What Is Munchausen Syndrome?

Munchausen syndrome is a rare, psychiatric disorder in which a person intentionally makes up symptoms or causes themselves to have  real symptoms in order to appear sick or take on a “sick role.” Although Munchausen syndrome is currently known as factitious (meaning false) disorder imposed on self (FDIS), many in the medical community use the term Munchausen syndrome to refer to severe, chronic, and dramatic cases.

People with Munchausen syndrome desire to appear sick, but not to receive external gains like time off from work. Instead, they are driven by internal gains such as getting more attention or emotional support. The exact cause of Munchausen syndrome is unknown. However, researchers suspect factors like feelings of abandonment or childhood trauma may increase the risk of developing the condition.

Starting treatment for Munchausen syndrome can be difficult. When a person is confronted about a suspected diagnosis, they may react with hostility or denial. However, if a person does seek treatment, psychotherapy is the standard form of treatment for Munchausen syndrome.

Symptoms

People with Munchausen syndrome falsify symptoms of any type of illness, injury, or disease. As a result, symptoms of Munchausen syndrome can vary a great deal. People with Munchausen syndrome may fake or greatly exaggerate symptoms such as:

• Chest pain
• Abdominal pain
• Vomiting
• Diarrhea
• Seizures
• Vision loss
• Skin wounds

It is common for a person with Munchausen syndrome to induce (or, bring on) symptoms on themselves on purpose by eating spoiled food, overdosing on medications, or injecting insulin. They may also edit their medical records or sabotage lab results so they appear sick or ill. 

Healthcare providers may notice other behaviors that hint at a possible Munchausen syndrome diagnosis, such as:

• Providing inconsistent symptom information or lying about symptoms altogether
• Displaying symptoms that are dramatic, out of proportion, or inconsistent with human anatomy  
• Resisting the release of their medical records
• Declining the need to contact family members to confirm medical history
• Not finding a definite diagnosis of their condition, even after proper testing 
• Having a previous medical history with several different medical conditions 

Because people with Munchausen syndrome present with a wide variety of symptoms, it can be hard for healthcare providers to confirm a diagnosis with blood work or other tests for a specific health condition. As a result, people with Munchausen syndrome may take pride in being a “medical mystery.” In such cases, a primary healthcare provider may request the support of a mental health professional to reach an accurate diagnosis.

Causes

Researchers don’t know the exact cause of Munchausen syndrome. However, they suspect a variety of mental, emotional, and social factors that may increase the risk of developing the condition, such as:

• Childhood trauma 
• Experiencing the death of a loved one at a young age
• Abandonment from a caregiver or loved one 
• Seeking attention or care that might not be felt or given at home 
• Creating a sense of importance and finding a place of belonging

Factitious disorders like Munchausen syndrome are under-identified and under-diagnosed. However, researchers have found that Munchausen syndrome is more common in women, people who are unmarried, and healthcare professionals.

Diagnosis

People with Munchausen syndrome present with a wide variety of symptoms, making it tough for healthcare providers to give an accurate diagnosis. However, healthcare providers use the following criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM) to help determine a Munchausen diagnosis:

• Falsifying or being dishonest about symptoms 
• Self-inducing symptoms of an injury or disease 
• Displaying symptoms of being ill, injured, or impaired
• Having an existing mental health condition that does not explain deceptive behaviors
• Not recognizing an external motivation or reward for lying about one’s health 
• Experiencing recurring episodes of misleading or false actions 

If a healthcare provider suspects Munchausen syndrome, they may not directly or immediately confront a person’s symptoms or even offer a diagnosis. Instead, healthcare providers may focus their efforts on learning more about any deceptive behaviors or trying to find the cause of someone’s self-reported symptoms. They can do this by: 

• Ordering lab work that shows symptoms are false (e.g., a stool sample for someone saying they have diarrhea) 
• Looking for methods that may show that a person is inducing their own symptoms—such as using sedatives, laxatives, or blood pressure medications
• Recognizing a person’s eagerness to undergo extensive lab work or invasive procedures
• Understanding a person’s reaction when they are told they are going to be discharged from the hospital—usually because those with Munchausen syndrome have a desire to stay in the care of a provider 

Treatment

If you or a loved one are living with Munchausen syndrome, you or they may find it difficult to start treatment for a few reasons. If a healthcare provider confronts you or a loved one about a suspected diagnosis, you or they may refuse to acknowledge the provider’s observations. Lack of acknowledgment, hostility, denial, threatening a lawsuit, or seeking care with a different hospital system are common reactions to the news—and that’s OK.

However, providers are there to help you get the treatment you need. Treatment for Munchausen syndrome requires a team of healthcare providers such as a psychiatrist, psychologist, primary care provider, social worker, and nursing staff. Healthcare providers and your family members can help you develop insight into your behaviors and support you in your recovery.

The main goal of treatment is to reduce the urge to fake symptoms and lower the risks and costs related to unnecessary treatment and diagnostic tests. Psychotherapy is the standard therapy for Munchausen syndrome. If your healthcare provider suspects childhood trauma is related to your case of Munchausen syndrome, they may recommend treatment with targeted cognitive behavior therapy and trauma healing techniques.

Treatment with antidepressants or anti-psychotic medications shows no benefit in treating the Munchausen syndrome itself. However, selective serotonin reuptake inhibitors (SSRIs) have been used to treat impulsive urges, such as faking symptoms.

How to Prevent Munchausen Syndrome

There is no way to prevent Munchausen syndrome. However, there are ways to slowly reduce symptoms and behaviors related to the condition. 

It’s important to avoid seeking care from multiple healthcare providers, emergency rooms, or different hospital systems. This helps your primary care provider keep a cohesive track of your medical history, records, and symptoms. If your healthcare provider suspects Munchausen syndrome based on your medical records, this will help:

• Avoid unnecessary tests or procedures
• Speed up the diagnosis process
• Start treatment sooner 

When confronted about a possible Munchausen diagnosis, people with the condition deny their behaviors and try to seek care at a different medical care facility. If your or your loved one’s healthcare provider talks to you about a suspected diagnosis, it’s important to resist the urge to change providers and accept treatment for Munchausen syndrome. Keep in mind: this is easier said than done, but that’s why emotional support from loved ones is crucial with this condition.

Comorbid Conditions

People living with factitious disorders like Munchausen may often experience comorbid conditions (or, conditions that occur at the same time as Munchausen syndrome). These conditions may include:

• Depression
• Anxiety
• Substance use disorders
• Personality disorders 

Living With Munchausen Syndrome

Most people living with Munchausen syndrome are not willing to admit they falsify, exaggerate, or induce their own symptoms of illness or injury. As a result, they might undergo unnecessary lab and imaging tests, hospital stays, and surgical procedures so their healthcare provider can learn the root cause of their symptoms. This can lead to financial or legal trouble.

If they’re able to induce symptoms through harmful methods, people with Munchausen syndrome may cause significant disability or mortality to themselves. In some cases, this can even lead to an inaccurate diagnosis or cause irreversible harm.

Most people with Munchausen syndrome deny a possible diagnosis and refuse related treatment. Of those who do accept a diagnosis and start therapy, most drop out of treatment after some time. However, research shows that people living with Munchausen syndrome who engage in long-term therapy do have better health outcomes.