Munchausen's syndrome

What is it?

People with Munchausen's syndrome create the symptoms of illness, either in themselves or in another person. They may create their illness by pretending to have symptoms that don't really exist, or by deliberately harming themselves. They may inflict cuts and bruises, for example, or even ingest toxic substances.

In the form of the disorder that used to be called Munchausen's by proxy but is now known as fabricated and induced illness (FII), they may invent or fake symptoms in someone else.

Many of those with Munchausen's have a comprehensive knowledge of medical terms and procedures, so are able to create plausible explanations for their claims. Their portrayal of the symptoms is usually so convincing that medical tests and investigations are necessary to rule out possible underlying medical conditions.

Which symptoms are reported?

The most common symptoms that patients with Munchausen's complain of include breathlessness, allergic reactions, diarrhoea and vomiting, seizures, abdominal pain and blackouts.

Those with Munchausen's will often attend many different hospitals and clinics. Each time, they'll tell the same or a similar story and report the same symptoms, so they undergo the same investigations time and again.

Even if someone attends the same hospital on a regular basis, the accuracy of the portrayal of symptoms leaves staff no choice but to run tests again.

Fabricated and induced illness

In FII, a person fakes the symptoms of an illness in another person. This usually involves a parent faking the symptoms of an illness in their child, but in another, more sinister, form of FII, the parent will actually inflict harm on their child to support their claims.

Who's affected?

It usually begins in early adulthood and is more common in men. Those who work in a healthcare environment are at greater risk of developing it. Some people believe that experiencing abuse or neglect in childhood increases the risk.

How's it diagnosed?

As little is understood about why Munchausen's syndrome occurs, it's difficult to spot it or prevent it from developing.

Someone with Munchausen's may have a long history of illness that, in spite of being thoroughly investigated, remains unexplained. Deliberate self-harm or the investigative surgery many undergo for their claimed condition means they can be left with multiple scars. Often they'll have extensive medical notes.

What's the treatment?

Diagnosing Munchausen's syndrome is difficult; treating it even more so. Once Munchausen's is suspected and the patient is questioned about their behaviour, they often become extremely agitated or defensive.

They often disappear to avoid detection and seek help at a different hospital where they're not known.

It's important for medical staff to build a supportive relationship with the patient and try to prevent further unnecessary tests and treatments.

If a person can acknowledge they have a problem, the involvement of a psychiatrist or psychologist and social services may be of help.