Munchausen and Munchausen By Proxy Syndromes and Their Treatments

The Munchausen and Munchausen by proxy syndromes are psychological disorders that are medically and financially costly. They can be lethal to the patient or others in their care.

What is Munchausen Syndrome?

Munchausen and Munchausen by proxy syndromes are psychological disorders that are very costly to the patient, both medically and financially. They can be lethal to the patient or even to others who are in their care. Munchausen syndrome is a “facetious” psychological disorder which was named after an 18^th century officer who was known for a reputation of telling exaggerated tales. Patients with Munchausen syndrome will act as though they are sick, even when they are not actually ill. They will create or embellish their imaginary symptoms, and they could even harm themselves and alter tests.¹ The patients perform these actions in order to receive sympathy and attention.

The disorder is not a physical but a mental illness. It might also be known as “thick chart syndrome”, “hospital hopper syndrome”, and “hospital addiction syndrome”. The medical staff of the healthcare establishments which the patients frequently visit sometimes refer to them as “frequent flyers”. Munchausen syndrome sufferers have a history of repeat hospitalization, and they may have elaborate tales about past experiences. Many of the patients are very experienced with medicine and symptoms. Their knowledge and actions can lead them to end up with undergoing unnecessary operations, remaining for extended hospital stays, and participating in many costly medical examinations and tests.

Possible Causes

Unlike hypochondria or somatoform disorders, Munchausen patients intentionally produce symptoms. Growing up, patients may have had traumatic childhoods, emotionally unavailable parents, and possibly sick parents or a serious childhood illness. Some patients may have had aspirations to work in the field of medicine which ultimately failed. Low self-esteem is common among patients who have Munchausen syndrome. This disorder is generally more of a common occurrence in younger to middle-aged adults and males.²

Warning Signs

Warning signs of Munchausen syndrome include unclear symptoms that worsen under treatment, predictable relapses following improvement, inconsistent and dramatic medical history, multiple surgical scars and extensive textbook knowledge of medicine, new symptoms after negative tests, symptoms appearing only when under observation, frequently changing hospitals, and reluctance to allow doctors to talk with family or former practitioners.³

What is Munchausen by Proxy (MSbP/MSP/MBPS)?

Munchausen by proxy (MBPS) is a disorder which is similar and related to Munchausen syndrome, but patients trigger the symptoms in a child who is in their care instead. The child receives medical attention, but the caretaker is really performing a form of “medical abuse” on the child. Parents and guardians with this disorder may also have suffered from spousal abuse, depression, psychosis, or psychopathy.⁴ The adult who is the caretaker of the child will deliberately mislead doctors and others about a child’s symptoms. They may actually poison the child in order to produce symptoms.

Most cases of MBPS involve the mother’s negative influence over the child. Professionals and loved ones give the parent sympathy and attention for what they have been tricked into believing is a parent caring for their sick child. Because of this, the MBPS patient feels that they are put in a position of greater power and importance than the people they are deceiving. The more medical knowledge the caregiver has, the harder it is to diagnose MBPS. Preschoolers are the most common age range of the victims.⁵

Treatments Available

Once it has been determined that the patient does not have an undetected disease, doctors will need to look at the medical, social, and psychological history of the patient. They need to work quickly to determine whether the illness of the patient has been faked in order to begin to take the proper actions. If the patient is a danger to themselves or others, especially if there is a child in the patient’s care, then this would warrant psychiatric hospitalization. Without treatment, millions of dollars can be spent on unnecessary tests, treatments, and hospitalizations. Patients can actually become seriously ill (or trigger previously nonexistent illness in their child) by using blood thinners, laxatives, or bacterial injections. They may reopen wounds and cut or burn the skin. Patients (and victims) could lose organs, limbs, or their lives if Munchausen syndromes are allowed to continue for too long.

Mental health specialists should be brought in to look at the underlying psychiatric disorder that the patient is likely suffering from. These can include anxiety, mood, and borderline personality disorders. Most patients who have depression and anxiety can be treated with cognitive behavior therapy and medication. Personality disorders have a poor prognosis as they are stable and pervasive. The patient’s spouse and home life should also be examined, in case there is an additional factor contributing to the disorder there.⁶ Victims who survive MBPS can also have psychological damage that will need to be treated in addition to the serious (and possibly permanent) medical harm. Patients might need to continue seeking therapy regularly in order to avoid falling into a relapse and causing further harm to themselves or others.⁷