Munchhausen Syndrome

Munchhausen Syndrome:  Repeated fabrication of physical illness - usually acute, dramatic and convincing - by a person who wanders from hospital to hospital to hospital and doctor to doctor for treatment.  Patient actually may have ingested or injected substances (poison) so they can seek medical attention.

Munchhausen syndrome patients may simulate many physical disorders, such as; Myocardial infarction, acute abdominal conditions and fever of unknown origin.  Their abdomen may be criss-crossed with scars from multiple abdominal surgeries.  The patient may have had a limb or a digit amputated.  many have lengthy surgical histories.  These patients eventually become the responsibility of the medical community - doctors, hospitals and surgical clinics.  However, this illness is primarily psychiatric.  It is far more complex than simply dishonest simulation of symptoms.  It is associated with severe emotional difficulties. 

Patients may have prominent histrionic personality features; they are usual intelligent and resourceful.  They know how to simulate disease and are sophisticated regarding medical practices.  They differ from malingerers because although their deceits and simulations are conscious, their motivations for forging illness and quest for attention are largely unconscious.  Commonly there is and early history of emotional and or physical abuse.  They appear to have problems with their identity, intense feelings, inadequate impulse control, a deficient sense of reality, brief psychotic episodes and unstable personal relationships.  Their need to be taken care of conflicts with their lack of trust of any authority figures, whom they manipulate and continuously provoke or test. 

Patients with Munchhausen syndrome and psychotic psychopathology as part of a character logic disorder are rarely treated successfully.  Acceding to their manipulations relieves their tension, but their provocation's escalate, ultimately surpassing what physicians are willing or able to do.  Confrontation or refusal to meet treatment demands results in angry reactions, and patients generally move to another hospital or doctor.  Psychiatric treatment is usually refused or circumvented; but consultation and follow up care may be accepted. at least to help relieve a crisis.  Management is generally limited to recognizing the disorder early and avoiding risky procedures and excessive or unwarranted use of drugs.

Munchhausen Syndrome By Proxy:  or MSBP is a bizarre variant in which a child is used as a surrogate patient .  The parent falsifies history and may injure the child to simulate a disease.  The parent seeks medical care for the child and always appears to be deeply concerned and overly protective.  The child is often seriously ill, and requires frequent hospitalization and may even die.    MSBP is very hard to detect.  MSBP victims may undergo numerous lab tests, multi medication trials, and surgical procedures that aren't really needed.

Munchhausen syndrome by proxy parent or caregiver has a need to feel "special"  or heroic to stimulate attention from people, such as family, friends, community, and medical professions.  Often using their child as the victim, and the child has been under medical care most of their young life.

When MSBP is suspected, health care professionals/providers are required by law to report their concerns to law enforcement and social service agencies.

Munchhausen's syndrome was named for the fictitious Baron Munchhausen - who told many 'tall tales'.

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