of children in Ireland and the United Kingdom estimated that Munchausen syndrome by proxy occurred annually in 0.5 of every 100,000 children under age 16, and in 2.8 of every 100,000 children under the age of one.

Causes and symptoms

The exact cause of Munchausen syndrome is unknown. It has been theorized that Munchausen patients are motivated by a desire to be cared for, a need for attention, dependency, an ambivalence toward doctors, or a need to suffer. Factors that may predispose an individual to Munchausen include a serious illness in childhood or an existing personality disorder. Some research indicates that children and adolescents who develop Munchausen syndrome are more likely to have been previous victims of Munchausen syndrome by proxy.

The Munchausen and Munchausen by proxy patient can appear to have a wide array of physical or psychiatric symptoms, usually limited only by their (or their caregiver's) medical knowledge. Many Munchausen patients are very familiar with medical terminology and symptoms. Some common complaints include fevers, rashes , abscesses, bleeding, and vomiting . Common Munchausen by proxy symptoms include apnea (cessation of breathing), fever , vomiting, and diarrhea . In both Munchausen and MSBP syndromes, the suspected illness does not respond to a normal course of treatment, and diagnostic tests turn up nothing out of the ordinary. Patients or parents may push for invasive procedures and display an extraordinary depth of knowledge of medical therapies.

Diagnosis

Because Munchausen sufferers often go from doctor to doctor, gaining admission into many hospitals along the way, diagnosis can be difficult. They are typically detected rather than diagnosed. During a course of treatment, they may be discovered by a hospital employee who encountered them during a previous hospitalization. Their caregivers may also notice that symptoms such as high fever occur only when the patient is left unattended. Occasionally, medication used to induce symptoms is found with the patient's belongings. When the patient is confronted, they often react with outrage and check out of the hospital to seek treatment at another facility with a new caregiver.

A diagnosis of Munchausen syndrome may be even more difficult in children and adolescents. A physician may be able to recognize a pattern of symptoms (e.g., those that occur only when the child is alone or that begin only when the parent is present with the child) or the child may admit to fabricating or self-inflicting symptoms upon questioning. Surveillance video may record the child or the child's caregiver inducing symptoms.

Treatment

There is no clearly effective treatment for Munchausen syndrome. Extensive psychotherapy may be helpful with some Munchausen patients. If Munchausen syndrome coexists with other mental disorders, such as a personality disorder, the underlying disorder is typically treated first. Children who develop the syndrome may respond more favorably to therapy than adults, particularly if they are diagnosed at an early age.

Children who are victims of Munchausen syndrome by proxy are usually removed from the offending caregiver immediately and placed in protective custody. Therapy may also be beneficial to these children in recovering from the emotional trauma of MSBP.

Prognosis

The infections and injuries Munchausen patients self-inflict can cause serious illness. Patients often undergo countless unnecessary surgeries throughout their lifetimes. In addition, because of their frequent hospitalizations, they have difficulty holding down a job. Further, their chronic health complaints may damage interpersonal relationships with family and friends.

Children victimized by sufferers of MSBP are at a real risk for serious injury and possible death. A UK study published in 1998 found that although the majority of children with MSBP studied (90 percent) were placed in child protection care at diagnosis, at two-year follow up the number had fallen to 32 percent. A reported 17 percent of children who were victims of MSBP and who were eventually returned to an abusive caregiver suffered further abuse. Those who survive physically unscathed may suffer developmental and emotional problems.

Prevention

Because the cause of Munchausen syndrome is unknown, formulating a prevention strategy is difficult. Some medical facilities and healthcare practitioners have attempted to limit hospital admissions for Munchausen patients by sharing medical records. While these attempts may curb the number of hospital admissions, they do not treat the underlying disorder and may endanger Munchausen sufferers that have made themselves critically ill and require treatment. Children who are found to be victims of persons with Munchausen by proxy syndrome should be immediately removed from the care of the abusing parent or guardian.

KEY TERMS

Apnea The temporary absence of breathing. Sleep apnea consists of repeated episodes of temporary suspension of breathing during sleep.

Factitious disorder A mental condition in which symptoms are deliberately manufactured by patients in order to gain attention and sympathy. Patients with factitious diseases do not fake symptoms for obvious financial gain or to evade the legal system.

Malingering Pretending to be sick in order to be relieved of an unwanted duty or obtain some other obvious benefit.

