Munchausen syndrome is a condition in which a patient regularly feigns illness or injury in order to receive medical treatment. Patients with the condition may be hospitalized repeatedly for short stays or travel from place to place searching for care. It is the most severe form of factitious disorder, in which patients intentionally produce or fake physical or psychological symptoms to convince others they are sick.

Patients with Munchausen syndrome tend to report signs or symptoms of physical illness (e.g., stomachache, chest pain, fever). Munchausen syndrome is sometimes used interchangeably with the term "factitious disorder." However, patients with Munchausen syndrome tend to lie about physical, rather than psychological, symptoms. This form of factitious disorder is named after Baron von Munchausen, an 18^th century German nobleman who became a famed teller of tall tales. Although most factitious disorders are more common in females than males, the most chronic and severe cases of Munchausen syndrome generally occur in males.

The causes of Munchausen syndrome are not completely understood. The specific symptoms of Munchausen syndrome depend upon the type of disorder that a patient chooses to fake. In most cases, patients complain of physical symptoms or exhibit signs of physical illness, such as chest pain, stomach problems or fever. Patients often injure themselves to create physical symptoms.

At first, it may not be obvious to a physician that a patient is faking symptoms. This may become clear, though, when test results come back negative or treatments fail to cure the patient’s alleged symptoms. Once a physician suspects a patient of feigning illness, a psychiatrist, psychologist or other mental health professional may be brought in to help diagnose the patient’s true disorder.

Patients with Munchausen syndrome typically lie about their illness and refuse to admit that they are not sick. As a result, the prognosis for treating this condition is very poor. Patients who are willing to seek help may benefit from psychotherapy, which helps them explore the root of their compulsion for lying about illness.

Munchausen syndrome should not be confused with Munchausen syndrome by proxy (MSBP), a condition in which a parent or other caregiver fabricates or exaggerates the symptoms of someone – usually a child – under their care in order to receive attention in a medical setting.

Munchausen syndrome is a mental health disorder in which a person feigns symptoms of illness or injury, presumably to gain the attention of others. It is a form of factitious disorder, in which patients intentionally produce or fake physical or psychological symptoms to convince others they are sick.

Although some medical professionals use the term “Munchausen syndrome” interchangeably with “factitious disorder,” this is not technically correct. Munchausen syndrome is actually a chronic variant of factitious disorder in which the patient complains mostly of physical symptoms (e.g., stomachache, chest pain, fever) rather than psychological ones. Despite this definition, there are examples of Munchausen syndrome that involve mostly psychological symptoms.

Patients who have Munchausen syndrome may make up symptoms, alter diagnostic tests or intentionally injure themselves in order to assume a “sick role” and receive medical attention. Such injuries can lead to serious long-term health problems and even death.

Munchausen syndrome usually starts in early adulthood and may continue on and off for decades. In rare cases, a patient may experience just a single episode of Munchausen syndrome. Munchausen syndrome is different from Munchausen syndrome by proxy (MSBP), a condition in which a parent or other caregiver fabricates or exaggerates the symptoms of someone – usually a child – under their care in order to receive attention in a medical setting.

Although Munchausen syndrome is considered rare, there are no accurate statistics about the condition. People with Munchausen syndrome are surprisingly successful at misleading healthcare professionals. When discovered, patients will usually seek treatment at another healthcare facility.

Munchausen syndrome is a poorly understood disorder, and its causes are not known. However, some psychological and biological factors may be involved. Some experts suggest that Munchausen syndrome may be a form of self-punishment. Other theories suggest the syndrome may be a form of self-defense against impulses that are sexual or aggressive.

Other factors that have been linked to Munchausen syndrome include a history of abuse or neglect as a child or a history of hospitalizations. It also appears to be more likely to occur among people who have healthcare professionals in their families. However, it is unclear if the development of the disorder is a result of this or if these people are simply able to provide what appears to be a more valid medical history because they are more knowledgeable about medical conditions.

Research into the disorder has been extremely difficult because patients with Munchausen syndrome usually hide their condition from others and typically seek out other healthcare professionals when they are confronted about their subterfuge.

Men appear to be at greater risk than women for the most chronic and severe forms of Munchausen syndrome.

The specific symptoms of Munchausen syndrome depend upon the type of disorder that a patient chooses to fake. In most cases, patients complain of physical symptoms or exhibit signs of physical illness, such as chest pain, stomach problems or fever. Physical signs of illness may be genuine, but self-inflicted. For instance, a person may take laxatives to cause diarrhea. In other cases, symptoms are completely made up by the patient and have no basis in reality.

