Unmasking Munchausen: Why are your patients faking illness?
Key Takeaways
Munchausen syndrome (also called factitious disorder imposed on self) is an illness which causes a person to induce, falsify, or exaggerate an illness to get sympathy or attention.
Approximately 1.3% of hospitalized patients suffer from Munchausen syndrome, and those who do are often subject to long-term psychiatric consequences as a result of self-abuse.
Standard therapeutic treatment for patients with Munchausen syndrome includes psychotherapy such as cognitive behavioral therapy.
If you’ve ever had a patient who went to great lengths to seem ill—such as harming oneself to create desired symptoms, or sabotaging medical tests—the culprit may be a rare psychological disorder known as Munchausen syndrome.
The primary goal of those who have Munchausen syndrome is to win the sympathy and attention that a truly sick person often gets. Patients with this diagnosis may deny it or become hostile when confronted about it.
At present, cognitive behavioral therapy is thought to be the most effective treatment for patients who have Munchausen syndrome.
What does Munchausen look like—and who has it?
Munchausen syndrome can manifest in several ways.
According to an article published by the Cleveland Clinic, people who have this mental disorder may “falsify, exaggerate, or induce physical, emotional, or cognitive disorders.” They achieve this through a number of deceitful and dangerous methods.[]
Patients who falsify illnesses, for instance, may pour blood into their urine to sway test results. Others who induce or exaggerate an illness may strategically injure or poison themselves to be recognized as an ill person.
Smearing feces or dirt into open wounds to catalyze an infection, burning oneself, and eating contaminated foods are also common among patients with Munchausen. (The etymological roots reference an 18th century German officer known as Baron von Munchausen, a man who reportedly embellished the stories he told about his life adventures.)
Patients with Munchausen syndrome aren’t merely trying to get out of work or score specific medications. They simply want to garner attention. There is no other “concrete benefit” to report.
The people who tend to develop Munchausen may do so as a result of childhood trauma or abandonment. The death of a loved one early in life, for example, may lead the patient to feel they weren’t taken care of.
The authors of an article published by StatPearls wrote about how this dynamic lays the groundwork for Munchausen syndrome.[]
“Through the fabrication of a medical illness, these patients are able to receive the attention and, sometimes, care within the healthcare community that they might not have had at home.”
"Of the relatively few patients who have accepted their diagnosis, [they] almost always report that their intention was to create a sense of importance and find a place of ‘belonging.’ "
— Authors, StatPearls
Prevalence and diagnostics
Munchausen syndrome affects approximately 1.3% of all hospitalized patients in the US.
An article published by Nursing Clinics of North America states that diagnosing Munchausen syndrome in patients is often a complex process due to the presentation of the illness.[] You may consider Munchausen a possibility in patients, however, if the illness they claim to have presents in an unusual way, or if treatment does little to help.
Those who do have Munchausen syndrome are subject to significant morbidity and mortality.
The self-inflicted abuse characteristic of this illness can also cause long-term psychological damage, which doctors could prevent by diagnosing and treating patients early on.
Treating Munchausen syndrome
So, what is the treatment protocol for this rare psychological disorder?
According to StatPearls, psychotherapy is the go-to treatment method. Specifically, cognitive behavioral therapy can be used to uncover and address childhood trauma that may have led to the development of Munchausen syndrome.
The tricky part of treating this syndrome often lies in the patient’s denial or hostility when confronted about their illness.
While the patient doesn’t need to admit to having a factitious disorder, you can still initiate referrals to psychiatric resources including therapy.
Outside of therapies, patients with Munchausen syndrome have not been shown to benefit from medications such as antidepressants or antipsychotics.
Above all, physicians should maintain an empathetic and supportive approach when treating patients with Munchausen syndrome. You may find evidence of other psychiatric illnesses as you get to know these patients.
What this means for you
Patients who take desperate measures to seem sick to get attention and sympathy from others likely have Munchausen syndrome. Diagnosing patients with Munchausen syndrome may be a complex process due to the nature of the illness, but research estimates about 1.3% of hospitalized patients have it. You can treat this illness by implementing cognitive behavioral therapy into the patient’s treatment regimen.