Diseases

Munchausen syndrome - signs and therapy


The pathological lying

Munchausen syndrome describes invented diseases. Affected people pretend to be a sick person, thereby harming their health and forcing doctors to take care of them. They provoke symptoms that could only be treated in the hospital - if they were real.

Simulants?

We call pretending something like simulation. But are people suffering from the syndrome simulants? In the medical sense, they are not. A simulator knows what he is doing and is mentally healthy; for example, he goes to the doctor for supposed back pain to skip work for a few weeks, or manipulates the clinical thermometer to avoid going to school. It does not harm itself, but sneaks an advantage.

However, those who suffer from this disorder harm themselves, they injure themselves to show the symptoms of the invented disease; he is mentally ill. He controls his deception, but compulsively executes it - in a pathological sense.

The invented diseases

Affected people simulate diseases in almost every part of the body: appendicitis as well as diarrhea, gastrointestinal ulcers and heart problems. They invent complaints on the spine, motor failures, uncontrolled outbursts of emotion, headaches, but especially skin diseases: abscesses, boils, eczema or infected wounds.

Cystitis, pain in the lower abdomen. They present disorders of menstruation, joint pain, muscle tension as well as circulatory problems and pulmonary embolism.

Sometimes they provide the explanation for their “suffering” and at the same time simulate drug withdrawal, alcohol addiction, dizziness or depression. However, the presentation of psychological symptoms is rarely part of the syndrome; the patients want to go to the hospital and not to therapy.

The staging

Munchausen patients particularly like to come to a clinic at the time of the emergency service and describe their "complaints". You have studied the relevant medical literature in an intensive way and can therefore present the symptoms convincingly. They also know about the course of "their" illness and bring a credible narrative of the illness process.

The admission doctor is overwhelmed by the mostly serious illnesses that the affected person plays. As a rule, he examines the patient and then sends him to the respective specialist ward. This is exactly what the swindler creates.

First of all, those affected develop a clinical picture in a refined manner. If the doctor hesitates, because it is unclear what it is, he is secondly obliged to clarify the ambiguity; thirdly, the disturbed manipulate themselves to such an extent that a doctor who is not familiar with the syndrome hardly thinks of deception.

They pour acid on the skin, rub and squeeze it, twist arms and legs until they show bruises and lymphatic congestion; they inject saliva or irrigation water under the skin to appear to the doctor with a real infection.

They artificially create a fever, they take anticoagulants to inhibit blood clotting - in wounds that cause themselves. They take thyroid hormones to show an overactive thyroid gland, they inject insulin to keep their blood sugar low, they artificially increase the level of potassium in the blood.

They even stage heart and lung problems by swallowing blood to cough up blood. Women with this disorder fake vaginal bleeding with blood or burn their mucous membranes. Men and women use blood to simulate injuries to the rectum and urethra. They falsify urine samples, for example, with faeces.

Those affected are particularly successful when they have had a real operation. Then they manipulate wound healing by tearing open the scars or carrying infectious substances on the wound.

In extreme cases, the patients suffer a great deal of damage. For example, a victim had a wound after knee mirroring that did not heal. The doctors operated again, but the wound was still not healing. The infection spread to the bones and the doctors had to amputate the lower leg. It was only much later that it became clear that the patient had caused the inflammation himself.

The unmasking

These delusions usually only work for a short time. The doctors first check for a variety of causes, sometimes they even carry out medical interventions. But after a comprehensive analysis, the fake is exposed.

The sufferers often unmask themselves through their behavior: with zeal for fire they not only allow interventions, but demand them, while "normal" patients are more afraid and only endure because the doctor explains the need to them. The swindlers usually even show an increased pain tolerance.

But while they are greedy for the treatment of their “illness”, they are indifferent to the result and the healing process. The situation is the reverse for “normal” patients: they feel uncomfortable with the treatment, but are happy when the wounds heal and they go home.

Munchausen patients do not show openly that they do not want to be discharged, but it is clear that they are not enthusiastic.

Behavior and causes

Munchausen patients break off their relationships, constantly travel around, especially from one hospital to another, they lack social roots and often wander around aimlessly.

