An unusual and little-studied psychological disorder—Munchausen syndrome—was talked about again after the release of the series “Sharp Objects” [you can watch it on the Amediateka service]. His heroine - the classic "Munchausen" - literally healed healthy children by inventing diseases for them. Manifestations of the syndrome are often reflected in popular culture (literary works, films), but in real life only isolated cases are known. According to a 1990 study by members of the Department of Psychiatry at the University of Toronto, people with Munchausen syndrome account for approximately 0.2–1.3% of all mentally ill patients. Researchers called the syndrome rare and its danger underestimated.
What kind of syndrome is this, is it widespread in Russia, how do people live with it and what psychiatrists say about it - in the material “Such Cases”.
Such different liars
A person suffering from Munchausen syndrome is called a malingerer, a fraudster, a “professional patient,” a “hospital flea”... In fact, he has a borderline psychiatric disorder, a form of hysteria. Such people strive to get into the hospital by hook or by crook. Such cravings often arise after a real physical illness, the loss of a loved one, a breakup with a loved one, as a result of loneliness. Previously, it was believed that there were more male Munchausens than females, but today women are ahead here too.
Since most malingerers dream of going under a scalpel, the most common type of syndrome is acute abdominal: “barons”, complaining of severe abdominal pain, require immediate surgery. And especially “gifted” ones so reliably imitate a perforated stomach ulcer that they confuse the doctor: blood tests seem to be normal, but the patient is writhing in pain! Just in case, the surgeon arms himself with a scalpel, and now a fresh scar appears on the malingerer’s stomach - the third, fifth, and maybe tenth in a row. For the sake of the desired surgical intervention, some swallow foreign objects - nails, spoons, forks, medical instruments...
Another type of Munchausen syndrome is hemorrhagic (hysterical bleeding). Patients periodically experience natural, and more often artificially induced, bleeding from various parts of the body. Many use animal blood for dramatization and, through skillful cuts, achieve the impression of natural injuries. These conditions are reminiscent of the “vicarary bleeding” of fanatical Catholic women who, during menstruation, experience blood on their palms and soles, where the nails were driven in during the crucifixion of Jesus.
There is also a neurological type: in imaginary (and suspicious) patients, transient symptoms occur - seizures, paralysis, fainting, unsteadiness of gait, severe headache, loss of sensitivity. Sometimes they even manage to “beg” neurosurgeons to perform complex brain surgery.
The Munchausens instantly adapt to the situation: the necessary symptoms “miraculously” correspond... to the profile of the nearest hospital. It is no wonder that new types of syndrome have appeared: cutaneous (self-damage to the skin up to the appearance of non-healing ulcers), cardiac (imitation of angina pectoris, paroxysmal ventricular fibrillation or myocardial infarction - the so-called hysterical pseudo-infarction, characteristic of patients with borderline mental disorders), pulmonary (simulation of tuberculosis and other diseases of the respiratory system) and a mixed type, including all of the above. The rarest and most casuistic is when, say, a woman in the last stages of pregnancy caused early labor pains by piercing the amniotic sac with a long hat clip. And a malingerer with “acute porphyria” - a hereditary disorder of pigment metabolism - for a long time stole urine for analysis from a patient with a real illness.
Several cases from psychiatry
Wendy Scott
There is a known case in psychiatry where a patient named Wendy Scott was hospitalized about 600 times throughout her life, and on 42 occasions she underwent various operations. The woman described and depicted all the symptoms of the disease so believably that even experienced doctors could not help but believe her.
When the patient was finally able to recover, she told the doctors about what she had experienced over all the years of her life. Thus, it was possible to establish the real cause of poor health. It turns out that little Wendy’s childhood was very difficult: she did not experience parental love and care, and experienced sexual abuse. With warmth, she could remember only one moment when her appendicitis became inflamed and she ended up in the hospital. The nanny who cared for the child truly fell in love with the girl. At this time, Wendy felt like a truly happy person. Having grown up, she could still feel cared for only by people in white coats. It was at this time that the syndrome began to develop.
