Munchausen syndrome

Munchausen syndrome is a rare psychological condition. A person with it pretends to be ill, and they might also harm themselves to cause an illness or make it worse.

They deliberately produce the symptoms of illness in their own body. The main reason is to have people care for them and to become the centre of attention.

A few clues may suggest that a person has Munchausen syndrome:

• visiting hospitals often, and in different areas
• claiming a history of complex and serious medical conditions, with little or no evidence
• claiming they've spent a long time out of the country
• having symptoms that don't match test results
• having symptoms that get worse for no clear reason
• having very good medical knowledge
• getting few or no hospital visitors (they might have little contact with friends or family)
• being willing to go through tests and procedures that are often painful or dangerous
• reporting symptoms that are vague and inconsistent
• reporting a pattern of symptoms that are "textbook examples" of certain health conditions
• telling elaborate stories about themselves, like claiming to be a war hero or to have rich and powerful parents

Someone with Munchausen syndrome may pick symptoms that are hard to disprove, such as a severe headache or pretending to faint.

They may heat a thermometer to show a fever, or add blood to a urine (pee) sample.

A person with Munchausen syndrome may cut or burn themselves. They may also poison themselves with drugs, or eat food that is contaminated with bacteria.

Someone with Munchausen syndrome may try to make their own health worse. They might rub poo into wounds to cause an infection, or open up wounds that had healed.

Some people spend years travelling from one hospital to another, faking illnesses as they go. When the lie is discovered, they may leave the hospital suddenly and move to another area.

People with Munchausen syndrome can be very manipulative. In the most serious cases, they may go through painful, life-threatening surgery, even though they know it's unnecessary.

Munchausen by internet is when a person joins an internet support group for a serious health condition, such as cystic fibrosis or leukaemia, and then claims to have the illness themselves.

This can harm support groups and online communities. People who have a genuine health condition may feel angry and betrayed when they find out the person has been lying.

Munchausen syndrome is complex, and doctors still don't understand it well. Many people with the syndrome won't accept psychiatric treatment or psychological assessment, so it's unclear why they behave the way they do.

Several factors could play a part in Munchausen syndrome. These include:

• emotional trauma or illness during childhood, which often led to a great deal of medical attention
• a personality disorder, which causes patterns of abnormal thinking and behaviour
• a grudge against authority figures or healthcare professionals

Munchausen syndrome can be hard for doctors to diagnose. People who have it are often very convincing, and they're skilled at manipulating and exploiting the doctors and other health workers who care for them.

If doctors suspect Munchausen syndrome, they'll start by looking through the person's health records. They check for differences between the medical history the person claims and the one that's actually on record.

Doctors can also run tests to look for signs that the person has made themselves ill. They can check whether clinical tests have been tampered with. For example, blood samples can be checked for traces of a medicine the person shouldn't be taking, one that might explain their symptoms.

Doctors will also want to rule out other possible motives. The person could be faking illness for financial gain, or because they want strong painkillers.

Munchausen syndrome can usually be diagnosed if:

• there's clear evidence of fabricating or inducing symptoms
• the person's prime motivation is to be seen as unwell
• there's no other likely reason or explanation for their behaviour

Treating Munchausen syndrome can be difficult, because most people with the condition refuse to admit they have a problem. They often won't co-operate with a treatment plan either.

Some experts recommend that doctors take a gentle, non-confrontational approach. This includes suggesting that the person may benefit from seeing a psychiatrist.

Others argue that the person should be asked why they've lied. They might also be asked whether they feel stress and anxiety.

People with Munchausen syndrome have a mental health condition, but they will often only admit to a physical illness.

If a person does admit to their behaviour, they can be referred to a psychiatrist for treatment. If they don't admit to lying, most experts agree that doctors should limit their medical contact with them.

The reason is that the relationship between doctor and patient rests on trust. If there's evidence the patient can no longer be trusted, the doctor is unable to carry on treating them.

Treatment for Munchausen syndrome can help control the symptoms, but only if the person admits they have a problem. They also need to be willing to co-operate with the treatment.

There's no standard treatment for Munchausen syndrome. A combination of psychoanalysis and cognitive behavioural therapy (CBT) might be offered.

Psychoanalysis is a type of psychotherapy. It tries to address beliefs and motivations that a person isn't aware of.

CBT helps a person spot unhelpful and unrealistic beliefs and patterns of behaviour. A therapist then teaches the person ways of replacing those unrealistic beliefs with more realistic ones.

People with Munchausen syndrome who are still in contact with their family may be offered family therapy.

The person and their close family members sit down together and talk about how the syndrome has affected the family. They also talk about the positive changes that can be made.

Therapy can teach family members how to avoid reinforcing the person's behaviour too. For example, they may learn to recognise when the person is playing the "sick role" and to avoid showing them concern or support.