What are Munchausen's Syndrome and Malingering?
One is a Factitious Disorder in Which Illness is Faked
People with Factitious Disorders deliberately manufacture or fake psychological or physical symptoms. Their motivation is only to take on the role of being sick. Other incentives for the behavior, such as monetary gain or avoiding legal accountability, are absent. Sub-classifications are based on whether the symptoms are primarily psychological, physical or both.
Munchausen’s Syndrome
People with this disorder fake, exaggerate, or produce illnesses. They want attention and nurturing from others and feel this is the only way they can receive it. They don’t look for material gains such as monetary assistance or narcotics, although they might obtain them. In some cases, feigning illness is an expression of anger, envy or wanting to control others.
Richard Asher MD coined the term “Munchausen’s Syndrome,” based on a character in Rudolph Erich Raspe’s fictionalized book about the18th century Prussian cavalry officer, Baron Karl Friedrich Hieronymus Freiherr von Munchhausen, who allegedly told outrageous stories about his adventures.
Hypochondriasis differs from Munchausen’s in that hypochondriacs don’t deliberately fake illnesses. They fear them and convince themselves they’re sick. They repeatedly visit physicians and have a history many procedures and surgeries, only to have the symptoms return.
Munchausen’s Syndrome by Proxy (MBP)
In a case of Munchausen's Syndrome by Proxy, a person fakes or induces illness in another individual for the sake of garnering attention. Children are usually the victims of Munchausen's by proxy; their mothers, the perpetrators.
Most cases of MBP are reported in pediatric literature, not psychiatric. Roy Meadow, MD, coined the term after observing two cases of mothers who were causing illness in their children.
Malingering
This is intentional producing false or larger-than-life symptoms motivated by external incentives, such as obtaining compensation or drugs, avoiding work or evading incarceration. They might be pathological liars.
Malingering is not considered a psychiatric disorder or psychopathology, but is one of other conditions that might be a matter of clinical consideration. It can also co-exist with diagnoses, especially Antisocial and Histrionic Personality Disorders. Malingerers don’t want treatment because they’re using the medical system for personal gain.
What Munchausen’s, Malingering and MBP Have in Common
All intentionally mislead people to believe they or their children have serious psychological or mental problems. They will undergo testing, hospitalization and surgery. The three involve illness by deception. In variations of the underlying problem, some people seek the hero or victim role, instead of the sick role. They may:
- Fake illnesses, as exemplified by phony tics, or act as if they have Multiple Personality Disorder, MPD
- Exaggerate medical problems
- Initially avoid treatment to intensify a minor medical problem until it becomes serious
- Aggravate an existing condition
- Falsify lab results by adding substances to a urine specimen
- Induce an illness by injecting themselves or their child with bacteria to cause an infection
- Ingest or give a child a substance that causes negative reactions
Munchausen’s Syndrome - Treatment and Prognosis
The initial medical treatment is relieving the claimed symptoms and any injury made by the person to create them. The doctor must be prudent with invasive diagnostic tests or surgeries, while trying not to miss serious medical conditions that may exist. Medications can be useful if conditions co-exist with Munchausen’s, depending on the other disorder(s). Various types of psychotherapy have been reported helpful in certain cases.
Patients with Munchausen’s are rarely successfully treated. They’re often unwilling to admit they have the disorder, are hesitant to seek help and usually aren’t willing to receive psychiatric treatment.
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Source:
- Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, American Psychiatric Association, (American Psychiatric Association, 2000).
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Malingerers May Fake for Financial Gain
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