Munchausen Syndrome

Baron von Munchausen was a german nobleman who lived from 1720 to 1797. He fought with the Russian army against the Turks where he had a lot of unbelievable stories to tell. This stories were collected by Rudolf Erich Raspe which he put in a book called 'The surprising adventures of baron Munchausen'. The stories in this book were even more unbelievable than the stories the baron told himself.

The stories told that the baron could do amazing things like flying with cannonballs, horse riding on a split-in-two- horse, turn some hungry wolves inside-out and pull himself out of a swamp with his own hair.

In 1951, Richard Asher was the first to describe a pattern of self-harm, where individuals fabricated histories, signs, and symptoms of illness. Remembering Baron Münchausen, Asher named this condition Münchausen's Syndrome in his article in The Lancet in February 1951,[1] quoted in his obituary in the British Medical Journal:

"Here is described a common syndrome which most doctors have seen, but about which little has been written. Like the famous Baron von Münchausen, the persons affected have always travelled widely; and their stories, like those attributed to him, are both dramatic and untruthful. Accordingly the syndrome is respectfully dedicated to the Baron, and named after him."
-British Medical Journal, R.A.J. Asher, M.D., F.R.C.P.[2]

Originally, this term was used for all factitious disorders. Now, however, there is considered to be a wide range of factitious disorders, and the diagnosis of "Münchausen syndrome" is reserved for the most severe form, where the simulation of disease is the central activity of the affected person's life.

Munchausen syndrome is a type of factitious disorder, or mental illness, in which a person repeatedly acts as if he or she has a physical or mental disorder when, in truth, they have caused the symptoms. People with factitious disorders act this way because of an inner need to be seen as ill or injured, not to achieve a concrete benefit, such as financial gain. They are even willing to undergo painful or risky tests and operations in order to get the sympathy and special attention given to people who are truly ill. Munchausen syndrome is a mental illness associated with severe emotional difficulties.

People with this syndrome deliberately produce or exaggerate symptoms in several ways. They might lie about or fake symptoms, hurt themselves to bring on symptoms, or alter diagnostic tests (such as contaminating a urine sample). Possible warning signs of Munchausen syndrome include the following:

* Dramatic but inconsistent medical history
* Unclear symptoms that are not controllable and that become more severe or change once treatment has begun
* Predictable relapses following improvement in the condition
* Extensive knowledge of hospitals and/or medical terminology, as well the textbook descriptions of illnesses
* Presence of multiple surgical scars
* Appearance of new or additional symptoms following negative test results
* Presence of symptoms only when the patient is alone or not being observed
* Willingness or eagerness to have medical tests, operations, or other procedures
* History of seeking treatment at numerous hospitals, clinics, and doctors offices, possibly even in different cities
* Reluctance by the patient to allow health care professionals to meet with or talk to family, friends, or prior health care providers
* Problems with identity and self-esteem

The exact cause of Munchausen syndrome is not known, but researchers believe both biological and psychological factors play a role in the development of this syndrome. Some theories suggest that a history of abuse or neglect as a child, or a history of frequent illnesses requiring hospitalisation might be factors associated with the development of this syndrome. Researchers also are studying the possible link with personality disorders, which are common in individuals with Munchausen syndrome.

There are no reliable statistics regarding the number of people in the United States who suffer from Munchausen syndrome, but it is considered to be rare. Obtaining accurate statistics is difficult because of dishonesty in representation. In addition, people with Munchausen syndrome tend to seek treatment at many different health care facilities, which causes misleading statistics.

While Munchausen syndrome can occur in children, it most often affects young adults.

Diagnosing Munchausen syndrome is very difficult because of the dishonesty that is involved. Doctors must rule out any possible physical and mental illnesses, and often use a variety of diagnostic tests and procedures before considering a diagnosis of Munchausen syndrome.

If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist -- mental health professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use a thorough a medical history and physical, laboratory imagery, and psychological assessment tools to evaluate a person for Munchausen syndrome. The doctor bases his or her diagnosis on the exclusion of actual physical or other mental illness, and his or her observation of the patient's attitude and behaviour.

Questions to be answered include:

* Do the patient's reported symptoms make sense in the context of all test results and assessments?
* Do we have collateral information from other sources that confirm the patient's information? (If the patient does not allow this, this is a helpful clue.)
* Is the patient willing to take the risk for more procedures and tests than you would expect?
* Are treatments working in a predictable way.

The doctor then determines if the patient's symptoms point to Munchausen syndrome as outlined in the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition (DSM-IV), which is the standard reference book for recognised mental illnesses in the United States.

Although a person with Munchausen syndrome actively seeks treatment for the various disorders he or she invents, the person often is unwilling to admit to and seek treatment for the syndrome itself. This makes treating people with Munchausen syndrome very challenging, and the outlook for recovery poor.

When treatment is sought, the first goal is to modify the person's behaviour and reduce his or her misuse or overuse of medical resources. Once this goal is met, treatment aims to work out any underlying psychological issues that might be causing the person's behaviour or help them find solutions to housing or other social needs.

As with other factitious disorders, the primary treatment for Munchausen syndrome is psychotherapy (a type of counseling). Treatment likely will focus on changing the thinking and behaviour of the individual (cognitive-behavioural therapy). Family therapy also might be helpful in teaching family members not to reward or reinforce the behaviour of the person with the disorder, but often the person is estranged from his or her family.

There are no medicines to treat factitious disorders themselves. Medicine might be used, however, to treat any related disorder -- such as depression, anxiety, or a personality disorder. The use of medicines must be carefully monitored in people with factitious disorders due to the risk that the drugs might never be picked up from the pharmacy or might be used in a harmful way.

People with Munchausen syndrome are at risk for health problems (or even death) associated with hurting themselves or otherwise causing symptoms. In addition, they might suffer from reactions or health problems associated with multiple tests, procedures, and treatments; and are at high risk for substance abuse and suicide attempts.

Some people with Munchausen syndrome suffer one or two brief episodes of symptoms (non chronic). In most cases, however, the disorder is a chronic, or long-term, condition that can be very difficult to treat. Further, many people with Munchausen syndrome deny they are faking symptoms and will not seek or follow treatment. Even with treatment, it is more realistic to work toward managing the disorder rather than to try curing it. Avoiding unnecessary, inappropriate admissions to the hospital, testing, or treatment is important.

Males diagnosed with the psychological subtype of Munchausen are generally considered to have the worst prognosis. Self-mutilation and suicide attempts are common in these individuals. The prognosis for Munchausen's syndrome is poor; the statistics for recurrent episodes and successful suicides range between 30% and 70%. These individuals do not usually respond to psychotherapy. The prognosis for non-chronic Munchausen in women is variable; some of these patients accept treatment and do quite well. This subcategory of FD, however, often resolves itself after the patient turns 40