Munchausen Syndrome

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Julia Dobmeier is currently completing her master's degree in clinical psychology. Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of ​​enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.

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Munchausen syndrome is a severe mental disorder in which patients fake or intentionally cause physical illness. This includes compulsive self-harm, inventing spectacular medical histories, and constantly changing doctors. Read everything you need to know about the causes, symptoms, diagnosis and treatment of Munchausen Syndrome here!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F68

Munchausen syndrome: description

Munchausen syndrome is a serious mental disorder. Those affected feign physical or psychiatric symptoms and disabilities - or they deliberately cause them. Such behavior is also known as an artificial disorder.

People with Munchausen Syndrome do not shy away from pain, permanent physical damage or effort to convincingly convey that they are sick. They do not put off painful treatments or dangerous interventions such as surgery. Your life revolves primarily around wandering from one doctor to another and from clinic to clinic. However, they avoid staying in psychiatric or psychosomatic facilities. They usually have no insight into the disease or are afraid of having to give up their compulsive behavior.

The disturbance is named after the famous "Baron of Lies" Hieronymus Carl Friedrich von Münchhausen. Unlike other patients with an artificial disorder, people with Munchausen Syndrome often invent spectacular medical histories and often think up experiences that affect other areas of life.

Differentiation from simulants

People with Munchausen Syndrome may injure themselves or cleverly fake health problems. However, they have no financial interests or other external incentives for their behavior, they just want to get attention and receive medical treatment. Therefore, they do not count among the simulators. This is because they are mentally healthy and benefit from pretending to be sick, for example of a financial nature.

Differentiating people with Munchausen Syndrome from simulators can be very difficult.

Who does Munchausen Syndrome affect?

There are currently no studies that reliably estimate the number of people affected. Experts assume that around two percent of all hospital patients suffer from artificial disorders, some of them from Munchausen syndrome. The actual number could be significantly higher, however, as many cases are not recognized.

While artificial disorders mostly affect women (especially those with medical expertise), Munchausen syndrome is more common in men. In addition to the symptoms of Münchhausen syndrome, they are often diagnosed with personality disorders such as borderline, narcissistic or antisocial personality disorder.

Munchausen deputy syndrome

A special form is the Münchhausen-Stellvertreter-Syndrome (also called Münchausen-by-Proxy-Syndrome). Those affected do not harm themselves, but others. Mostly it is mothers who hurt their children and make them sick. They then have them treated by a doctor and take care of them self-sacrificingly. This shocking behavior towards one's own children does not happen out of malice or sadism, but out of an inner compulsion.

Munchausen syndrome: symptoms

Munchausen syndrome is one of the artificial disorders. It is characteristic that the patients simulate or artificially cause illnesses. In contrast to other people with artificial disorder, however, patients with Munchausen syndrome do not have an intact social environment. In the following you can read more symptoms that are typical of Munchausen Syndrome.

Self-injurious behavior

Patients with Munchausen Syndrome sometimes take drastic measures to receive medical treatment. They inflict wounds on their skin, infect their skin or burn it with liquids, deliberately subvert their hypoglycemia or draw blood from themselves to cause anemia.

They can also present organic problems such as gastrointestinal or heart problems so convincingly that they can even be operated on by doctors. After the operation, they sabotage healing, for example by infecting scars. They also use unnecessary medication and substance abuse to damage their bodies.

Lack of psychological stress

The pain that those affected cause themselves or through unnecessary medical interventions seem to be indifferent to them. A healing is sabotaged. The goal is always to create or maintain a physical illness. In clinics, patients with Munchausen Syndrome often stand out because they are not happy about a successful treatment.

Breakups

As soon as they have been treated in a clinic, people with Munchausen syndrome break off their stay early against medical advice and are admitted to another clinic. Even if the attending physician suspects, they look for a new one. Jumping from one doctor to the next is known as "doctor hopping" or "doctor shopping". It also often leads to patients constantly changing their whereabouts. Because of this and also because they fear being confronted with the untruth of their stories, they have no social environment. The medical staff is often the only point of contact.

Compulsive lying

The so-called pathological lying or "pseudologica phantastica" is typical of the Münchhausen syndrome. They live out their symptoms very dramatically.

Identity disorder

Munchausen syndrome is usually caused by a personality disorder. The patients are in great conflict with their own identities and suffer from severe self-esteem problems. The invented stories help them to build up a new identity over and over again, of which they are also convinced themselves at times. As soon as doctors look behind the facade, they break off the relationship in order to protect their false identity.

Munchausen syndrome: causes and risk factors

The exact causes of Munchausen Syndrome are still unknown. However, many patients report traumatic experiences in childhood. This can be, for example, frequent experiences of loss, abuse or neglect in childhood. In some cases, one parent already suffered from Munchausen Syndrome.

Some experts suspect that Munchausen syndrome is due to fatigue. The constant self-harming behavior is an indication of trying to take your own life. At the same time, it reveals the disturbed self-image. The often underlying personality disorders also play a central role.

Munchausen syndrome: examinations and diagnosis

Munchausen syndrome is difficult for doctors to recognize because patients rarely stay with a doctor for long periods of time. The Münchhausen patients also play the diseases very credibly, so that the doctor will first carry out detailed examinations and treat injuries they have caused themselves. Munchausen syndrome only becomes apparent after a while or after talking to a previous doctor.

One indication of Munchausen Syndrome is patient indifference to painful or dangerous medical interventions. It is also noticeable that, according to the patient, the symptoms worsen again and again after they have been treated. If, in the course of treatment, it turns out that the symptoms are self-induced - for no apparent reason - the doctor will recommend a psychiatrist or psychotherapist.

According to the international classification of mental disorders (ICD-10), the following criteria must be met for the diagnosis "Munchausen Syndrome":

1. Persistent behaviors that create or simulate symptoms and / or self-harm to induce symptoms.
2. There is no external motivation, such as financial compensation, for this behavior.
3. The reservation of exclusion is the lack of a confirmed physical or mental disorder that could explain the symptoms.

Munchausen syndrome: treatment

First of all, the inflicted injuries or artificially created symptoms must be treated. In extreme cases, the self-damaging behavior can even be life-threatening, which requires rapid medical action.

Psychotherapy is necessary for the actual treatment of Munchausen Syndrome. However, it is risky to ask Munchausen patients about psychological problems. Most are frightened when their lies are exposed and then break off contact. It is important for them that their medical histories are taken seriously. A trusting relationship between doctor and patient is therefore the basis for treatment. In the best case scenario, the Münchhausen patients agree to seek therapeutic help after a while. As a rule, however, they refuse psychological treatment.

If the patient can be motivated to undergo therapy, this is often carried out as an inpatient in a clinic. Experts also report good successes with an interval setting. The patients repeatedly stay in the clinic for longer periods of time and receive outpatient care in between.

Patients with Munchausen Syndrome often pose an ethical dilemma for doctors and bring about legal conflicts. They abuse the medical system and cause enormous costs. However, it should be remembered that this is a psychological problem. Munchausen patients cannot stop their pathological behavior because it has an obsessive nature.

Munchausen syndrome: disease course and prognosis

Munchausen syndrome usually develops in adulthood. The further course of the disease can be very different. However, it is always characterized by countless visits to the doctor and hospital stays and often by many unnecessary operations.

According to current knowledge, Munchausen syndrome has a poor prognosis, as patients usually refuse adequate treatment as part of psychotherapy. As soon as they are asked about their problem by the doctors, they stop the treatment. The constant change of doctor makes the necessary long-term treatment more difficult.

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