Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Munchausen syndrome is a condition in which a person intentionally fakes, simulates, worsens, or self-induces an injury or illness for the main purpose of being treated like a medical patient. Munchausen syndrome is named after a German military man, Baron von Munchausen, who traveled around telling fantastic tales about his imaginary exploits. In 1951, Richard Asher applied the term to people traveling from hospital to hospital, fabricating various illnesses.
The term Munchausen syndrome is often used interchangeably with factitious disorder. Factitious disorder refers to any illness that is intentionally produced for the main purpose of gaining attention associated with assuming the sick role, although that purpose is unknown to the "sick" person. Munchausen syndrome most appropriately describes people who have a chronic variant of a factitious disorder with mostly physical signs and symptoms, although there are reports in literature regarding psychological Munchausen syndrome, meaning that the simulated symptoms are psychiatric in nature.
People with Munchausen syndrome intentionally cause signs and symptoms of an illness or injury by inflicting medical harm to their body, often to the point of having to be hospitalized. These people are sometimes eager to undergo invasive medical interventions. They are also known to move from doctor to doctor, hospital to hospital, or town to town to find a new audience once they have exhausted the workup and treatment options available in a given medical setting. People with Munchausen syndrome may also make false claims about their accomplishments, credentials, relations to famous people, etc.
A related condition, called Munchausen by proxy syndrome, was described
using that term in 1977 by Roy Meadow in cases involving caregivers who fake
symptoms by causing injury to someone else, often a child, and then want to
be with that person in a hospital or similar medical setting. Since mothers continue to be the primary caregivers in many societies, the mother is often the individual identified as having Munchausen
syndrome by proxy, but anyone in the role of parent or caregiver may develop this condition. Accurate statistics on how many people have this condition are difficult to determine because of its secretive aspect. Estimates range from
one in 1 million children to 2.8 in 100,000 children.
Child protective services, law enforcement, and doctors are all involved in treatment for Munchausen syndrome by proxy. Caregivers who have this condition need long-term counseling. They may resist treatment or deny that there is a problem. Medicines are used only when the caregiver has another health problem, such as anxiety disorder, along with MSBP.
Even after treatment, caregivers may repeat their behavior. So doctors, counselors, and family members need to closely watch how the caregiver interacts with her children.
For victims, the first step is to protect the child by moving him or her into safe custody. Then a doctor will monitor the child for symptoms. Most of the time, the child's symptoms stop after the child is away from the caregiver. Some children need counseling or other help.
The medical case literature provides compelling documentation of patients who have intentionally exaggerated, feigned, simulated, aggravated, or self-induced an illness or injury for the primary purpose of assuming the sick role.
