What is Münchhausen Syndrome?
Münchhausen Syndrome is characterized by the intentional production of physical symptoms by the subject, so that he/she receives medical treatment. Among the characteristics of the syndrome, we can mention pathological lying and pilgrimage between hospitals to receive medical treatment.
The DSM – IV, the Diagnostic and Statistical Manual of Mental Diseases, classifies Münchhausen syndrome in the group of Factitious Disorders and specifies the predominance of physical symptoms. For this, it establishes the following diagnostic criteria: A) intentional production or simulation of predominantly physical symptoms and signs; B) the sick role is what motivates the behavior; C) absence of external incentives for behavior (economic gain, avoidance of legal responsibility or improvement in physical well-being). It cannot occur exclusively during the course of another Axis I disease, such as schizophrenia.
How is the diagnosis made?
The diagnosis of Münchhausen Syndrome is quite complex and requires attention to details beyond diagnostic criteria. It is essential to know the patient's medical history, where data such as the number and places of hospitalization can be found in the in recent years, in addition to the reasons for leaving the hospital, since a large number of patients in this condition leave the room against guidance doctor. Paying attention to some signs can be quite significant, including:
- Incompatibility of stories told;
- Great knowledge of medical terminology, without worrying about the consequences of the diseases to which it is attributed (belle indifference);
- Self-destructive behaviors;
- Presence of symptoms without the underlying disease;
- Difficulty in responding to appropriate medical treatments for the physical condition;
- Response to placebo treatments;
- Exacerbation of symptoms when the patient knows he is being watched.
It is important to emphasize the similarity of the characteristics with some symptoms of psychotic illness, such as schizophrenia. However, the absence of psychotic symptoms is striking in Münchhausen Syndrome, which facilitates the diagnosis, without ruling out the possibility of association with the personality disorder condition, such as Borderline.
What are the possible treatments?
The main objective of any treatment for Münchhausen Syndrome is to avoid the damage resulting from medical procedures that are not necessary for the patient. Furthermore, the treatment should aim at establishing some type of therapeutic relationship, although there is still no consensus on the best psychological approach to this problem. Psychiatric follow-up is extremely relevant in these cases.
Careful observation and the effort to understand the diagnosis are essential. Thus, it is important to emphasize the human character of the training of the medical team to welcome patients with Münchhausen syndrome, since many of these patients are mistaken for liars, pretenders. In these cases, instead of helping the patient, the team ends up establishing aversive relationships and, in some cases, it even prosecutes the patient legally or punishes him with poor quality and inhumane care. The best option is always to avoid confrontation, allowing the patient to know their situation gradually, aiming at cooperation and acceptance of the treatment. It is necessary for the patient to understand that their situation is not physical, but psychic, so that the chances of adhering to treatment increase. The use of antidepressants and other medications seems to be effective only in cases where there is a concomitant affective disorder.
How to find out more?
The series House presented for eight seasons the daily life of a doctor inside a hospital dealing with diagnostic enigmas. Among these, the ninth episode of the second season – “The Disappointment” (deception) – presented a case of Münchhausen Syndrome that can be very illustrative about the conditions and the relationship that patients establish with the medical system and treatment.
It is important to remember that, in some cases, Münchhausen Syndrome can establish itself in the mother-infant relationship, in this way, the mother would cause symptoms in the child so that later she could treatment. In these cases, it is Münchhausen Syndrome by Proxy, precisely when the disease is caused in another person close, most of the time, their own children. In these cases, it is important for the mother and the child to be immediately removed for treatment so that she can receive specific care. On this subject, Discovery Home&Health launched, in 2011, the documentary series “My Mother, My Assassin” (Munchhausen Moms) which tells the story of women with this pattern of behavior.
Juliana Spinelli Ferrari
Brazil School Collaborator
Graduated in Psychology from UNESP - Universidade Estadual Paulista
Brief psychotherapy course by FUNDEB - Foundation for the Development of Bauru
Master's Student in School Psychology and Human Development at USP - University of São Paulo
Source: Brazil School - https://brasilescola.uol.com.br/doencas/sindrome-munchausen.htm