Munchausen and Munchausen By Proxy Syndromes and Their Treatments

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 syndrome is a “facetious” psychological disorder named after an 18^th century officer who was known for telling exaggerated tales. Patients with Munchausen syndrome will act sick, even when they are not ill, they will create or embellish symptoms, and they can harm themselves and alter tests.¹ The patients perform these actions to get sympathy and attention. The disorder is a mental illness, known as “thick chart syndrome”, “hospital hopper syndrome”, and “hospital addiction syndrome”. Sometimes the patients are called “frequent flyers” by medical staff. 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, and their knowledge and actions can lead them to end up with operations, long hospital stays, and many costly medical examinations and tests. 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 “failed aspirations to work in the medical field”. Low self-esteem is common. This disorder is more common in younger to middle-aged adults and males.²Warning 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 similar disorder, but patients trigger the symptoms in a child 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 will deliberately mislead doctors and others about a child’s symptoms, and they may actually poison the child. Most cases of MBPS involve the mother. Professionals and loved ones give the parent sympathy and attention, and the MBPS patient feels “more important and powerful” 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. If the patient is a danger to themselves or others, psychiatric hospitalization would be warranted. Without treatment, millions of dollars can be spent on tests, treatments, and hospitalizations. Patients can become seriously ill (or trigger 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. Mental health specialists should be brought in to look at the “underlying psychiatric disorder”. These can include anxiety, mood, and borderline personality disorders. Most with depression and anxiety can be treated with cognitive behavior therapy and medication. Personality disorders have a poor prognosis as they are stable and pervasive.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.⁷