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Munchausen syndrome

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Munchausensyndromeisararetypeofmentaldisorderinwhichapersonfakesillness.Theperson
maylieaboutsymptomsorelseproducesymptomsusingtrickeryorself-harm.Apersonwith
Munchausensyndromecanbeveryconvincing,whichresultsindoctorsprovidingunnecessary
treatmentincludingsurgery.
ApersonwithMunchausensyndromedoesntpretendtobeillforpersonalgain,suchas
prescriptiondrugsormoney.Instead,thepersonisdrivenbycomplexpsychiatricreasons,
includinganabnormaldesireforattentionandsympathy.
Thistypeofmentaldisorderismostoftenseeninyoungadultsandisconsideredatypeofselfmutilation.OftenapersonwithMunchausensyndromeisemotionallydisturbedfromatroubled
childhood.Munchausensyndromeisalsoknownasfactitiousdisorder.

Symptoms
ApersonwithMunchausensyndromegainsintensesatisfactionfromtheattentionassociatedwith
playingtheillpatientorvictim.SignsandsymptomsthatmaysuggestMunchausensyndrome
include:

Aspectacularmedicalhistorythatincludesalargenumberoftests,medicalprocedures
andoperations
Oddcollectionofseeminglyunrelatedsymptoms
Noconclusiveresultsdespiteintensemedicalinvestigations
Newsymptomsthatappearaftermedicaltestsprovenegative
Extensivemedicalknowledgeofmanydifferentillnesses
Frequentingmanydifferentdoctors,sometimesinotherstates
Frequentpresentationatemergencydepartments,usuallyatdifferenthospitals
Requestsforinvasivemedicalproceduresorsurgeries
Failuretoimprovedespitemedicaltreatment,includingrelapsingforunknownreasons.

Common tactics
ApersonwithMunchausensyndromemayconvincedoctorsinmanyways.Forexample,theymay:

Pretendtobeinpain
Exaggeratesymptoms
Fakesymptoms,includingpsychologicalsymptoms
Poisonthemselveswithchemicals
Infectthemselveswithuncleansubstances
Tamperwithdiagnostictestsforexample,contaminateaurinesamplewithsugaror
blood
Interferewithamedicalconditionsothatrecoveryisntpossibleforexample,repeatedly
openorcontaminateaskinwoundornottakeprescribedmedication
Ignoreagenuinemedicalproblemuntilitbecomesserious.

Common complications
ApersonwithMunchausensyndromeisatriskofmanycomplicationsincluding:

Sideeffectsfromprescriptionmedicines,includingoverdose
Complicationsfrompoisoningorself-harmpractices

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Complicationsfrommedicalproceduresorsurgeries
Deathfromself-harmorcomplicationsofmedicalintervention.

Risk factors
SomepeoplemayhaveahigherriskofdevelopingMunchausensyndromethanothers.Riskfactors
mayinclude:

Chronicillnessduringchildhoodthepersonmayhavereceivedalotofattentionbecause
oftheirillness
Chronicillnessofasignificantfamilymemberwhenthepersonwasachild
Self-esteemoridentityproblems
Relationshipproblems
Difficultydistinguishingrealityfromfantasy
Abilitytolieandmanipulate
Ahistoryofmentalproblemssuchasdepression,hallucinationsorpost-traumaticstress
disorder(PTSD)
Theneedtoblamepersonalfailuresonexternalfactors,suchasillness.

Diagnosis
Diagnosisisdifficultbecausearangeoflegitimatephysicalandmentalillnessesmustberuledout
first.Tocomplicatemattersfurther,apersonwithMunchausensyndrometendstoseekhelpfrom
varioushealthcareproviderstoavoidtippingoffanyonedoctor.Diagnosis,ifithappensatall,
maydependonabstractconceptssuchas:

Thepersonssymptomsdontmakesensewhencomparedwiththetestresults.
Thepersonisunusuallyeagertoundergoinvasivemedicalproceduresandoperations.
Thepersondoesntrespondtotreatmentsinapredictablefashion.
Otherpeopleinthepatientslifedontconfirmthepersonssymptoms.

Treatment
Treatmentaimstomanageratherthancurethecondition,butisrarelysuccessful.Recoverytends
tobeslowornon-existent.Treatmentoptionsmayinclude:

Medicationstotreatassociatedmentaldisorderssuchasdepressionoranxiety.
Unfortunately,apersonwithMunchausensyndromemaymisuseprescriptiondrugsto
provokesymptomsforfurthermedicalintervention.
Cognitivebehaviourtherapy(CBT)mayhelptochangethepersonsbeliefsandactions.
However,thetypicalpersonwithMunchausensyndromewillneveradmittofalsifying
symptoms,whichmakesprogressdifficult.Somepatientsflatlyrefusepsychiatrichelp.
Avoidingunnecessarytestsandsurgeriesisimportanttoreducetheriskofcomplications.
However,thetypicalpersonwithMunchausensyndromemovesontootherdoctorsand
startstherusealloveragain.

Munchausen syndrome by proxy

Munchausensyndromebyproxy(MBP)wasthetermpreviouslyusedforararebutseriousformof
abusewherethepersoneitherfakesorproducessymptomsinsomeoneelse,usuallytheirchild.In
Australia,MBPisnowknownasfabricatedorinducedillnessbycarers(FIIC),todistinguishit
fromthementaldisorderMunchausensyndrome.InAustralia,FIICisconsideredchildorvictim
abuse,ratherthanamentaldisorder.
Typically,thecarerdeliberatelypoisonsorharmsthechildtoprocureunnecessarytestsand
medicalprocedures.Themostcommonformofabuseappearstobeapnoea(stoppingbreathing).
Thechildmayberevivedbyambulanceofficersandtakentohospital,wherealltestsprove
negative.Sometimesthechilddoesntsurvivethecarer-inducedapnoea.
FIICisveryrare,withestimatessuggestingthatbetween15and24casesoccurinAustraliaevery
year.Themotheristheperpetratorinmostcases.However,thisisthoughttoreflectthehigh
numberofwomenwhotakeontheroleofprimarycaregiver.

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Where to get help

Yourdoctorforinformationandreferral
Communitymentalhealthservice
AustralianPsychologicalAssociationonTel.1800333497
AssociationforRelativesandFriendsoftheMentallyIll(ARAFMI)Tel.1300794992
ChildProtectionCrisisLine(24hrs,7daysaweek)Tel.131278

Things to remember

Munchausensyndromeisamentaldisorderinwhichthepatientfakesillnesstogain
attentionandsympathy.
Recoveryisslowornon-existent.
Munchausensyndromebyproxy(MBP)istheoldtermforaformofabusewherethe
personeitherfakesorproducessymptomsinsomeoneelse,usuallytheirchild.Thisisnow
calledfabricatedorinducedillnessbycarers(FIIC)andisdifferenttoMunchausen
syndrome.

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MentalHealthFoundationofAustralia
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