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Munchausen syndrome • when the lie becomes an illness

Munchausen syndrome is a mental illness in which physical and psychological symptoms and disabilities are simulated or created. Affected people injure themselves or others, invent medical histories and thus provoke diagnostic and therapeutic measures.

Strikingly frequent visits to the doctor and examinations are a typical symptom of the Munchausen syndrome.

Munchausen syndrome belongs to the simulated disorders (also: artificial disorders) and is characterized as such by repeated and groundless manipulative interventions with the aim of producing symptoms. The namesake is the baron of Munchausen who became known as the "Liar Baron". Those affected are predominantly female, living alone or separately and often suffer from a personality or mental disorder. They often have a medical assistant job.

A special form is the Münchhausen Substitute Syndrome (also: Münchhausen-by-proxy syndrome) in which the affected person harms himself instead of another person. Most of them are mothers, grandmothers or female babysitters, and their victims are usually infants and young children.

Overview of article content

Gentle help for the soul: psychotropic drugs from nature

Gentle help for the soul: psychotropic drugs from nature

Causes: How does Munchausen syndrome come about?

The causes of Munchausen Syndrome and Munchausen Substitute Syndrome are not clearly understood. The following explanations exist in specialist circles:

  • Those affected have a very low self-esteem and use their behavior to strive for uniqueness, attention and care. In the case of the Münchhausen representative syndrome, this is done by taking on the supposedly caring and organizing role.

  • People with Munchausen syndrome often experienced violence, abuse and neglect in their childhood. Psychodynamic approaches assume a re-enactment of traumatic experiences behind the disease.

  • Due to the experience of violence or medical treatments in the past, the relationship between those affected and their own bodies is disturbed. It only serves them as a means to achieve their goals, even if they are mostly unconscious.

  • Since they themselves had no empathy and had to endure pain, those affected react conspicuously empathetically and pitilessly to the expression of suffering of other people, even that of their children.

  • Approaches based on family dynamics suggest that in the case of the Munchausen proxy syndrome, the focus on a supposedly ill child serves to regulate and stabilize conflict-ridden couple relationships.

  • It is striking that Munchausen syndrome often occurs together with other mental illnesses – such as eating, borderline, narcissistic, dissocial and Histrionic personality disorders. In this context, the behavior observed may serve to regulate affects and tensions.

Symptoms: How does Munchausen syndrome manifest itself?

The most striking symptom of the Munchausen syndrome is frequent visits to the doctor or hospital ("treatment hikes"). Affected people literally demand medical care, for this they use dramatic and imaginatively decorated medical histories. They pretend to be painful or actually (or others) inflict painful injuries – they don't care about the physical consequences. The following methods are used to produce physical symptoms:

  • Use of acids and alkalis or spraying of allergy-causing substances to simulate a skin disease

  • Manipulation of the thermometer or injection of faecal suspensions in infusions to simulate an infectious disease

  • Self-drawing of blood to produce anemia, taking anticoagulants

  • Taking thyroid hormones to trigger an overfunction, excessive use of laxatives, triggering hypoglycaemia by injecting insulin

  • Taking beta-blockers or sympathomimetics to simulate heart disease

  • Use of animal blood to simulate bleeding

  • Taking medication to induce paralysis or epileptic seizures

  • Describe rape or other trauma to pretend post-traumatic stress disorder (PTSD)

If there is an (unnecessary) operation, everything will be done afterwards to disturb the healing. A typical symptom is a massive increase in symptoms with largely unremarkable diagnostic findings before a planned discharge. If the manipulation is uncovered, those affected change doctors or discharge themselves from the hospital. They often have complex medical knowledge, but are indifferent to the course of the disease and the prognosis.

Diagnosis: This is how the doctor recognizes Munchausen syndrome

Often those affected pretend their illnesses so convincingly that it is difficult for doctors to recognize Munchausen syndrome. According to the international classification system ICD-10, the following criteria for the diagnosis of Munchausen syndrome must be met:

The suspicion is borne out if there is a very long and unusual medical history, if no known illness can explain the laboratory findings or if the person affected is even found to be manipulated.

Diagnosis of Munchausen proxy syndrome

The Munchausen proxy syndrome can also only be proven using evidence. The following indicators should be clarified urgently:

  • Report on physical events in the child that only occur in the presence of the mother

  • Constantly recurring description of the mother's symptoms about her child despite previous medical clarification

  • Manipulation of medical records, laboratory samples or written orders

  • Administration of non-prescribed medication

  • frequent bleeding, diarrhea, respiratory arrest, loss of consciousness and other atypical symptoms in the child

Social behavior and high levels of care are typical of people who suffer from the Munchausen Deputy Syndrome. They also agree to their child's painful exams, never leave them alone and want to be with every treatment.

Treatment of Munchausen syndrome

The first step is to treat any injuries and artificially created symptoms. In the case of the Münchhausen Substitute Syndrome, the mother and child may be separated to protect the child.

Psychotherapy is required to treat the syndrome itself. This is often very difficult because those affected usually strictly reject the appropriate treatment and, in the event of a direct confrontation with their deceptive and self- or externally injurious behavior, reject any further therapy offers and change the practitioner. It is therefore essential to build a stable and trusting doctor-patient relationship: those affected learn that they are taken seriously and do not have to produce any dramatic symptoms in order to be in regular contact with doctors. The use of supportive, face-preserving techniques can help accept appropriate treatment.

If the person concerned agrees to treatment, it is often carried out in the form of interval therapy: outpatient care is provided between several inpatient stays. Close cooperation between the different practitioners is required to prevent inefficient practices and frustration on the part of doctors, psychotherapists and nurses. The inclusion of relatives is also recommended.

Course of the disease and prognosis

Since the Münchhausen syndrome is a serious mental illness and the sufferers usually suffer from other mental disorders, complete cure is rarely possible. The disease almost always has a chronic course and requires long-term therapeutic support.

If the person concerned engages in psychotherapy, at least the injuries and symptoms inflicted on themselves or others can be stopped. Without therapy, there is a high risk that these injuries will lead to permanent health damage.

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