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Munchausen Syndrome

What Is It, Causes, Diagnosis, and More

Author:Nikol Natalia Armata

Editors:Alyssa Haag,Emily Miao, PharmD,Kelsey LaFayette, DNP, RN

Illustrator:Jillian Dunbar

Copyeditor:Sadia Zaman, MBBS, BSc


What is Munchausen syndrome?

Munchausen syndrome, also known as factitious disorder imposed on self, refers to a psychiatric condition in which an individual intentionally presents with a physical or mental illness without actually having a health problem. In most cases, individuals with Munchausen syndrome are seeking the attention of being a “patient.” Initially, their medical diagnosis may be characterized as medical mysteries as their clinical presentation and diagnostic workup can be inconsistent. 

What is Munchausen syndrome by proxy?

Munchausen syndrome by proxy is another psychiatric condition in which caregivers act as if the individual they are taking care of—usually a child or an elderly adult—has a physical or mental health condition when the individual is actually healthy. Munchausen syndrome by proxy is considered a form of abuse, as it often involves repetitive medical tests and/or unnecessary treatments. Notably, it has been observed that victims of individuals with Munchausen syndrome by proxy may later on develop Munchausen syndrome themselves. 

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What causes Munchausen syndrome?

The exact cause of Munchausen syndrome is currently unknown, yet several common factors have been identified in the affected individuals. People with Munchausen syndrome  often experience traumatic childhood experiences, like abuse from family members, loss of a loved one at a young age, and abandonment. In such cases, it has been postulated that individuals pretend to have medical problems in order to receive the attention they never received. 

What are the signs and symptoms of Munchausen syndrome?

Signs and symptoms of Munchausen syndrome vary in presentation, but mainly consist of somatic complaints, such as chest and abdominal pain, vomiting and diarrhea, or anemia leading to weakness. Other common presentations include hypoglycemia, infections, seizures, headaches, vision loss,  skin wounds, and arthralgias. Those symptoms may even be intentionally generated by harming themselves, overdosing on medication, or performing another action that would then require the intervention of a health care professional. However, their test results and clinical presentation typically differ, thereby creating a puzzling case for the health care professionals. 

How is Munchausen syndrome diagnosed?

Diagnosing Munchausen syndrome can often be challenging as the clinical presentation of individuals may be misleading, therefore, it is frequently underdiagnosed. Individuals with Munchausen syndrome usually have a long history of hospitalizations in many different hospitals and visits to multiple healthcare facilities, however, many refuse to share their medical records and the results of their medical tests. 

The diagnosis is generally based on an individual’s medical history, as well as clinical presentation. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) mentions the  four criteria that are required in order to confirm the diagnosis. Firstly, the individual must intentionally present to others as sick, harmed, or injured, fabricating physical or psychological signs and symptoms, or self-inducing injury or illness. Secondly, their deceptive behavior should be evident even in the absence of obvious external rewards. Next, the presenting symptoms must not be better explained by another mental disorder, such as a delusional or depressive disorder. Finally, there must be evidence that the suspected individuals are intentionally implying various medical conditions. Underlying psychiatric conditions, like schizophrenia, should always be excluded. 

How is Munchausen syndrome treated?

The only effective treatment for individuals with suspected Munchausen is psychotherapy. If individuals become aggressive and deny needing help when first approached with the diagnosis, it is necessary to provide them with such support. It is not necessary for the individual to admit their condition and notably, most of them never do. However, cognitive-behavioral therapy (i.e., a type of psychotherapy that helps individuals modify dysfunctional thinking and behavior, as a way of solving current problems), targeted toward their childhood trauma, has shown to be very helpful in treating the condition. There isn’t robust evidence to support that administering medications, like antidepressants or antipsychotics, are beneficial for Munchausen syndrome.  

What are the most important facts to know about Munchausen syndrome?

Munchausen syndrome, also known as factitious disorder imposed on self, refers to a psychiatric condition in which individuals consciously fake symptoms of illness without actually being sick. The exact cause of Munchausen syndrome is currently unknown, yet several factors, like traumatic childhood experiences, loss of a loved one at a young age, and abandonment, are common factors noticed in individuals with this syndrome. The diagnosis is mainly based on four criteria according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Treatment mainly relies on psychotherapy and requires a supportive approach by health care professionals in order to be better tolerated by the individual. 

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Related links

Factitious disorder
Somatic symptom disorders: Clinical practice

Resources for research and reference

Melton L. (2017). Brief Introduction to Cognitive Behavioral Therapy for the Advanced Practitioner in Oncology. Journal of the advanced practitioner in oncology, 8(2): 188–193. DOI: 10.6004/jadpro.2017.8.2.6

University of Michigan Health. (2022). Munchausen Syndrome by Proxy. In University of Michigan Health Michigan Medicine. Retrieved November 9, 2021, from https://www.uofmhealth.org/health-library/hw180537.  

Weber, B., Gokarakonda, S. B., & Doyle, M. Q. (2021, July 31). Munchausen Syndrome. In StatPearls [Internet]. Retrieved February 11, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK518999/