Parental concerns

Parents who suspect that their child may be deliberately hurting themselves or falsifying symptoms should contact their pediatrician immediately for assessment. Children who are thought to pose potentially life-threatening danger to themselves may require hospitalization, and a referral to a child psychologist or therapist will be necessary. It is important to remember that properly treating the condition requires addressing the motives and emotions behind the disorder, not simply punishing the behavior.

Resources

BOOKS

Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR). Washington, DC: American Psychiatric Press Inc., 2000.

Feldman, Marc. Playing Sick?: Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder. New York: Brunner-Routledge, 2004.

Mart, Eric G. Munchausen's Syndrome by Proxy Reconsidered. Manchester, NH: Bally Vaughn, 2002.

PERIODICALS

Libow, Judith. "Child and Adolescent Illness Falsification." Pediatrics 105, no. 2 (February 2000): 336.

Schreier, Herbert. "Munchausen by Proxy Defined." Pediatrics 110, no. 5 (November 2002): 985.

ORGANIZATIONS

American Psychiatric Association. 1000 Wilson Blvd., Suite 1825, Arlington, VA 22209. Web site: <www.psych.org>.

American Psychological Association (APA). 750 First St. NE, Washington, DC 200024242. Web site: <www.apa.org>.

National Alliance for the Mentally Ill (NAMI). Colonial Place Three, 2107 Wilson Blvd., Ste. 300, Arlington, VA 222013042. Web site: <www.nami.org>.

National Institute of Mental Health (NIMH). Office of Communications, 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 208929663. Web site: <www.nimh.nih.gov>.

Paula Ford-Martin

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"Munchausen Syndrome." Gale Encyclopedia of Children's Health: Infancy through Adolescence. . Encyclopedia.com. 22 Aug. 2017 <http://www.encyclopedia.com>.

"Munchausen Syndrome." Gale Encyclopedia of Children's Health: Infancy through Adolescence. . Encyclopedia.com. (August 22, 2017). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/munchausen-syndrome

"Munchausen Syndrome." Gale Encyclopedia of Children's Health: Infancy through Adolescence. . Retrieved August 22, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/munchausen-syndrome

Munchausen Syndrome by Proxy

Munchausen Syndrome by Proxy


Munchausen Syndrome by Proxy (MSbP) is the name that has been given to a situation in which one person fabricates an illness in a second person and presents the second person to a doctor. The term was first used in the title of an article by Roy Meadow, a professor of pediatrics (Meadow 1977). MSbP has usually been used to refer to a situation involving a mother and child. Other adults, occasionally the father, have been reported to fabricate illnesses in a child under their care.

There has been controversy about MSbP, including usage of the term. MSbP refers to a situation comprising behaviors and psychological states of the fabricator, a victim, and a medical professional in a triadic interaction. MSbP is not a psychiatric diagnosis applicable to the fabricator, although many reports indicate consistent findings regarding the psychology of fabricators.

Recognition of fabrication is usually made by the doctor following bewilderment at the medical presentation, which may be one of a series of similar presentations. Following strong suspicion or confirmation of MSbP, multidisciplinary action under local child protection procedures is usually appropriate, with the paramount task being to ensure the health and safety of the child.

A psychiatrist or a clinical psychologist will usually carry out a detailed assessment of the fabricator. The importance of consulting the health records of the fabricator (as well as the victim and siblings) and meeting with reliable relatives or friends of the fabricator who will act as informants cannot be over-emphasized.

The fabricator psychopathology (abnormal psychology) has been found to range in type and severity across a spectrum. Usually there will have been a history of presentations of physical symptoms, which are the result of a somatizing process (a tendency to experience emotional problems as physical symptoms detached from the emotional aspect of the problem). This may be extreme as in chronic factitious disorder (sometimes known as Munchausen's Syndrome, as described by Richard Asher in 1951) in which the adult lives a life centered around the fabrication of illness and gaining access to hospitals. In some cases the fabricator has been found to have a history of criminal behavior (especially involving deception, such as fraud), repeated self-harm, or misuse of medications or alcohol (Bools et al. 1994). The diagnosis made by a psychiatrist will often be of a personality disorder.

