Munchausen’s Syndrome
— Rudolph Erich Raspe (1737-1794) German scientist and librarian
BChapt. 1 (1895) Y the looks of it, Munchausen’s syndrome is almost always a diagnosis by hindsight. It’s like knowing you’ve been scammed after getting scammed. There’s just no going around that because con men are professionals while a Munchausen’s sick and intelligently sick at that. I was reminded of Munchausen’s because recently I believe I met one who fit the profile.
What is it? Munchausen’s syndrome is a psychiatric condition in which a person PRETENDS to have an illness that doesn’t exist. Since this “patient” is knowledgeable about the symptoms, she can fake them. When challenged, she usually becomes aggressive. A variant of Munchausen’s is Munchausen’s by Proxy or Fabricated or Induced Illness (FII). In this bizarre form, a parent or caregiver fakes the illness in another person, usually a child. Sometimes the parent may hurt the child and take him to the emergency room giving a completely different explanation. Lab specimens such as urine can be tampered with (adding blood or contaminants) to make sure that results will support the disease. Now Munchausen’s is different from your occasional malingerer who calls in sick to go to the mall or watch the latest flick. A person with Munchausen’s has deep psychological and emotional problems. Falsifying illness is used to seek attention.
Clues to Munchausen’s. Doctors and other health professionals can be alerted by the following:
• Symptoms may be expressed but not verifiable with certainty by tests.
• The patient appears to get better in the hospital but gets “sick” again upon going home.
• Blood in lab specimens not matching the blood type of the patient.
• Drugs or chemicals in stool, urine, or serum.
• The attending parent is overly caring or over attentive.
• The parent can may be involved in the health care field.
Fabricated or Induced Illness may even be more difficult to diagnose because the child is really a victim. The child may be unable to articulate her problems to the health provider and will be intimidated in the presence of the parent. In such situations, find a way to speak to the child when she is alone.
Treatment. This exasperating but fascinating illness is properly the preserve of the psychiatrist. However, all concerned loved ones and the attending doctor should do their share of raising suspicions — for the good of the troubled patient. As a psychiatric conundrum, the solution of Munchausen’s demands all volunteered but sensible input.
The psychiatrist, with the help of the physician in charge, will usually conduct a thorough physical and psychological profiling. Counseling is made available to the whole family. Finally, the patient should undergo individual therapy. It is also true that the parent or care giver involved in a case of FII may be criminally liable. However, psychiatric support should also be given.
Prognosis. A good outcome depends on early recognition. This in turn is a result of awareness and maybe a dose of intuition as well. What experts seem to agree on is that health professionals should be nonconfrontational and not aggressively “expose” the patient. Much progress can be made if the patient is drawn out with compassion.
Is this patient fabricating her illness? Why does she seem to know all the treatment options? It is often the case that the person with Munchausen’s has already “doctor-shopped” and may even name drop.
The truth is, not only doctors but also caring relatives and friends as well, ought to have Munchausen’s as a probable culprit when a patient does not seem to get better when she should. As for the patient I suspected to have Munchausen’s, he conveniently retreated from surgery when he realized I was on to him. What a sad life he must be living.