If you’ve ever had a patient who went to great lengths to seem ill—such as harming oneself to create desired symptoms, or sabotaging medical tests—the culprit may be a rare psychological disorder known as Munchausen syndrome.

The primary goal of those who have Munchausen syndrome is to win the sympathy and attention that a truly sick person often gets. Patients with this diagnosis may deny it or become hostile when confronted about it.

 

What does Munchausen look like—and who has it?

Munchausen syndrome can manifest in several ways.

According to an article published by the Cleveland Clinic, people who have this mental disorder may “falsify, exaggerate, or induce physical, emotional, or cognitive disorders.” They achieve this through a number of deceitful and dangerous methods.

Munchausen syndrome (Factitious disorder imposed on self). Cleveland Clinic. Updated November 23, 2020.

 

Patients who falsify illnesses, for instance, may pour blood into their urine to sway test results. Others who induce or exaggerate an illness may strategically injure or poison themselves to be recognized as an ill person.

Smearing feces or dirt into open wounds to catalyze an infection, burning oneself, and eating contaminated foods are also common among patients with Munchausen. (The etymological roots reference an 18th century German officer known as Baron von Munchausen, a man who reportedly embellished the stories he told about his life adventures.)

The people who tend to develop Munchausen may do so as a result of childhood trauma or abandonment. The death of a loved one early in life, for example, may lead the patient to feel they weren’t taken care of.

The authors of an article published by StatPearls wrote about how this dynamic lays the groundwork for Munchausen syndrome.

Weber B, Gokarakonda SB, Doyle MQ. Munchausen syndrome. StatPearls Publishing. Updated May 8, 2022.

 

“Through the fabrication of a medical illness, these patients are able to receive the attention and, sometimes, care within the healthcare community that they might not have had at home.”

Of the relatively few patients who have accepted their diagnosis, [they] almost always report that their intention was to create a sense of importance and find a place of ‘belonging.’

 

Prevalence and diagnostics

Munchausen syndrome affects approximately 1.3% of all hospitalized patients in the US.

An article published by Nursing Clinics of North America states that diagnosing Munchausen syndrome in patients is often a complex process due to the presentation of the illness.

Abeln B, Love R. An overview of Munchausen syndrome and Munchausen syndrome by proxy. Nursing Clinics of North America. 2018;53(3):375–384.

You may consider Munchausen a possibility in patients, however, if the illness they claim to have presents in an unusual way, or if treatment does little to help.

 

Those who do have Munchausen syndrome are subject to significant morbidity and mortality.

 

Treating Munchausen syndrome

So, what is the treatment protocol for this rare psychological disorder?

According to StatPearls, psychotherapy is the go-to treatment method. Specifically, cognitive behavioral therapy can be used to uncover and address childhood trauma that may have led to the development of Munchausen syndrome.

While the patient doesn’t need to admit to having a factitious disorder, you can still initiate referrals to psychiatric resources including therapy.

Outside of therapies, patients with Munchausen syndrome have not been shown to benefit from medications such as antidepressants or antipsychotics.

Above all, physicians should maintain an empathetic and supportive approach when treating patients with Munchausen syndrome. You may find evidence of other psychiatric illnesses as you get to know these patients.