Generality
Münchausen's syndrome is a mental and behavioral illness that causes people to grieve over invented ailments and symptoms; all with the sole intention of putting yourself at the center of the scene and appearing seriously ill.
The symptoms of Münchausen syndrome consist of very particular behaviors, such as self-causing physical damage, altering diagnostic tests, undergoing invasive and dangerous treatments without reason, etc.
Diagnosis is by no means easy, because patients know how to pretend very well.
To heal, a lot of cooperation is needed on the part of the patient, who must realize that he is suffering from Münchausen's syndrome and that he needs help.
What is Münchausen's syndrome?
Münchausen's syndrome is a psychiatric and behavioral disorder, which causes those affected to complain of non-existent diseases and symptoms for the sole purpose of placing themselves at the center of attention and passing for a sick person.
In other words, people with Münchausen syndrome try in every way to place themselves at the center of the scene, inventing physical or psychological problems or deliberately harming themselves.
PLEASE NOTE: Münchausen syndrome is also known as a fictitious disorder or hospital addiction.
EPIDEMIOLOGY
Some Anglo-Saxon research reports that the most ill with Münchausen syndrome are:
- Women between the ages of 20 and 40, who very often work in some hospital facility as a nurse or laboratory technician.
- Unmarried white men aged between 30 and 50.
It is difficult to establish how widespread Münchausen's syndrome is, as the people who suffer from it are very good at "deceiving doctors. Just think that some particularly serious patients, if discovered, turn to other doctors by changing their identity.
VARIANT OF MÜœNCHAUSEN SYNDROME
Figure: A classic example of Münchausen syndrome by proxy is mothers who voluntarily make a child sick to get attention.
Some people voluntarily do harm to those who depend on them in order to attract attention. This particular behavior is linked to the Münchausen syndrome and is, in fact, also called Münchausen syndrome by proxy.
A classic example of Münchausen syndrome by proxy is represented by certain mothers who, to place themselves at the center of the scene, do everything to make their child or children sick.
IS IT HYPOCHONDRIA? OR IS IT THE SO-CALLED "PLAYING SICK"?
Münchausen's syndrome is neither hypochondria nor the so-called "pretending to be ill" to avoid some annoying chore.
Hypochondriacs are people obsessed with "having some disease and who" see ", in every little malaise, a serious pathology. It is not, however, their intention to put themselves morbidly at the center of attention.
People who have the habit of pretending to be sick, on the other hand, are subjects who have a much more concrete personal purpose than those suffering from Münchausen syndrome: they try, with their "inventions", to free themselves from burdensome and unwelcome commitments (for example, in the workplace or school).
WHERE DOES THE NAME COME FROM?
Figure:: the Baron of Münchausen and his adventures were also the subject of a film.
The name Münchausen syndrome derives from a German aristocrat, Baron Karl Friedrich Hieronymus Freiherr von Münchhausen, who was famous for telling fantastic stories and adventures in which he had participated as a protagonist.
Causes
The causes of the onset of Münchausen syndrome are unclear and still have some open points. According to experts, who are keen to clarify that every theory is yet to be proven, hospital addiction could be due to:
- A particular childhood, characterized by an emotional trauma, an emotional disturbance or an illness for which long medical treatments have been practiced.
- A personality disorder, which is a mental health problem for which the affected patient has abnormal thoughts and behavior.
TRAUMATIC CHILDHOOD
The thesis according to which a "traumatic and difficult childhood can give rise to the Munchausen syndrome derives from the" observation that:
- Some sufferers, during their childhood, were abandoned or excessively neglected by their parents. According to experts, this neglect has given rise to the desire in these people to place themselves at the center of attention, sometimes even with dangerous methods (such as by purposely obtaining wounds).
- Other patients were affected, at a young age, by a disease that required special attention and prolonged medical care. According to the supporters of the aforementioned thesis, an event of this kind can lead an individual to desire, even in adulthood, the same regards and the same concern from the world around him.
PERSONALITY DISORDER €
According to some scholars of mental illnesses, there are personality disorders strongly connected to the Münchausen syndrome (N.B: this belief derives from the fact that patients show the symptoms). The three main ones are:
- The antisocial personality disorder. Affected individuals disregard any law or rule of society, are aggressive, irresponsible, indifferent to the feelings of others and disregarding their own or others' safety.
- Borderline Personality Disorder. Affected people have an unstable mood, are extremely impulsive, have turbulent relationships with others, and struggle to organize their thoughts.
- The narcissistic personality disorder. Affected individuals believe they are special or unique, are concerned only with their own personal success, do not give any importance to the feelings of others and are convinced that others feel envious of them.
As you can guess, the three conditions described above lead the patient to isolate himself from the social context and not to have affections or stable relationships with relatives and friends.
Symptoms and Complications
People with Münchausen syndrome complain of ailments they do not have or they self-harm by becoming sick with something, and putting themselves at the center of attention.
They have various habits:
- They "choose" symptoms or physical problems that are difficult to demonstrate or document, such as severe headaches, intense stomach pains, fainting, epilepsy attacks, etc.
- They alter the result of easy-to-tamper diagnostic tests. For example, they warm up the thermometer they used to measure their body temperature or add blood to the urine collected for analysis.
- They self-inflict cuts and burns, purposely take large doses of drugs and / or voluntarily eat expired or badly stored foods.
- They go to great lengths to worsen their suboptimal health condition. For example, if they have gotten a wound (deliberately or not, it is not important), they try to infect it in any way, by touching feces and any object that may be a source of bacteria.
