Munchausen Overview


People with Munchausen syndrome often make themselves or their child sick.
George Doyle/Getty Images

Being sick is something most people try to avoid. A small percentage of people, however, relish the thought of going to the doctor, undergoing

tests -- even having painful surgery. Though they know they aren't really sick, people with Munchausen syndrome pretend to be ill because they're seeking attention and sympathy.

Munchausen syndrome is a strange -- but very real -- mental health condition. It's the most severe type of factitious disorder, a group of conditions in which people purposely exaggerate, invent or even cause disease symptoms.

It's hard to know exactly how many people have Munchausen syndrome because most are so adept at hiding their behavior. Some people even adopt aliases or travel to different areas to avoid detection.

In 1951, British physician Richard Asher first described the condition in the medical journal The Lancet. He named it after Baron von Munchausen, an 18th-century German military officer who told highly exaggerated tales about his life.

Munchausen syndrome isn't the same thing as hypochondria, a condition in which people really believe that they are sick. Those with Munchausen know that they are healthy, but they want to be sick. It's also different than malingering, in which people pretend to be sick for financial gain (such as to win a lawsuit) or to get out of work.

In this article, we'll look into the mysteries of Munchausen syndrome, as well as the related Munchausen syndrome by proxy, and find out why anyone would want to hurt themselves -- or another person -- just to get attention.

Munchausen Syndrome Causes

Researchers aren't sure exactly what causes Munchausen syndrome, but they believe the risks include:

  • A history of sexual, physical or emotional abuse
  • A serious illness during childhood
  • A relative who was seriously ill or died
  • A career in the health industry, or a desire to work as a health professional
  • Poor self-esteem
  • A personality disorder, such as self-destructive behavior, passive-aggressive personality or poor impulse control

Most people who have the condition are either young or middle-aged, but Munchausen syndrome can occur at any age.

People with Munchausen syndrome will go to great lengths to feign illness. They might pretend to be sick by tampering with instruments (for example, heating a thermometer) or altering blood or urine samples, or they might actually cause symptoms by injecting themselves with foreign substances (such as toxins) or taking unnecessary medications.

Some of the symptoms of Munchausen syndrome include:

  • Symptoms that fit precisely into the textbook description of an illness but that can't be controlled with treatments
  • An eagerness to undergo different tests and procedures, no matter how uncomfortable or painful they are
  • An inconsistent medical history
  • A willingness to travel to different doctors and hospitals (sometimes in far-flung areas)
  • An in-depth understanding of illnesses and hospital procedures
  • A refusal to let doctors talk to their family or friends

Munchausen syndrome can lead to real health problems from taking medicines and undergoing unnecessary procedures. It also can increase the risk of suicide, interfere with work and family relationships, and can even lead to death.

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Munchausen Syndrome by Proxy

In the late 1970s, a British pediatrician named Roy Meadow published an account of two baffling medical cases. In one case, a 6-year-old girl named Kay had been admitted to the hospital 12 times for a urinary tract infection and had been treated with eight different antibiotics -- all unsuccessfully. In the other case, a 14-month-old boy named Charles had been hospitalized many times with drowsiness and vomiting that had no apparent medical cause. Meadow ultimately discovered that the two cases, although they appeared different, had a lot in common. Kay's mother had altered her urine samples to make it appear as if the child were sick. Charles's mother had induced his illness by feeding him large quantities of salt (he eventually died).

Meadow called this condition, in which caregivers knowingly falsify information or inflict harm on their children to garner sympathy, Munchausen syndrome by proxy. Proxy means "through a substitute." The caregiver, not the sick person, is the one faking or causing the illness.

Munchausen syndrome by proxy has also been called Polle syndrome, for Baron von Munchausen's son Polle, who reportedly died under mysterious circumstances around the time of his first birthday. However, some experts say that historical information is incorrect, and the term is no longer used today.

This condition is very rare -- there are only about 1,000 cases a year, according to best estimates. The most common scenario is a mother pretending that her child is sick, or making her child sick because she craves the sympathy she receives as a result. The mother might change test results (for example, by adding a foreign substance to a urine test), inject chemicals into the child, withhold food, suffocate the child or give drugs to cause vomiting. Then the mother will insist that the child go through many tests or procedures to treat the supposed problem. Because the victim is a child, Munchausen syndrome by proxy is considered a form of child abuse.