To the manipulated illnesses lie stories about one's own biography, origin and illness - as with Borderliners. In fact, Munchausen syndrome is now considered a borderline group. Patients provide false names and addresses and falsify medical records. This is how they make a name for themselves in clinics and health insurance companies.

Sometimes those who are disturbed even show dissocial behavior or slip into crime; many are dependent on medication. Child abuse often occurs in their résumés, along with incest, addicted parents, criminal fathers and drinking mothers.

Munchausen sufferers often suffer from other mental disorders, including extreme narcissism, classic borderline syndrome, some even show schizophrenic psychoses.

The risk of suicide is high; The self-harm can also cause permanent damage - from mutilation to physical disabilities to poisoning and mental disorders. They can even lead to death if, for example, the person affected causes sepsis that affects vital organs.

There is a risk of confusion with (more harmless) simulations, neuroses and psychoses. Hypochondriacs also behave in a similar way, but differ significantly: they do not lie, but firmly believe in an ominous illness that keeps them under control.

Munchausen syndrome is also different from disorders in which people openly injure themselves - forms of borderline, post-traumatic stress disorder, eating disorders and drug illness.

Professor Annegret Eckhardt-Henn, head of the department for psychosomatic medicine at the Stuttgart Clinic, sees compulsive lying as an essential symptom, but considers the label of the baron of lies to be wrong. According to her, they did not deliberately fake the diseases like simulants. Eckhardt-Henn writes: “Those affected have an inner urge to inflict these injuries. You have to think of it as if you had an addiction. ”

Pure Munchausen patients are very rare. They are characterized by coldness, lack of attachment, lack of impulse control and a lack of guilt. They are aggressive and violent. Eckhardt-Henn says: "You break off the relationship with the doctor as soon as he becomes suspicious."

Artifact diseases

Artifact diseases - a kind of Munchausen syndrome light - are much more common than the real Munchausen syndrome.

This behavior often develops in people who work in medical professions: nurses, medical assistants or X-ray assistants. In addition, women predominate here, while men suffer above all from Munchausen syndrome.

The symptoms are similar, but the sick are not dissocial, rarely involved in violent crimes, and less often victims of child abuse or broken families.

On the contrary, those affected are usually firmly integrated into their families and their jobs. Self-harm that threatens life is the absolute exception. Artifact patients have better control over their deceptions, which means that they remain within a framework that does not endanger their professional existence.

They do not argue cruelly with the clinic's doctors and travel less from hospital to hospital. Since many also come from medical professions, they know exactly at what point their behavior becomes apparent. The number of unreported cases of such patients is therefore likely to be high.

Nevertheless, they are not simulants. The psychological causes of Munchausen syndrome and artifact diseases are not yet fully known. Presumably it is a projection of her actual mental illness onto the physical; they are looking for a hospital because they are sick and in need of treatment.

Patients with artifact disorders usually do not invent a fantasy biography. They mostly deceive in a harmless way, take laxatives, drugs with strong side effects or mix blood in the urine.

So they implicitly express: "Help me," but would rigorously reject any diagnosis of a mental disorder and are not aware of it.

Anyone who has been abused as a child but has never been able to pronounce it is seriously injured. Expressing this on your own body and forcing specialists to deal with the disease appears to be an unconscious cry for help. This becomes clear when walking through the hospital.

It can be rated as the futile search for help for real injuries experienced in childhood; those affected may be really snubbed when the doctor tells them they can't find anything. You suffer real.

Munchausen proxy syndrome

This expanded Munchausen syndrome is the most dangerous because defenseless third parties, namely children, are involved in the pathological deception. Mothers manipulate their underage sons and daughters here and drag them to the clinic with invented diseases.

These mothers act like super-mothers to the doctors, so they are extremely caring. Even if doctors find that the child has no illness, they often suspect that the mother is just too worried.

Since there are actually such mothers who are afraid that the child will catch a cold when walking around outside or, if the child feels slightly uncomfortable, immediately run to the doctor, this suspicion is reasonable. Exaggerated care can even take on morbid forms, often the worst loss of the mother, or hidden aggression, namely the desire for control.

