Pretending To Be Ill: The Truth About Munchausen Syndrome

Munchausen syndrome can be defined as a rare mental illness in which someone claims to have an illness they don’t really have. People with this condition may go to extreme lengths to make it appear that they are sick. They may exaggerate an illness they already have, do things to their body to induce symptoms, or falsify information altogether. Diagnosing and treating this condition can be extremely challenging, as it tends to be rooted in dishonesty, making it hard to identify the truth.

Pretending to be ill: Factitious disorder imposed on self

In 2000, the condition was renamed in the Diagnostic and Statistical Manual of Mental Disorders as “factitious disorder imposed on self.” People with this condition are usually aware of their deceit and typically want to be seen as ill to receive attention, among other potential benefits. While they may benefit from treatments like cognitive behavioral therapy, those with Munchausen syndrome tend to be unlikely to seek help. However, those impacted by others with the condition can often benefit from the professional insight and support offered by online or in-person therapy.

Symptoms of Munchausen syndrome

People with Munchausen syndrome often use a variety of tactics to lie about or fake their symptoms.

Signs range from mild (slight exaggeration of symptoms) to severe

• Extensive but inconsistent medical history
• Unclear symptoms that do not improve, worsen, or change after treatment
• Relapses after reported improvement
• Deep knowledge of medical terminology and textbook definitions of various illnesses
• Extensive knowledge of hospitals
• Presence of multiple scars from surgeries and other medical interventions
• Appearance of new symptoms after negative test results
• Reports of events happening only when the patient is alone (for example, passing out, throwing up, seizures)
• Eagerness to undergo painful procedures, testing, or surgeries
• History of seeking treatment from multiple doctors or facilities 
• Reluctance to allow health care providers to talk to family members or medical professionals who cared for them in the past
• Identity problems
• Low self-esteem
  

Additional warning signs of this mental health disorder

People with this condition may also harm their bodies to elicit real symptoms. For example, they may inject themselves with chemicals, rub dirt into wounds, put blood in their urine, deliberately dehydrate themselves, or pretend to swallow necessary medication. They may drink something they know is poisonous, physically injure themselves, or lie about feeling depressed or suicidal* after a significant life event that never actually occurred. 

Factitious disorder imposed on another

Munchausen syndrome by proxy, or “factitious disorder imposed on other,” is generally considered to be a form of child abuse. It typically happens when a child’s caretaker, usually the mother, either makes up symptoms or causes real symptoms to make the child sick. Caretakers may go to extremes to fake illness and associated symptoms in their child.

How caretakers may influence a child’s medical history

• Adding blood to the child’s urine or stool
• Not allowing the child to eat so they lose weight
• Falsifying lab results
• Giving the child substances to cause diarrhea or vomiting
• Purposely causing an infection in IV lines or catheters

Most people with this condition are mothers with young children or those caring for an older parent. These individuals may work in healthcare and have extensive medical knowledge. They may describe their child’s symptoms in great detail and like to be involved in the care their child is receiving. 

Outward appearances may suggest that the parent is extremely devoted to their child, making it difficult to pick up on the signs of Munchausen syndrome. However, there are usually potential warning signs to look for in the child that can tell the real story.

Warning signs of factitious disorder imposed on another

• The child has been hospitalized a lot and seen by multiple healthcare providers. 
• The child has been through many surgeries, tests, and procedures.
• The child’s symptoms are inconsistent with any disease and do not match test results.
• The child’s symptoms are never seen by health care professionals, only the caregiver.
• The child’s symptoms disappear in the hospital but return when they get home. 
• The child’s blood samples may not match their blood type. 
• Chemicals or other substances may be found in the child’s stool, urine, or blood.

Diagnosing Munchausen syndrome

Diagnosing factitious disorder imposed on self can be very challenging. People with this disorder are often skilled at faking many conditions, and they may cause enough damage to create a real life-threatening condition. 

Healthcare providers may assist in the identification and diagnosis of Munchausen syndrome by recognizing certain fictitious symptoms. Some signs that may raise suspicion include the person's health records not making sense, injury or illness that occurs without a plausible reason, contradictory or inconsistent lab results, a lack of healing or improvement despite treatment, an illness that does not follow the traditional course, or actively catching the person in the act of lying or causing an injury. 

Diagnosing Munchausen syndrome by proxy

Diagnosing Munchausen syndrome by proxy can also be challenging. Providers may pick up on signs by reviewing the child’s medical history and seeing what the child has been through. Often, this condition goes undiagnosed, but if Munchausen syndrome by proxy is suspected, the child must be protected, which may mean that they need to be removed from the care of the individual suspected of harming them. 

Causes of Munchausen syndrome: Why fabricate medical history?

The exact cause of Munchausen syndrome is currently unknown, but there are a few theories regarding how this syndrome may develop. Some researchers believe that a history of child abuse or neglect or a history of frequent illnesses and hospitalizations may contribute. Other possible causes could include the death of a loved one at a young age and a feeling of abandonment. There may also be a link to personality disorders, as they tend to be common in people with Munchausen syndrome.

Mental health care for Munchausen syndrome

Even when people with Munchausen syndrome are directly confronted with evidence that they have been caught, they are unlikely to admit to their actions. Instead, they may become hostile, file lawsuits, or go to another doctor, hospital, healthcare system, or even state to receive care. 

Although more recent evidence may be necessary, research has shown that treatment with antipsychotic or antidepressant medication is usually not effective for this disorder. 

Standard mental health care for Munchausen syndrome

The standard treatment is typically psychotherapy, specifically cognitive behavioral therapy, which can help individuals identify and work through unhelpful and unrealistic beliefs. However, because most people with this disorder do not agree to treatment, they may never have access to these interventions. That said, the person does not have to admit to any of their deceit or having Munchausen syndrome to attend therapy. Sometimes, therapy focused on any childhood trauma or previous experiences that may have occurred to cause Munchausen syndrome can help. 

Using therapy to manage this mental health disorder

If you know someone who has Munchausen’s syndrome or if you have been affected by Munchausen syndrome by proxy, you may be experiencing many complex feelings. Talking to a therapist can help you understand the condition and learn how to manage your emotions so you can move forward. 

Benefits of online therapy for factitious disorder imposed on self

If you don’t want to attend therapy in person or are looking for a more convenient way to receive care, online therapy through a platform like BetterHelp may be a useful alternative. When you sign up for online treatment, you’ll usually be matched with a vetted mental health professional within 48 hours. You can start treatment from the comfort of your own home and receive personalized support according to your needs. Online therapy generally allows you to move at your own pace so that the process remains comfortable throughout your healing journey. 

Effectiveness of online therapy for managing symptoms

Those who have been affected by Munchausen syndrome often develop mental health conditions like PTSD, depression, anxiety, and more. Research has shown that online therapy can be a useful tool for managing and overcoming these disorders. In a 2022 study, researchers assessed the efficacy of an internet-based therapy intervention for PTSD and found that it typically produced the same results as in-person therapy.