Little known to the general public, Münchhausen or Münchausen syndrome is a factitious disorder that is 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 Münchhausenan 18th century German officer, mythomaniac And storyteller. A factitious disorder is defined as the falsification of physical or psychological symptoms without any obvious external motivation. Münchhausen or Münchausen syndrome is characterized by the need to fake illness or trauma to gain attention or sympathy. “The person presents with a complaint concerning his body – a complaint which he addresses to a third party whom he calls upon. This complaint is related to something she inflicted on herself: wound, skin lesionsalteration of these induced vital parameters, then concealed intake of a treatment”, explains Camille Pellerin, psychiatrist.
Unlike direct Munchausen syndrome, Munchausen syndrome by proxy is a factitious disorder involving an adult responsible for a childWho causes or creates manifestations in this child simulating organic pathology. The adult then seeks care in order to submit the child to useless explorations and treatments. This pathology, considered a serious form of abusewas described for the first time in 1908 by Dieulafoy then in 1977 by R. Meadow, recognized pediatrician.
The person with Münchhausen syndrome will create the symptoms corresponding to a disease. For this, she will not hesitate to inflict trauma. “Most often, she will then challenge the healthcare system and ask for solutions to one’s suffering“, indicates Camille Pellerin. “A patient may, for example, be admitted to the emergency room or to a diabetology department for hypoglycaemia secondary to voluntary injections of insulin but the origin of which the doctors will not understand, since these injections are concealed by the patient.“, completes Dr. Clara Brichant-Petitjean, liberal psychiatrist in Paris. According to the criteria of the DSM-5 (fifth edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association), we can cite three main symptoms:
- There intentional production or feigning of signs or physical or psychological symptoms;
- There motivation of the behavior being to play the sick role;
- I’absence of external motives to this behavior.
Other symptoms may appear: repeated hospitalizationsof the pathological lies that intrigue and fascinate the interlocutor… “The complaints are repeated, there is a return to the emergency room each time… a patient status and a way of calling on the third party is created”notes Camille Pellerin.
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.
In the latest version of the DSM-5 manual of mental disorders, Münchhausen syndrome is classified in the section devoted to disorders with somatic symptomatology: a “behaviour focused on oneself to that directed towards others”.
He is difficult to diagnose Munchausen syndrome. “The diagnosis can often be difficult and long to put on“explains Dr. Clara Brichant-Petitjean. “When the simulated disorders or the complaints are somatic, these patients will rarely consult a psychiatrist spontaneously: we generally note a very low demand for psychiatric help.” The diagnosis is based on the clinical examination and any other complementary examination necessary to “eliminate physical disturbances and demonstration of exaggeration, fabrication, simulation and/or induction of physical symptoms3.” Seeking early psychiatric or psychological consultation remains important, in order to avoid risky invasive examinations, surgical procedures or excessive use of medication as much as possible.
There is no no really effective treatment. If the patient can manage to be relieved thanks to the setting up of a treatment, “the escalation 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 “Factitious disorder imposed on oneself”. 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 disease. In any case, it is necessary to indicate to the patient that cooperation is in place between him and the doctor. “What is most important is to succeed in freeing oneself from the question of renewed somatic complaints around the body.to shift them in an attempt to understand what causes suffering of the person”, recalls Camille Pellerin. “We must try to take the patients away from the complaint and allow them to construct their story differently that way.”
Thanks to Camille Pellerin, psychiatrist and to 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.
- “Factitious Disorder Imposed on Self”, By Joel E. Dimsdale, MD, University of California, San Diego.