The patient was able to overcome the disease due to two reasons:
- Ms. Scott has had so many surgeries that one more could be her last. The patient’s health was undermined and it became difficult for the body to cope with the next anesthesia.
- A few years later, the woman found someone who would truly love her and with whom she could feel happy. This was her cat, for whom Wendy lived for a very long time.
Delegated Munchausen syndrome
One day, the mother of a one-year-old child came to a medical facility. She complained about the appearance of blood in the baby's urine. Doctors conducted a series of studies, studied tests and actually found the presence of blood in the urine, although outwardly the child did not give the impression of being sick. Some time later, while examining the baby, the nurse saw how the mother pricked her finger and squeezed blood into a test tube with the baby’s biomaterial.
It turned out that the woman suffered from a special type of illness - delegated syndrome. Often such excessive care leads to disability or even death of the child. That is why in psychiatry there are many cases where several healthy children die of the same mother.
Portrait with a family background
And yet, where does such a frantic craving for treatment come from? From childhood! Future Munchausens, as a rule, grew up in single-parent families, but even with both parents they experienced a lack of love and security. Many of them suffered a serious illness at an early age, during which their relatives and doctors surrounded them with care. Gradually, such a child developed a model of illness (serious, of course!), which made it possible to recreate the desired atmosphere of attention and affection.
Despite the different motives for “travelling” to hospitals - the desire to be the center of attention, dissatisfaction with doctors and clinics, the desire to get painkillers (drugs) or shelter for the night, or even an attempt to hide from law enforcement - the image and style of behavior of Munchausen patients is almost the same .
All “barons” are characterized by egocentrism, narcissism, hypochondria, a tendency to wander, loneliness, masochism, pathological deceit, emotional immaturity and the impossibility of close contact with others. They are only interested in specialized medical literature, impressing doctors with their thorough knowledge of the simulated illness. By imitating the disease, women behave more hysterically, and men become aggressive.
Such individuals are characterized by violations of self-esteem, they have a strong need for dependence, and when seriously disappointed, they retreat into the world of fantasies and dreams. At the same time, there are no changes in formal thinking, and the intelligence quotient (IQ) is normal or above average.
They prepare seriously for hospitalization, preferring to go to emergency departments late in the evening, at night or on holidays, when, in their opinion, young, inexperienced doctors are on duty at the hospital. Well, what if the surgeon did not heed the “sincere” complaints of acute abdominal pain, “catastrophic bleeding,” “blackouts for a long time” and other “life-threatening” symptoms? Then the sufferer immediately leaves the hospital in order to be admitted to another hospital with an “acute condition” the same night.
For obvious reasons, the Munchausens try not to go to the same clinic twice. They go to various hospitals dozens, and sometimes hundreds of times! There is a known case when such a patient managed to visit 60 hospitals in just a year - a record worthy of the Guinness Book! That is why in small Western countries, in many clinics, the names of the “barons” are included in a special “list of scammers”, with which the ambulance doctor can always check.
Munchausen syndrome - symptoms and treatment
Munchausen syndrome is a disorder in which a patient, for the sake of attention from doctors, deliberately feigns or artificially induces symptoms of a disease. Doctors providing emergency care are more likely to encounter this disease.
In the scientific literature, there are about 20 variants of the name of the disorder: false illness, induced illness, Van Gogh syndrome, Munchausen syndrome, dementia of self-awareness, chronic factitious disorder, hospital fraud, professional patients, traveling patients, hospital criminal syndrome, simulators, etc. [1] .
This disorder was first described by the British physician H. Gavin in the mid-19th century, using the term “factitious disorder” - a disorder accompanied by fictitious, false imaginations [5].
A detailed study of the disease was conducted by the American psychiatrist R. Asher in 1951. He studied a number of clinical cases in which patients “complained about their fate” and filled their biography with implausible dramatic facts. It was R. Asher who gave the modern name to this syndrome [2].