The child victim of MSbP may come to serious physical harm if, as part of the fabrication, physical signs of illness are actually caused in the child. Many methods of such illness induction have been reported: smothering to produce fits, poisoning to produce drowsiness or diarrhea, and abrading skin. Clearly such action constitutes physical child abuse. In situations in which illness is fabricated in the child without direct physical harm, the child may undergo medical investigations and procedures, such as surgery or toxic medications, so that in the end some physical harm results. In the absence of physical harm the child is likely to suffer psychological harm, including the effect of substantial school nonattendance (Bools et al. 1993). The relationship between the mother and child is usually highly pathological with the attachment needs of the child not being met, resulting in emotional and behavioral disturbance as well as the risk of abnormal personality development. The actions of the mother are likely to constitute some degree of emotional (psychological) child abuse.

Teresa Parnell (1998) noted that the majority of the fabricators gave histories consistent with emotional, physical, or sexual abuse in their own childhoods, which, together with constitutional factors, are likely to be important in the development of the abnormal relationship with the child and the eventual fabrication. Moreover, the husbands/partners of fabricating mothers typically reported minimal involvement in family life. The distance between the partners may be emotional, physical, or both, and when the mother is over-involved with the child, the father becomes peripheral in the family system. This situation allows the mother to develop the fabricated illness in the child with little challenge—or even knowledge—of the father. Therefore, using a family systems perspective, treatment will require therapeutic work with both parents, later including the child victim, to complement the individual treatments. One aspect of the treatment is likely to include work to bring the father and child(ren) closer, improve the emotional environment for the child, and increase the protective role of the father.

In a number of cases, psychiatric treatment of fabricators has been successful enough to allow the rehabilitation of the fabricator as a caregiver of the child (Berg and Jones 1999). Important aspects in the assessment in this respect are the acknowledgement of the fabricating behavior and its impact on the child victim, and a capacity to tolerate an intensive psychotherapeutic treatment regime. Unfortunately, in many cases treatment was not found to be possible.

Most reports of MSbP have come from English-speaking countries; however, reports from non-English-speaking countries are growing in number (Brown and Feldman 2001). An estimate of incidence of MSbP in the United Kingdom—based on an epidemiological study—was at least 0.5 per 100,000 of children under sixteen years of age, and at least 2.8 per 100,000 of children ages under one year (McClure et al. 1996). There are no epidemiological data available from other countries.

See also:Child Abuse: Psychological Maltreatment; Child Abuse: Sexual Abuse; Child Abuse: Physical Abuse and Neglect; Developmental Psychopathology; Therapy: Family Relationships


Bibliography

asher, r. (1951). munchausen's syndrome. the lancet 1:339–341.

berg, b., and jones, d. p. h. (1999). "outcome of psychiatric intervention in factitious illness by proxy (munchausen's syndrome by proxy)." archives of disease in childhood 81:465–472.

bools, c. n. (1993). "follow up of victims of fabricated illness (munchausen syndrome by proxy)." archives of disease in childhood 69:625–630.

bools, c. n.; neale, b. a.; and meadow, s. r. (1994). "munchausen syndrome by proxy: a study of psychopathology." child abuse and neglect 18:773–788

brown, r., and feldman, m. (2001). "international perspectives on munchausen syndrome by proxy." in munchausen's syndrome by proxy: current issues in assessment, treatment and research, ed. g. adshead and d. brooke. london: imperial college press.

meadow, s. r. (1977). "munchausen syndrome by proxy: the hinterland of child abuse." lancet 2:343–345

mcclure, l. j.; davis, p. m.; meadow, s. r.; and sibert, j. r. (1996). "epidemiology of munchausen syndrome by proxy, non-accidental poisoning and non-accidental suffocation." archives of disease in childhood 75:57–61.

parnell, t. f. (1998). "guidelines for identifying cases." in munchausen by proxy syndrome: misunderstood child abuse, ed. t. f. parnell and d. o. day. thousand oaks, ca: sage publications.

CHRISTOPHER N. BOOLS

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Munchausen Syndrome

Munchausen Syndrome

Definition

Munchausen syndrome is a psychiatric disorder that causes an individual to self-inflict injury or illness or to fabricate symptoms of physical or mental illness, in order to receive medical care or hospitalization. In a variation of the disorder, Munchausen by proxy (MSBP), an individual, typically a mother, intentionally causes or fabricates illness in a child or other person under her care.

Description

Munchausen syndrome takes its name from Baron Karl Friederich von Munchausen, an 18th century German military man known for his tall tales. The disorder first appeared in psychiatric literature in the early 1950s when it was used to describe patients who sought hospitalization by inventing symptoms and complicated medical histories, and/or inducing illness and injury in themselves. Categorized as a factitious disorder (a disorder in which the physical or psychological symptoms are under voluntary control), Munchausen's syndrome seems to be motivated by a need to assume the role of a patient. Unlike malingering, there does not seem to be any clear secondary gain (e.g., money) in Munchausen syndrome.

