Münchhausen syndrome or Münchausen is a disorder characterized by the simulation of an illness or trauma. Difficult to diagnose, its management remains complex.
Considered a chronic factitious disorder, this syndrome takes its name from Baron Von Münchhausena German officer from the 18th century, mythomaniac And confabulator. Factitious disorder is defined as falsification of physical or psychological symptoms without obvious external motivation.
What is Münchhausen syndrome?
It is a syndrome characterized by the need to fake illness or trauma to gain attention or compassion. “The person presents himself with a complaint concerning his body – a complaint which he addresses to a third party whom he calls upon. This complaint is linked to something she inflicted on herself: wound, skin lesionsinduced alteration of these vital parameters, then concealed treatment”, explains Camille Pellerin, psychiatrist. In the latest version of the American mental disorders manual DSM-5, Münchhausen syndrome is classified in the section dedicated to disorders with somatic symptoms : A “behavior focused on oneself rather than that directed towards others”.
What is Münchhausen syndrome by proxy (MPPS)?
THE Münchhausen syndrome by proxy is a factitious disorder involving an adult responsible for a childWho causes or creates manifestations in this child simulating an organic pathology. The adult then seeks care to subject the child to unnecessary explorations and treatments. This pathology, considered a serious form of mistreatmentwas described for the first time in 1908 by Dieulafoy then in 1977 by R. Meadow, a recognized pediatrician.
The 3 main symptoms to know
The person with Münchhausen syndrome will create symptoms corresponding to an illness. For this, she will not hesitate to inflict trauma on oneself. “Most often, it will then challenge the healthcare system and ask for solutions to their suffering“, indicates Camille Pellerin. “A patient may, for example, be admitted to the emergency room or to a diabetology department for hypoglycemia secondary to voluntary insulin injections but whose origin the doctors will not understand, since these injections are hidden by the patient“, adds Dr Clara Brichant-Petitjean, liberal psychiatrist in Paris. According to the DSM-5 criteria, we can cite three main symptoms:
- There intentional production or feinting of signs or physical or psychological symptoms;
- There motivation of the behavior being to play the role of patient;
- L’absence of external motives to this behavior.
Other symptoms may appear: repeated hospitalizationsof the pathological lies which intrigue and fascinate the interlocutor… “The complaints are repeated, there is a return to the emergency room each time… a sick status and a way of calling on the third party is created”notes Camille Pellerin.
“The diagnosis can often be difficult and time-consuming to make”
What are the causes ?
The exact causes of Münchhausen syndrome are not not known, even if we often find in patients a history of stress, anxiety-depressive disorder, severe personality disorder – most often borderline traits (borderline).
He is difficult to diagnose Münchhausen syndrome. “The diagnosis can often be difficult and time-consuming to install“explains Dr. Clara Brichant-Petitjean. “When the simulated disorders or complaints are somatic, these patients rarely spontaneously consult a psychiatrist: we generally note a very low demand for psychiatric help.” The diagnosis is based on the clinical examination and any other additional examination necessary to “eliminating physical disorders and the demonstration of exaggeration, fabrication, simulation and/or induction of physical symptoms.”
What is the treatement ?
There does not exist no real effective treatment. If the patient can achieve relief through the implementation of treatment, “the overbidding appears quickly and the doctor ends up being overwhelmed by his requests“, writes Joel E. Dimsdale, a researcher at the University of San Diego and author of the article “Factificial Disorder Imposed on Self.” SO, “a non-aggressive, non-punitive, non-confrontational approach should be considered when diagnosing factitious disorder presented to patients.” Some experts recommend a psychological treatment without requiring patients to admit their role in their illness. In all cases, it is necessary to indicate to the patient that cooperation is established between him and the doctor. “What is most important is to be able to free ourselves from the question of renewed somatic complaints around the bodyto shift them in an attempt to understand what causes suffering of the person”, recalls Camille Pellerin. “We must try to decenter patients from the complaint and allow them to construct their story differently that in this way.”
Thanks to Camille Pellerin, psychiatrist and Dr Clara Brichant-Petitjean, liberal psychiatrist in Paris.
- “Munchausen’s syndrome: a factitious disorder?”, A case report E. Reich, H. Kajosh, P. Verbanck and C. Kornreich, Department of Psychiatry, CHU Brugmann.
- “Factificial Disorder Imposed on Self,” By Joel E. Dimsdale, MD, University of California, San Diego.