In 1968, another American scientist H. Spiro proposed a different name for the disorder - chronic fictitious (artificially caused) disease. He analyzed 38 cases in which patients showed aggression towards themselves, “fell ill,” deceived doctors and diagnosed themselves [11].
Today, Munchausen syndrome is included by the American Psychiatric Association in the category of fictitious disorders in which patients deliberately feign other physiological or psychiatric pathologies in order to attract more attention to themselves [4]. It is curious that such behavior has nothing to do with socio-economic benefits - benefits, additional payments, exemption from criminal punishment, taxes or loans. It is also impossible to explain it only as a delusional state.
Munchausen syndrome is a rare disorder. It accounts for 0.2-1.3% of all mental illnesses [12]. Moreover, women suffer from this disorder more often than men [14]. The average age of patients is 34 years, the age limits are 8 years and 62 years [12].
The causes of Munchausen syndrome are unclear. It is believed that people are motivated to feign illness by the desire to receive more care and attention, the need for sympathy and psychological support, which they lack.
There are several factors that increase the risk of developing the syndrome. These include:
- childhood mental trauma;
- experience of sexual violence;
- a serious illness suffered in childhood, due to which relatives paid more attention to the child;
- having a relative who suffered from a serious illness;
- loss or death of a loved one;
- identity disturbance, low self-esteem;
- unfulfilled desire to become a doctor or nurse;
- working in the healthcare system;
- histrionic and borderline personality disorder [7]
Unhappy children of the “barons”
In recent years, “Munchausen syndrome by proxy” has emerged: parents, obsessed with treatment, sophisticatedly manipulate the health of their baby, who cannot yet speak. In children, foreign objects are often found in the stomach, lungs, and colon. After the injury, the parents begin a “dramatic fight for the child’s health,” convincing doctors of the need for urgent surgery. This variant of Munchausen syndrome disappears as soon as the baby begins to speak and can present real complaints to the doctor, not those invented by the parents. Unfortunately, such cases often end in death, and the parents of the deceased baby begin a lengthy lawsuit against the doctors who allegedly killed him.
Forecast
When you first become acquainted with the disease, it may seem that the disease does not pose any threat to a person, since it does not affect any organs. But this is not true at all. Patients with the syndrome not only constantly feel lonely, but also risk their health due to mental disorders and unnecessary treatment.
A person with Munchausen syndrome has a deteriorating quality of life, social problems and complications of many diseases:
- Financial difficulties;
- Loss of job;
- Loss of performance;
- Diseases of internal organs, sometimes disability;
- Drug and alcohol addiction;
- Unfavorable communication environment;
- Death.
The police can bring parents to criminal liability if the child’s pathology arose due to the fault of the parents.
In order to improve the life of a patient with the syndrome, you need to register with a psychotherapist and regularly undergo the appropriate course of treatment. Sometimes the patient needs to undergo consultations with other specialists: a psychologist, a neurologist, a family doctor. They will not only help establish a truly correct diagnosis, but also prescribe the necessary treatment. The main thing is to start therapy as early as possible.
Treatment
Patients suffering from this disease require treatment from a psychiatrist. They are prescribed drug therapy based on the action of selective serotonin reuptake inhibitors. Antidepressants, tranquilizers, and antipsychotics are also prescribed. Psychotherapy is used as a concomitant treatment method.
Treatment of Munchausen syndrome will be effective only if the patient himself wants to be cured and follows all clinical recommendations.
What is the difficulty of treatment?
Munchausen syndrome is difficult to treat because the patient is not aware of the psychiatric nature of his illness. For patients with this diagnosis, the need for attention is extremely important. They see the only way to satisfy her is to get into a hospital.
In addition, the treatment of the syndrome is complicated by concomitant diagnoses, the clinical picture of which is overlapped by the demonstrative behavior of the “baron”.