Individuals with Munchausen by proxy syndrome use their child (or another dependent person) to fulfill their need to step into the patient role. The disorder most commonly victimizes children from birth to 8 years old. Parents with MSBP may only exaggerate or fabricate their child's symptoms, or they may deliberately induce symptoms through various methods, including poisoning, suffocation, starvation, or infecting the child's bloodstream.

Causes and symptoms

The exact cause of Munchausen syndrome is unknown. It has been theorized that Munchausen patients are motivated by a desire to be cared for, a need for attention, dependency, an ambivalence toward doctors, or a need to suffer. Factors that may predispose an individual to Munchausen's include a serious illness in childhood or an existing personality disorder.

The Munchausen patient presents a wide array of physical or psychiatric symptoms, usually limited only by their medical knowledge. Many Munchausen patients are very familiar with medical terminology and symptoms. Some common complaints include fevers, rashes, abscesses, bleeding, and vomiting. Common Munchausen by proxy symptoms include apnea (cessation of breathing), fever, vomiting, and diarrhea. In both Munchausen and MSBP syndromes, the suspected illness does not respond to a normal course of treatment. Patients or parents may push for invasive diagnostic procedures and display an extraordinary depth of knowledge of medical procedures.

Diagnosis

Because Munchausen sufferers often go from doctor to doctor, gaining admission into many hospitals along the way, diagnosis can be difficult. They are typically detected rather than diagnosed. During a course of treatment, they may be discovered by a hospital employee who encountered them during a previous hospitalization. Their caregivers may also notice that symptoms such as high fever occur only when the patient is left unattended. Occasionally, unprescribed medication used to induce symptoms is found with the patient's belongings. When the patient is confronted, they often react with outrage and check out of the hospital to seek treatment at another facility with a new caregiver.

Treatment

There is no clearly effective treatment for Munchausen syndrome. Extensive psychotherapy may be helpful with some Munchausen patients. If Munchausen syndrome co-exists with other mental disorders, such as a personality disorder, the underlying disorder is typically treated first.

KEY TERMS

Apnea A cessation of breathing.

Factitious disorder A disorder in which the physical or psychological symptoms are under voluntary control.

Prognosis

The infections and injuries Munchausen patients self-inflict can cause serious illness. Patients often undergo countless unnecessary surgeries throughout their lifetimes. In addition, because of their frequent hospitalizations, they have difficulty holding down a job. Further, their chronic health complaints may damage interpersonal relationships with family and friends. Children victimized by sufferers of MSBP are at a real risk for serious injury and possible death. Those who survive physically unscathed may suffer developmental problems later in life.

Prevention

Because the cause of Munchausen syndrome is unknown, formulating a prevention strategy is difficult. Some medical facilities and healthcare practitioners have attempted to limit hospital admissions for Munchausen patients by sharing medical records. While these attempts may curb the number of hospital admissions, they do not treat the underlying disorder and may endanger Munchausen sufferers that have made themselves critically ill and require treatment. Children who are found to be victims of persons with Munchausen by proxy syndrome should be immediately removed from the care of the abusing parent or guardian.

Resources

ORGANIZATIONS

American Psychiatric Association. 1400 K Street NW, Washington DC 20005. (888) 357-7924. http://www.psych.org.

American Psychological Association (APA). 750 First St. NE, Washington, DC 20002-4242. (202) 336-5700. ttp://www.apa.org.

National Alliance for the Mentally Ill (NAMI). Colonial Place Three, 2107 Wilson Blvd., Ste. 300, Arlington, VA 22201-3042. (800) 950-6264. http://www.nami.org.

National Institute of Mental Health. Mental Health Public Inquiries, 5600 Fishers Lane, Room 15C-05, Rockville, MD 20857. (888) 826-9438. http://www.nimh.nih.gov.

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Munchausen Syndrome

Munchausen Syndrome

How Did Munchausen Syndrome Get Its Name?

What Are the Signs of the Disorder?

What Causes Munchausen Syndrome?

Diagnosis and Treatment

Munchausen Syndrome by Proxy

Resource

Munchausen (MUNCH-how-zen) syndrome is a mental disorder in which a person pretends to be physically ill or produces the symptoms of illness in order to take on the role of a patient. In recent years, the condition has been classified as a factitious* disorder by the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders. Factitious disorders include pretending to be mentally ill.

