Munchausen syndrome is the most severe and chronic form of the factitious disorders, in which a person feigns, exaggerates, or even self-induces illness, with the apparent goal of winning attention and nurturance that has otherwise been unavailable. This is technically different from “malingering,” in which the illness is faked for external gains such as drugs or disability payments. The fabricated illness tends to be dramatic and convincing. Munchausen patients frequently have scars from multiple surgeries, genuine fevers (often due to infection of self-induced abscesses), or even amputated limbs. Patients tend to be intelligent and well informed regarding medical practices, diagnoses, and treatments.
Like malingerers, they are aware of their deceit; unlike malingerers, their motives seem to be at least partially unconscious. This syndrome, though dramatic, is extremely rare, and its cause is unknown. Patients with Munchausen syndrome have, however, been observed to have associated personality disorders (e.g., poor impulse control, self-destructive behavior, borderline or passive-aggressive personality trait or disorder). Some clinicians have also suggested that the Munchausen patient tends to have a history of abuse or neglect, coupled with an experience at some point of having become ill and consequently having received far better and more nurturing treatment than was customary for him or her. Also, most Munchausen patients are male.
The syndrome is named for Baron von Munchausen (1720–1797), a notorious traveler and liar, known for his wildly extravagant, yet utterly untruthful, accounts of distant lands and events. The name is appropriate, as he used these fantasies to seek attention that his relatively unexciting experiences were unlikely to attract.
Munchausen syndrome should not be confused with an odd variation on the disease, Munchausen syndrome by proxy (MSBP), which is an unusual form of child abuse. In MSBP, a parent, usually the mother, fakes symptoms of illness in her child and seeks frequent, and often intrusive, medical attention on the child’s behalf. In the hospital setting, the mother is very helpful and is seen by staff as unusually devoted and self-sacriﬁcing. Her frequent visits, of course, give her easy access to the child to create more symptoms. The motivation is believed to be much the same as in Munchausen syndrome: the mother receives a lot of positive attention as a result of her efforts on the child’s behalf.
MSBP has been a source of much controversy. The general consensus is that MSBP, like the classical Munchausen syndrome, is extremely rare, but the rate at which it is diagnosed is rising rather rapidly. The impact of the rising popularity of MSBP accusations is perhaps best illustrated by the ﬁrst two “hits” to appear in a recent internet search on Munchausen syndrome. The ﬁrst was the Web site of a large law ﬁrm, promising that “our criminal defense lawyers know how to defend Munchausen cases in any court in America”; the second was the home of Mothers Against Munchausen Allegations (M.A.M.A.), an advocacy group for mothers who have been falsely accused of harming their chronically ill children.
- Feldman, M. D. Playing Sick: Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder. New York: Brunner-Routledge, 2004.