Symptoms of pathology
Doctors who, by virtue of their profession, have direct contact with the Munchausen patient, note that the syndrome itself is an average state between simulation and a borderline state. “Barons and Baronesses” are patients of psychologists and psychotherapists. But direct contact and subsequent treatment are most often refused, provoking conflicts and placing inflated demands on others.
In most cases, they skillfully simulate diseases that can be provoked by taking certain medications (in extreme cases, they injure themselves):
- Heart attack;
- migraine;
- gastrointestinal diseases (ulcers, gastritis, diarrhea, etc.);
- asthma, tuberculosis;
- surgical diseases (appendicitis, adhesions, polyposis, etc.);
- tumors (including brain).
All Munchausen patients have common character traits and behavior, by which they are fairly easy to recognize by general practitioners:
- Artistic and convincing;
- have a rich imagination and fantasy;
- hysterical when rejected;
- self-centered (to the point of delusions of grandeur);
- infantile;
- narcissists;
- have a good education and a high level of intelligence;
- obsessed with the idea of getting well;
- incapable of social adaptation (lonely and not inclined to career growth);
- deceitful;
- have deep knowledge in the field of medicine and psychology;
- lonely and feeling unwanted.
They prepare carefully for each visit to the clinic, thinking through all possible dialogues. Most often, they do not waste time going to the clinic - they immediately call the ambulance service, because “they are dying and need to come immediately.” As a rule, a call is planned on a weekend or at night, hoping for the arrival of inexperienced doctors who will not be able to quickly understand the situation. If they go to the clinic, they deliberately choose the time at the end of the working day or on the day before the day off, when the doctor is already tired and will “fall for” the persuasion of the malingerer.
They do not report their “heroic exploits” of visiting doctors, as well as the results of previously conducted studies, so that it is impossible to trace the dynamics of the “pseudo-disease” and directly catch them in a lie.
The favorite way is to turn to specialists of the highest category, “luminaries of science,” since their disease is complex and difficult to diagnose by ordinary doctors. If the desired diagnosis is not confirmed, they bombard higher management with complaints and accuse the “luminaries” of incompetence, “bought diplomas,” etc.
Data by which you can recognize an adult “baron”:
- Frequent hospitalizations and examinations;
- sharp exacerbations of the disease, which are not confirmed by tests and examination data;
- colorful stories about illnesses and suffering;
- an acute desire to get help (even to the point of surgical intervention);
- an abundance of symptoms of a different nature that are not related to each other (cramps in the calves and asthma, for example);
- constant requests for medications, most often analgesics;
- good knowledge of medical terms and medications;
- instructions to doctors regarding incorrect dosage of drugs, prescriptions, involving them in disputes.
History of the term
Munchausen's disease was named after a real person - a baron who lived in Germany in the eighteenth century. This man not only became the prototype of the main character of the work of Rudolf Erich Raspe, but also gave the name to factitious mental disorder. During his lifetime, Karl Friedrich Hieronymus Baron von Munchausen became famous for his love of telling fictitious and significantly embellished stories.
In relation to the disease, the term began to be used in the fifties of the twentieth century. It was introduced into use by British specialist Richard Asher, while serving as the chief physician of one of the psychiatric hospitals in London. For a long time, the definition covered a wide range of conditions, ranging from deliberate self-harm in order to obtain a degree of disability or evade military service and ending with obtaining any benefits. In modern medicine, Baron Munchausen syndrome is considered as behavior that does not aim to obtain material and material benefits, but is aimed at attracting the attention of others.
Is the syndrome common in Russia?
It is difficult to talk about the prevalence of this pathology in Russia, since it is difficult to recognize. In Russian medical institutions, only 12–15 minutes are allotted to see a patient, which is clearly not enough to suspect the true cause of somatic abnormalities in mental pathology.
Emergency room employees in Russia call patients whose test results do not confirm their complaints as malingerers. They are not referred for examination to a psychiatrist, but are simply discharged. This is due to the fact that Munchausen syndrome is not considered a disease in the Russian Federation.