* factitious
means false. In this case it refers to an impression of illness produced falsely.

KEYWORDS

for searching the Internet and other reference sources

Hypochondria

Malingering

Somatoform disorders

How Did Munchausen Syndrome Get Its Name?

The disorder is named for Karl Friedrich Hieronymus, Baron von Münchausen (17201797), a German nobleman, soldier, and huntsman who was known for making up exaggerated stories of his exploits and adventures. The disorder itself was not recognized and fully described until the twentieth century, however, when the simpler form of the name, Munchausen, was applied to it.

What Are the Signs of the Disorder?

There are a great many symptoms that may be faked or produced in Munchausen syndrome. For example, a person may complain of abdominal pain, fever, rashes, bleeding, irregular heartbeat, dizziness, fainting spells, or seizures. These symptoms may appear to be signs of such disorders as appendicitis*, dermatitis*, anemia*, a heart problem, or a brain tumor, even though the person never actually had the symptoms they complained of.

* appendicitis
(a-pen-di-SY-tis) is a painful inflammation of the appendix, a small organ that branches off the large intestine.
* dermatitis
is a skin condition characterized by a red, itchy rash. It may occur when the skin comes in contact with something to which it is sensitive.
* anemia
is a blood disorder in which there are too few red blood cells to carry oxygen throughout the body. This condition can make a person weak and dizzy.

People with Munchausen syndrome often are very knowledgeable about medicine and hospitals. They may pretend to have a disease by complaining of a symptom, such as pain, that they do not have. Sometimes they exaggerate or imitate a disorder, such as seizures, that they really do have. Some people may actually injure themselves to create a symptom. For example, they may make themselves bleed to produce anemia. They also may describe an elaborate but false medical history to their physicians and demand medical tests and treatment with drugs or even operations. If the faking of people with Munchausen syndrome is discovered and they are denied treatment, they may start all over again, attempting to fool another doctor at another hospital. In some cases, this process may be repeated throughout a persons life.

What Causes Munchausen Syndrome?

The basic cause for the behavior of people with Munchausen syndrome is believed to be an intense need for care and sympathy. Why people with the disorder have this driving need differs for each person. Often, the disorder begins in early adulthood, after hospitalization for a true medical condition. Other influencing factors may include an important past relationship with a physician, medical employment, or even ill will harbored toward the medical profession.

Diagnosis and Treatment

The two main tasks for a physician diagnosing Munchausen syndrome are to determine that the patient does not really have the illness that the symptoms suggest and that he or she is not malingering. Malingering means that a person is pretending to have an illness because of some life situation, such as wanting to avoid military duty, work, or school.

Munchausen syndrome is treated with psychotherapy. The therapist attempts to help patients understand why they have an excessive need for sympathy, care, and attention. Therapists also help patients find more honest and less destructive ways to satisfy their emotional needs. In the meantime, attempts are made to protect the patient from having unnecessary operations or other medical procedures.

Munchausen Syndrome by Proxy

A variation of Munchausen syndrome, called Munchausen syndrome by proxy, occurs when a caregiver (often the mother) falsely claims that a child is ill. (By proxy means acting as a substitute for another.) The caregiver may either pretend that the child is ill or do something to cause a symptom or illness. For example, she may give the child too much of a laxative, causing diarrhea. Sometimes, causing illness may seriously harm the child or even result in death.

It is believed that people with Munchausen syndrome by proxy seek to gain attention as devoted caregivers rather than for being sick patients, as in Munchausen syndrome. They often have troubled marriages or may have suffered some type of abuse as a child. Munchausen syndrome by proxy is considered a form of child abuse, and in most states suspicion of this disorder must be reported to a child protective agency.

See also

Abuse

Conversion Disorder

Hypochondria

Malingering

Somatoform Disorders

Resource

Organization

Selfhelp Magazine. This on-line magazine contains an article on factitious disorder (Munchausen syndrome) that describes a case and discusses treatment. http://www.shpm.com/articles/chronic/factit.html

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Munchausen's syndrome

Munchausen's syndrome (muunch-how-zĕnz) n. a mental disorder in which the patient persistently tries to obtain invasive hospital treatment, especially surgery, for an illness that is nonexistent. M. s. by proxy (MSP) a condition in which the patient inflicts harm on others (often children) in order to attract medical attention. [ Baron von Munchausen, a fictional character who told exaggerated stories]

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