With enlarged Munchausen syndrome, mothers identify with their children to the same extent as over-worried mothers who project their fears onto the child, and the extremely close relationship between them and their children is striking. In addition, they suffer from Munchausen syndrome and also transmit this to their child.

Similar to the adults with this disorder, the child also routinely endures painful surgery when the mother requests it. The mothers manipulate their children with the same cruelty as other victims themselves: they inject air into their son's veins, they cover their baby's mouth and nose until the child threatens to suffocate; they break their daughter's arms and legs, smear dirt in the wounds, drive to the hospital, where the doctors are amazed at the strange inflammations.

Such mothers are severely mentally ill, and they seem to ward off their own mental breakdowns through the painful procedures on their child. The projection here presumably goes a step further than that of pure sufferers: While they use their invented physical suffering as a symbolic expression of their cry for help for their mental suffering, the mothers go one step further.

You are sick, namely mentally and urgently need treatment. Instead of harming themselves, they harm the child, who becomes an expanded part of their own mental space. These people do not perceive their children as independent individuals: the child becomes an abused object to create “therapy” for the mother.

If such mothers are exposed, they usually break down psychologically, get psychoses and now damage themselves, even attempting suicide.

The expanded Münchhausen syndrome also belongs to the borderline spectrum, and like classic borderliners, auto aggression tilts easily into aggression against others.

In total, mothers are responsible for around 40% of child abuse, and the rate for Münchhausen rises to well over 90%. Mostly they are single women or children whose fathers are very rarely at home.

In contrast to the classic Munchausen syndrome, the abusing mothers are conspicuously unobtrusive, even seem over-adjusted. They keep asking the doctors about the results, often nurses or medical assistants.

They cause anemia by drawing blood, manipulating clinical thermometers or falsifying the medical records.

Therapy

The number of unreported cases is probably high, especially in the lighter cases. With extended syndrome, it is important to avert serious damage, physically and emotionally, from third parties. Doctors and medical staff should therefore be systematically trained to identify suspicious behavior.

Mothers with proxy syndrome must be separated from their children. All those affected by the illness need lengthy psychotherapy; however, they are almost always resistant to advice. If there is already serious damage to oneself and others, there is hardly any way to avoid mandatory instruction.

Since it is a disorder that has its origin in traumatic experiences, it is not curable. However, the symptoms can be alleviated, for example by behavioral therapy. For those with a dissocial personality, it is unfortunately true that they are largely “immune” to such treatments.

It is legally important to treat the fraudsters as sick, and that means referring them to a therapeutic institution rather than prison terms. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch

Swell:

  • Amboss GmbH: Artificial disturbances (accessed: August 20, 2019), amboss.com
  • Lieb, Klaus / Frauenknecht, Sabine: Intensive course in psychiatry and psychotherapy, Urban & Fischer Verlag / Elsevier GmbH, 8th edition, 2015
  • Walter de Gruyter GmbH: Artificial fault (accessed: August 20, 2019), pschyrembel.de
  • Merck and Co., Inc .: Self-related Artificial Fault (Retrieved: August 20, 2019), msdmanuals.com
  • Sonnenmoser, Marion: Artificial Disorders: Puzzling and Dangerous, Deutsches Ärzteblatt, 2010, aerzteblatt.de
  • Berger, Mathias: Mental Illness, Urban & Fischer Verlag / Elsevier GmbH, 6th edition, 2018
  • German Society for Pediatric and Adolescent Medicine (DGKJ) / German Society for Pediatric Surgery eV (DGKCH) / German Society for Social Pediatrics and Adolescent Medicine eV (DGSPJ) / German Society for Pediatric and Adolescent Psychiatry, Psychosomatics and Psychotherapy (DGKJP) / Society for Pediatric Radiology (GPR) / German Society for Forensic Medicine (DGRM): S3 guideline on child abuse, abuse, and neglect involving youth welfare and education, as of February 2019, detailed view of guidelines

ICD codes for this disease: F68ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.


Video: Factitious Disorder by Proxy. Kati Morton (January 2022).