In 18th century Germany, an officer named Baron von Munchausen became well-known for exaggerating the stories of his life - from this grew the mental illness known as Munchausen Syndrome (also known as Factitious Disorder Imposed on Self). Those who suffer from this act as though they suffer from a physical, emotional, or mental disorder when the symptoms they experience are actually caused by themselves, and there is no real disorder present.
In hospital populations, it’s estimated that about 1% suffer from Munchausen syndrome; however, it’s considered to be a rare syndrome and it’s very hard to get reliable statistics, since those who have it will use different names and jump around to different hospitals (meaning some are never actually diagnosed with it). They are willing to have extensive and invasive testing to check for various disorders (and may even try to tamper with those test results to make a diagnosis possible), and will create symptoms through harming themselves.
The disorder develops from a need to gain sympathy and attention due to being ill or injured. This is not the same as faking a headache to get out of a shift - these people may not really have a concrete reason to be faking illness, and may not really even be aware of what they’re doing or why. Factitious disorder (of any kind) means the patient has severe emotional problems.
Factitious disorder extends beyond Munchausen syndrome to Munchausen syndrome by proxy, which is when the sufferer of Munchausen puts the symptoms of the fake illness/injury onto someone else (most often their children, and this is considered child abuse) to gain the same sympathy and attention.
Developing Munchausen syndrome could be a result of multiple things, similar to other mental disorders, such as:
- Feeling abandoned - whether by the death or illness of a loved one
- Childhood trauma
- Having a serious illness in childhood that resulted in attention
- Poor self-esteem or identity
- Depression or personality disorders
- Wanting to be associated with doctors, or certain medical centers
- Working in healthcare
Munchausen syndrome can develop at any age (the earliest would be young adulthood). Due to the variety of causes for the syndrome, it’s hard to say who will get it or how to prevent it.
A patient with this disorder that shows up in the hospital will most often be presenting with extreme presentation of the disorder they are trying to replicate, and have pathological lying when asked about their history, symptoms, and other information by healthcare professionals. While these patients are sometimes sent home with a “personality disorder” as the diagnosis after clinicians figure out there is not a physical illness present, it wasn’t until 1951 that the term Munchausen’s syndrome was created to better describe patients with this mental disorder.
Those diagnosed with Munchausen syndrome cause themselves injury (things like creating cyanosis on an extremity to fit a symptom of a disorder or making themselves physically ill by ingesting bacteria) and go to the hospital presenting with specific symptoms of a certain disorder. They may claim to experience other symptoms that aren’t currently present, or explain vague and irregular symptoms. They often have a lot of knowledge of about medical terms and diseases, and will be eager to undergo invasive procedures, including surgery.
They often will visit different hospitals with the same symptoms to receive care/attention while healthcare professionals attempt to make a diagnosis. As a result, many sufferers of this disorder have surgical scars and/or physical signs of frequent lab testing. As they receive attention at the hospital and from those in their life for being perceived as sick, this only increases their need to keep being “sick” to continue receiving the attention. As a result, any treatment given to help the illness they are presenting with won’t make any improvement on their condition.
Diagnosis and Treatment
People with factitious disorder can present with actual life-threatening conditions (even though they are caused by themselves), so they require real medical care. Using different doctors and visiting different hospitals, using a fake name and personal information, and lying about medical history makes it very difficult to identify someone who has the disorder.
A doctor will suspect Munchausen syndrome, or any factitious disorder, when certain things just don’t add up - the medical history doesn’t make sense (there’s no logical reason for the illness or injury), an illness follows a strange course or doesn’t respond to treatment, there are inconsistent symptoms/lab results, or the patient won’t allow access to information from previous medical records or other physicians.
From there, a doctor will assess if the patient meets the criteria for having a factitious disorder and consult with the patient further and may involve family members for extra information. Even if a formal diagnosis is reached, the patient may be resistant to treatment (since they want to remain in the role of being sick). Treatment would be conducted by a mental health professional, through therapy and possible medications.
Factitious Disorder and EMS
These patients, including those who are by proxy (so causing harm to someone else) will present with real physical symptoms that need treatment. Since EMS doesn’t focus on diagnosis, all they can do is help manage any physical symptoms and gain a detailed history from the patient.
Finding inconsistencies in the patient history when conducting a secondary assessment is something that’s important to note, along with any claims of symptoms that aren’t currently present. As always, getting detailed information is helpful for the hospital staff in treating the patient.
Sources and More Information
Cleveland Clinic, “Factitious Disorder Imposed on Self (Munchausen Syndrome)” https://my.clevelandclinic.org/health/diseases/9833-factitious-disorder-imposed-on-self-munchausen-syndrome
Mayo Clinic, “Factitious disorder” https://www.mayoclinic.org/diseases-conditions/factitious-disorder/symptoms-causes/syc-20356028
MedlinePlus, “Munchausen syndrome by proxy” https://medlineplus.gov/ency/article/001555.htm
US National Library of Medicine National Institutes of Health:
“Munchausen syndrome: Playing sick or sick player” by Jyoti Prakash, R. C. Das, K. Srivastava, P. Patra, S. A. Khan, and R. Shashikumar, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4261219/
Jenny Ewen, BA, EMT