OTHER SYMPTOMATIC BEHAVIORS OF MUNCHAUSEN'S SYNDROME
Münchausen syndrome sufferers are also distinguished by other particular behaviors (such as telling incredible stories about their past, constantly going to all the hospitals in the area where they live, etc.), which are considered extremely indicative of the disease.
The complete list of such behaviors, which could be defined by the term symptomatic, is shown in the table below.
Table. Complete picture of the symptomatic behaviors of a patient with Münchausen's syndrome.
They claim to have had a serious illness in the past, but they cannot document it with anything, because, at the time of this, they lived abroad.
They report symptoms that are not confirmed by any diagnostic test performed.
They have excellent medical knowledge.
While they are hospitalized, they do not receive any visits from relatives and friends (N.B: because they are people who tend to isolate themselves).
Unlike normal people, who fear surgery and invasive diagnostic procedures, they are very open to any type of treatment, even if it is extremely dangerous.
They are very vague in reporting the symptoms of a disease they claim to have or they describe them as if they had consulted a medical text just moments before.
They tell fantastic stories about their past (for example, they tell of having been former sports champions) or about the past of close relatives.
They subscribe to online support groups reserved for people with serious illnesses and participate in them as if they were real patients ("Münchausen on the Internet")
THE SICKS OF MÜœNCHAUSEN SYNDROME AND THE INTERNET
It has recently been discovered that Münchausen syndrome sufferers sign up for online support groups for people with serious illnesses (such as solid tumors, leukemia, cystic fibrosis, etc.) and deceive all participants by telling completely made-up stories.
This very unpleasant situation is now considered a symptom of the disease and has been defined by experts with the term "Münchausen on the internet" (in English it is: Münchausen by internet).
How to recognize a Münchausen syndrome sufferer on the web?
An expert from the so-called "Münchausen on the Internet" has compiled a list of symptomatic behaviors typical of those affected by this condition. Here are the key points:
- They generally write very long messages, full of information and similar in style to a medical website.
- They report having been the protagonists of very serious situations, which were, however, resolved with a miraculous recovery.
- They often contradict each other, because they forget what they say in the first place.
- They report that they are continually at the center of dramatic life experiences, involving them or some of their close relatives.
Diagnosis
Diagnosing Münchausen's syndrome is not at all easy, even for an experienced doctor. This is due to the fact that people with this disease know how to pretend very well and know different ways, all very effective, to do harm without arousing the slightest suspicion.
How is it then possible to notice?
To diagnose hospital addiction it is necessary to pay attention to the details and, above all, to the behaviors that were defined as symptomatic in the previous chapter.
WHAT DO DOCTORS DO IF THEY HAVE SOME SUSPICIOUS?
If a doctor is suspicious of a patient, he generally proceeds as follows. First of all, it evaluates whether or not there is "coherence or not between what the potential patient with Münchausen's syndrome affirmed and what emerges from the preliminary clinical investigations concerning the latter".
Second, try to get in touch with family members or close friends of the patient, to find out if their loved one is a sincere person or if they have some mental disorder.
Finally, it prescribes in-depth tests and chuck-ups, in order to clarify whether the physical ailments in progress are self-procured or not (for example, through a blood test, he understands whether the patient has taken drugs that could give one of the symptoms shown by the patient).
DIFFERENTIAL DIAGNOSIS
Once it is ascertained that the patient is lying about his state of health, the doctor is called to find out the reason for this behavior. To clarify this, he proceeds by exclusion, focusing his attention on three issues:
- Does the subject lie for an economic purpose, such as obtaining a disability or compensation?
- Does the subject lie in hopes of receiving opiate-based pain medications (which may be addictive)?
- Does the subject lie to be able to take time off from work or to escape some heavy duty?
If the answer to the three aforementioned questions is no, and if the only real motivation is to put yourself at the center of attention, then it is possible that the patient suffers from Münchausen syndrome.
The three fundamental points on which the diagnosis of Münchausen syndrome is based:
- Clinical data confirm that the patient self-procures the damage he complains in front of the doctor.
- The motivation that leads to invent, or to self-procure, disorders is due to the desire to pass for a sick person.
- There are no other reasons, if not the previous one, that lead to act against oneself and to harm oneself.
Treatment
Treating people with Münchausen syndrome is very difficult, because, very often, they do not admit or do not realize that they are sick and need help. This leads to the rejection of any form of psychotherapy and the support of experts in the field. However, when the patient is able to understand his condition and agrees to collaborate with his psychotherapist, he has a good chance of healing.
During the therapeutic process, the support of family members and closest friends is also fundamental, who must not isolate the sick relative but stay close to him, especially in the worst moments.
PSYCHOTHERAPY
A collaborative patient, in the hands of an experienced psychotherapist, usually undergoes psychoanalysis and cognitive-behavioral psychotherapy.
Psychoanalysis is based on the research and resolution of unconscious mistaken beliefs (which, according to Sigmund Freud who was the founder of psychoanalysis, are the reason for many mental illnesses).
Cognitive-behavioral psychotherapy, on the other hand, consists in preparing the patient to recognize and dominate the so-called "distorted thoughts" (ie the symptoms of Münchausen's syndrome). It includes a part "in the studio", with the psychotherapist, and a part "at home", reserved for the exercise and improvement of mastery techniques.
SUPPORT OF FAMILIES
As anticipated, family members and close friends must help the patient, even if, at times, it can be difficult to be in his company. To be successful in this, it is essential that these people understand the main characteristics of Münchausen syndrome and know how to behave in times of need.
DRUGS
During psychotherapy, antidepressant drugs, such as selective serotonin reuptake inhibitors (SSRIs), may also be prescribed to deal with any forms of depression due to social isolation.
However, it is good to remember that, with antidepressants alone, you cannot recover from Münchausen's syndrome.
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