Someone who has Munchausen syndrome by proxy may be seeking attention because she was abused or lost a parent as a child, or is going through difficult marital problems or another major life stress. Being seen as the caring parent by hospital staff is a way to earn praise that the sufferer might not have garnered otherwise.

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Signs of Munchausen Syndrome by Proxy

Signs of Munchausen syndrome by proxy include:

  • A child who is often hospitalized with unusual and unexplained symptoms that seem to go away when the caregiver is not present
  • Symptoms that don't match the child's test results
  • Symptoms that worsen at home but improve while the child is under medical care
  • Drugs or chemicals in the child's blood or urine
  • Siblings of the child who have died under strange circumstances
  • A caregiver who is overattentive to the child and overly willing to comply with health care workers
  • A caregiver who is a nurse or who works in the health care field

V­ictims of Munchausen syndrome by proxy have to go through unnecessary tests and treatments that can be painful or even dangerous. Because the caregiver seems so genuinely concerned, it's often hard for doctors to spot the problem before it's too late. This difficulty discerning Munchausen syndrome by proxy from real illness has led to a number of false allegations against parents.

In the 1990s, Dr. David Southall of England conducted an experiment using hidden video surveillance in hospital rooms to catch those suspected of having Munchausen syndrome by proxy. His video cameras captured horrifying images of mothers smothering and poisoning their children. Of the 39 suspected abusers he videotaped, 34 were captured on tape hurting their children and five later admitted to killing their children.

Although Southall was hailed as a champion of children in some­ circles, he was vilified as an enemy of mothers in others. A number of parents were sent to prison, and some say falsely accused, based on evidence he provided. In 2004, Southall was found guilty of serious professional misconduct after falsely accusing a man of murdering his children, and was temporarily banned from working with child abuse victims.

Munchausen Syndrome Treatments

Doctors have to do a lot of investigating to figure out that a patient has Munchausen syndrome.
Doctors have to do a lot of investigating to figure out that a patient has Munchausen syndrome.
George Doyle/Getty Images

Both types of Munchausen syndrome are difficult to treat because people who have these conditions are unwilling to admit they have a problem. Doctors have to investigate the patient's medical history and perform medical tests to confirm that the problem is psychological and not than physical.

Treatment for Munchausen syndrome usually involves psychiatric counseling to change the thoughts and behaviors that are causing the condition. Sometimes medication can help ease depression or anxiety if those are factors.

With Munchausen syndrome by proxy, it's important to get the child away from the caregiver before any further harm is done. The child may need treatment both for the physical complications of having undergone unnecessary tests and procedures, and for the psychological scars of abuse. About 10 percent of children who have been victims of Munchausen syndrome by proxy will die. Others could go on to develop Munchausen syndrome when they grow up.

Famous Cases

  • William McIlhoy made it into "Guinness World Records," but he didn't have many fans at Britain's National Hospital Service. After 400 operations in 100 different hospitals, McIlhoy ran up $4 million worth of medical bills. The famous Munchausen syndrome sufferer died in a retirement home in 1983.
  • All nine of Marybeth Tinning's children died between 1972 and 1985, most of them under mysterious circumstances. Each time, she faithfully played the role of the distraught mother and basked in the sympathy. When she was finally arrested in 1986, Tinning admitted to having smothered her children with a pillow. As is often the case with spouses of Munchausen by proxy parents, her husband hadn't interceded, despite his suspicions. When interviewed, he said, "you have to trust your wife. She has her things to do, and as long as she gets them done, you don't ask questions." [source: Crime Library]. Marybeth Tinning was convicted of murder in 1987 and was sentenced to 20 years in prison.
  • When five of Waneta Hoyt's six children died between 1965 and 1971, doctors suspected sudden infant death syndrome (SIDS). The case was even featured in prominent medical journals. But when New York State Prosecutor William Fitzpatrick read about the case, he grew suspicious. His investigation led to Hoyt's arrest in 1994. When she was interrogated, Hoyt broke down and admitted that she had killed her children in an attempt to quiet them. She was sent to prison for life.

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