Munchausen's syndrome: causes, symptoms, and clinical features

¶ … Munchausen's Syndrome

Is there a biological basis or genetic predisposition for this disorder?

There remains a paucity of timely and relevant studies concerning the basis for Munchausen's syndrome. In this regard, Cohen notes that, "It has been difficult to assemble patients to study in more detail, since -- once confronted -- they usually become defensive and leave, only to seek medical care elsewhere" (p. 389). Although the precise basis for developing Munchausen's syndrome remains unclear, what is known is that men are at higher risk of acquiring Munchausen's syndrome than women (Jacoby & Youngson, 2005; Gomez, 1993). Likewise, Trask and Sigmon (1997) report that, "Munchausen syndrome patients may have an organic pathology that accounts for their physical symptoms, even though the physical condition is self-induced" (p. 346).

Because the condition is chronic, an individual's temperament may play a role in the escalation of Munchausen's syndrome because current and future efforts to manipulate healthcare providers are typically more amplified and exaggerated than previous efforts (Turvey, 2002). People who develop Munchausen's syndrome appear to be motivated by the need for some type of unconscious psychological gain rather than some type of tangible reward for their behaviors (Cohen, 2003). As to the basis for predisposition, Cohen advises that, "Personality testing often reveals a mixture of histrionic, narcissistic, impulsive, and dependent traits" (2003, p. 389).

2.

Are there any biological stressors (e.g. prenatal, perinatal, postnatal or later injuries) that play a role in the development of this disorder?

Although the specific causes of individuals developing Munchausen's syndrome remain unclear and understudied, "Some doctors believe the condition dates from a long history of medical treatment in childhood. Some think it is a manifestation of a longstanding and severe grudge against doctors" (Jacoby & Youngson, 2005). In addition, Cohen reports that, "Past histories of childhood abuse and abandonment are common [in Munchausen's syndrome sufferers]" (p. 389).

3.

What role does the environment, especially the interpersonal environment, play in the development of this disorder?

Interestingly, there may be a link between an individual's profession and developing Munchausen's syndrome. According to Jacoby and Youngson, "Although it is comparatively rare, the syndrome often seems to occur in people working in health-related jobs" (2005, p. 1286). This link may be due to the availability of medical texts that provide these individuals with accurate descriptions of medical condition symptoms that these sufferers then use to manipulate and deceive healthcare providers. For instance, Ford notes that, "Lying and deception may be so pervasive for an individual that they take over much of that person's life. People who have factitious disorder (Munchausen's syndrome) represent an extreme example; these people spend most of their energy in fooling physicians and other health care professionals" (1996, p. 61).

4.

What is the role of life stressors?

Some authorities suggest that Munchausen's syndrome is a form of compulsive disorder that develops in response to various environmental stressors in people's lives (Murray, 1997). Other authorities cite a potential connection between dysfunctional relationships and, consistent with the adage that, "There is no problem that drinking cannot make it worse," substance abusing behaviors with the development of Munchausen's syndrome (Gomez, 1993). In contrast to malingering, Munchausen's syndrome sufferers do not respond to life stressors by faking illness for some type of financial gain or to avoid employment, which are more indicative of malingering (Trask & Sigmon, 1997). According to Murdach (2006), "Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms in pursuit of external incentives, such as escaping criminal prosecution, receiving financial compensation, or gaining access to drugs or medication" (p. 155). In addition, Cohen (2003) also notes that various interpersonal stressors may play a role in the development of Munchausen's syndrome.

5.

What are the vulnerability factors (i.e. what makes someone vulnerable to developing this disorder)? What are the resiliency factors? (i.e. what protects someone from developing this disorder)?

Generally speaking, women are at lower risk of developing Munchausen's syndrome than men; however, the incidence of a limited form of Munchausen's syndrome that involves dermatitis artefacta, a condition wherein sufferers damage their own skin while adamantly denying the practice appears to be as common in women as men (Gomez, 1993). There are also some other factors involved that may make an individual more vulnerable to developing Munchausen's syndrome. For instance, even though the condition is rare, Munchausen's syndrome is more common in the United Kingdom and other countries that provide free medical care than in the United States (Jacoby & Youngson, 2005). Therefore, the prevalence of Munchausen's syndrome may be related to an individual's desperate need for attention that then translates into assuming the sick role in ways that are facilitated by the availability of the requisite healthcare resources. In this regard, Trask and Sigmon report that, "Diagnostic criteria [for Munchausen's syndrome] include the intentional production or feigning of physical signs or symptoms, the motivation for which is to assume the sick role, with the absence of any external incentives for the behavior (e.g., economic gain, avoiding legal responsibility, or improving physical well-being)" (1997, p. 346). Likewise, Murray (1997) emphasizes that, "Unlike malingerers who have something to gain from their illness, (e.g., to miss military service or jury duty), Munchausen's syndrome patients are uncomfortable unless a great desire to deceive others and live for the sake of lies compensates them" (p. 343). Despite these fine distinctions, some patients who suffer from Munchausen's syndrome may also exhibit behaviors that, at least on occasion, reflect some signs of malingering, since the outcomes of their behaviors may involve some type of external gains that separate and apart from any unconscious psychological gain that may accrue to their self-inflicted injuries and deceptive behaviors with healthcare providers (Cohen, 2003).

Further, the fact that Munchausen's syndrome is more common in countries with free healthcare services would support this assertion, indicating, at least to some degree, that an individual who presents with Munchausen's syndrome in the United Kingdom would be less likely to engage in such behaviors if these healthcare resources were not available. This observation would suggest that disabled veterans in the United States, for example, may be at higher risk for developing Munchausen's syndrome than the general population given their free access to healthcare services, making this an area of interest for future studies.

Explain why Psychodynamic Theory (other than the Diathesis Stress Model) best explains the development of this disorder.

In reality, the diathesis-stress model could be used to explain and understand the development of Munchausen's syndrome. According to Windle, "The Diathesis Stress Model is consistent with the general model adopted in psychiatric research of the interaction between a person's constitutional predisposition to acquire a certain disorder (i.e., diathesis) and outside stressors" (1997, p. 185). In other words, the diathesis-stress model takes into account the importance of understanding the relationship between an individual's personal attributes together with environmental stressors that may contribute to the development of the condition (Windle, 1997).

This observation is also congruent with Zuckerman who cites the manner in which some people respond to external stressors in their lives based on genetic predispositions to the condition. In addition, the tenets of the diathesis-stress model hold that the excuses that people routinely make for their failures affect their reactions to such failures in the future in ways that make them self-fulfilling prophecies (Buchanan & Seligman, 1995). Moreover, the diathesis-stress model recognizes that a wide range of personal and environmental factors can influence the manner in which people response to external events in their lives (Buchanan & Seligman, 1995).