In general, people with Munchausen syndrome spend a lot of time scheduling physical examinations, hospitalizations and medical tests. Patients who have Munchausen syndrome may complain of dramatic symptoms that are inconsistent, especially when pressed to provide greater details. Symptoms also tend to be unresponsive to treatment or may become more severe after treatment has begun.

Patients with Munchausen syndrome may willingly undergo painful treatments just to gain attention. However, nobody knows why most patients with Munchausen syndrome falsify their complaints.  They may also suffer predictable relapses following improvement of their condition or may have new symptoms that occur despite negative test results.

Other possible indicators of Munchausen syndrome include:

• Constant requests for analgesics to treat pain. It is important to differentiate this from patients whose pain is being undertreated and are appropriately requesting analgesics and from those suffering from substance abuse or dependence.
  
  
• Extensive patient knowledge of medical terminology.
  
  
• Presence of numerous surgical scars.
  
  
• Symptoms that consistently appear only when the patient is alone or unobserved.
  
  
• History of seeking treatment in numerous hospitals, clinics and physician’s offices.
  
  
• Patient reluctance to allow healthcare professionals to consult with family members, friends and other healthcare providers.

Munchausen syndrome is diagnosed when a patient falsely reports and/or portrays mostly physical – or, sometimes, mental – signs or symptoms for the purpose of occupying a “sick role.” Also, the patient must not have other motives, such as those associated with malingering (feigned illness for the purpose of material gain).

Another mental disorder that presents with physical symptoms in the absence of diagnosable medical disorders is somatization disorder.  However, in contrast to those with Munchausen syndrome, patients with somatization disorder are honestly reporting their symptoms and do not seek to deceive healthcare professionals.

At first, it may not be obvious to a physician that a patient is faking symptoms. During an initial visit, a physician is likely to perform a complete physical examination and compile a thorough medical history. Various tests may be performed to try to identify the source of the patient’s complaints.

However, over time, it may become more obvious that the patient is faking the illness or has self-inflicted injuries. Patient history of multiple procedures and hospitalizations may offer one clue. Continuous complaints of new symptoms and constant requests for analgesics may offer other clues. Patients with Munchausen syndrome also have a tendency to falsely claim certain accomplishments, friendships with famous people or to make other similar self-aggrandizing claims.

Once a physician suspects a patient of feigning illness, a psychiatrist, psychologist or other mental health professional may be brought in to help diagnose the patient’s true disorder. The patient’s medical history and results from psychological testing may be combined with results of physical and laboratory tests to help reach a diagnosis.

The physician and mental health professional are likely to ask themselves several questions. These include:

• Do the patient’s test results make sense in light of the reported symptoms?
  
  
• Do outside sources seem to corroborate the patient’s claims?
  
  
• Is the patient reluctant to share information from other sources?
  
  
• Does the patient appear especially eager to undergo procedures or testing?
  
  
• Are the patient's treatments working as predicted?

Munchausen syndrome may be diagnosed when it is clear that the patient is intentionally faking physical or psychological symptoms with the sole motivation of assuming the sick role. When confronted, patients will usually deny that they are making up their symptoms. It is common for patients to move on to various physicians and hospitals to continue the ruse. In some cases, patients may seek medical care in another city, state or even another country.

Once a physician suspects Munchausen syndrome, the patient may be evaluated for other associated disorders. These include chemical dependency, depression and other mental health disorders.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Since patients with Munchausen syndrome usually deny that they have this disorder, family members may need to play a major role in arranging treatment. they may wish to ask the doctor the following questions related to Munchausen syndrome:

1. My loved one often complains of illness. What signs should I look for that might indicate Munchausen syndrome?
   
   
2. How is Munchausen syndrome usually diagnosed?
   
   
3. My loved one has Munchausen syndrome. Is there a good chance he or she has other mental illnesses as well?
   
   
4. What are the long-term consequences of my loved one’s attempts to hurt him or herself or to undergo multiple surgeries?
   
   
5. What are my loved one’s treatment options?
   
   
6. Can you recommend a good therapist for my loved one?
   
   
7. If my loved one is unwilling to recognize his/her condition, what can be done?
   
   
8. How can I help my loved one identify and overcome Munchausen syndrome?