Bill’s medical doctor sent him into counseling after several test results verified that his pain was not physical. Over the course of several sessions, Bill’s therapist began to discover the underlying reason for his pain. He has accumulated grief in several parts of his body. As a child, Bill was told that he could not express any hurt, pain, frustration, sadness, or anger. So, Bill stuffed his emotions which resulted in intense pain as he got older. He was diagnosed by his doctor as having Munchausen syndrome.
Is Munchausen another disorder? Yes, it is also known as a factitious disorder which is listed in the DSM-5. This is a mental condition and not a physical one even though physical symptoms are more apparent before the mental ones. A person with Munchausen will believe and then act as if they are sick when they are not. This could manifest in physical or mental illness. It is self-imposed. In extreme cases, the person might harm themselves as a way to prove that there is something wrong and then deny that it happened.
Why the name Munchausen? The name Munchausen is based on a fictional character in a 1785 popular book written by Rudolf Erich Raspe, a German writer. He loosely based Baron Munchausen on a real German aristocratic officer who was known for his elaborate stories and embellishments of his accomplishments and achievements. Although Baron Munchausen was known for his exaggerations in numerous areas, the name has come to refer to just physical symptoms.
What are the clinical symptoms? There are four components according to the DSM-5 of a factitious disorder that can occur as a single event or reoccurring.
- Falsification of physical or psychological signs or symptoms, or induction of injury or disease, associated with identified deception.
- The individual presents himself or herself to others as ill, impaired, or injured.
- The deceptive behavior is evident even in the absence of obvious external rewards.
- The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder.
How does this look to others? Those outside a professional counseling profession may see the warning signs of Munchausen as follows:
- Dramatic physical symptoms with an inconsistent medical diagnosis,
- Unclear and uncontrollable symptoms that become more severe or morph with treatment,
- Predictable relapses occurring just after an improvement,
- Extensive knowledge of hospital procedures, policies, and/or medical terminology,
- Multiple surgical scars,
- Secretly injuring self to fake test results,
- New or additional symptoms that appear following negative test results,
- Symptoms occur only when the person is with others or being watched,
- Unusual eagerness to have numerous medical tests, operations, or procedures,
- History of seeking treatment in different cities at hospitals, clinics, and doctor’s offices,
- More comfortable being in a hospital than at home,
- Reluctance to allow doctors to talk with family, friends, or prior doctors,
- Self-esteem seems to be based on being sick.
Why would a person do this? Usually, there is some type of gain to the person faking the illness, it might be a conscious intention or unconscious. For instance, by remaining the victim of an illness, a person might gain attention, financial support, gifts, or sympathy.
What is the cause? While there is no known cause for Munchausen, it is seen predominantly in those with an underlying personality disorder. The need for attention is met when others (friends and family members) express sympathy for the physical illness. This reinforces the idea that by having a severe illness, the person can gain even more attention. Other causes might be found in a traumatic experience in childhood, extensive hospitalization as a child, neglectful parenting, or helicopter parenting.
Is there another explanation for Munchausen? Yes. Recently, there has been research and books written about the mind-body connection. Several authors have suggested that if the mind is unstable or emotionally unhealthy, this can manifest in physical symptoms as well as cognitive issues (obsessive thinking) and emotional outbursts (anger, sadness). Other authors have suggested that emotional trauma resulting from a PTSD event can also be physically stored in parts of the body resulting in pain. So not only is the PTSD event mental and emotional (reoccurring thoughts, intense anxiety, and stress) but is can be physical as well.
What’s the solution? Working through any PTSD events while paying attention to any areas of the body that might be storing the pain can help to alleviate the physical symptoms. The exercise involves a level of self-awareness of where the physical pain resides, a willingness to address and release the trauma associated with the pain, and persistence to continue doing the exercise as new pains manifest.
What is the exercise? Start by laying down flat and take a couple of deep breaths. Pay attention to the breath and imagine it traveling throughout your entire body. Wherever there seems to ba resistance or pain, place your hand on that part of your body. This is best-done skin to skin. Then take several more breaths. Ask the pain where it is coming from or what memory is linked to it. Thank your body for holding onto that memory and tell it that it is time to release it. Take another couple of deep breaths and repeat the exercise with another area of the body.
What is the treatment? The most important factor is to rule out any and all physical disorders, conditions, or diseases. A medical doctor is usually the one to refer the person to therapy after it is determined that there is no underlying illness. Talk therapy is highly effective in the treatment of Munchausen. A trained therapist can identify the causes of the disorder, suggest more appropriate coping mechanisms, and teach the management of expectations, thoughts, and emotions.
What about medication? Normally, there is no medication that is prescribed for this disorder. However, the medical doctor and the therapist might determine that any underlying depression or anxiety needs to be treated with medication. This can reduce the intensity of the depression or anxiety but not eliminate it. It is still necessary to have talk therapy in addition to any medication.
After several months of therapy, Bill was able to fully recover and the Munchausen syndrome did not reoccur. This is fixable but only if the person is willing and has a desire to move from a place of victimization to victory.