Factitious disorder imposed on self

Factitious disorder imposed on self, also known as Munchausen syndrome, is a

Factitious disorder imposed on self is related to factitious disorder imposed on another, which refers to the abuse of another person, typically a child, in order to seek attention or sympathy for the abuser. This is considered “Munchausen by proxy” and the drive to create symptoms for the victim can result in unnecessary and costly diagnostic or corrective procedures.^[3]

Signs and symptoms

In factitious disorder imposed on self, the affected person

The exact cause of factitious disorder is not known, but researchers believe both biological and psychological factors play a role in the development of this disorder. Risk factors for developing factitious disorder may include childhood traumas, growing up with parents/caretakers who were emotionally unavailable due to illness or emotional problems, a serious illness as a child, failed aspirations to work in the medical field, personality disorders, and low self-esteem. While there are no reliable statistics regarding the number of people in the United States who have factitious disorder, FD is believed to be most common in mothers having the above risk factors. Those with a history of working in healthcare are also at greater risk of developing it.^[5]

Arrhythmogenic Munchausen syndrome describes individuals who simulate or stimulate

Due to the behaviors involved, diagnosing factitious disorder is very difficult. If the healthcare provider finds no physical reason for the symptoms, they may refer the person to a psychiatrist or psychologist (mental health professionals who are specially trained to diagnose and treat mental illnesses). Psychiatrists and psychologists use thorough history, physical examinations, laboratory tests, imagery, and psychological testing to evaluate a person for physical and mental conditions. Once the person's history has been thoroughly evaluated, diagnosing factitious disorder imposed on self requires a clinical assessment.[9]

Clinicians should be aware that those presenting with symptoms (or persons reporting for that person) may exaggerate, and caution should be taken to ensure there is evidence for a diagnosis.

People may fake their symptoms in multiple ways. Other than making up past medical histories and faking illnesses, people might inflict harm on themselves by consuming laxatives or other substances, self-inflicting injury to induce bleeding, and altering laboratory samples.[11] Many of these conditions do not have clearly observable or diagnostic symptoms and sometimes the syndrome will go undetected because patients will fabricate identities when visiting the hospital several times. Factitious disorder has several complications, as these people will go to great lengths to fake their illness. Severe health problems, serious injuries, loss of limbs or organs, and even death are possible complications.^{[medical citation needed]}

Treatment

Because there is uncertainty in treating suspected factitious disorder imposed on self, some advocate that health care providers first explicitly rule out the possibility that the person has another early-stage disease.

Healthcare providers may consider working with mental health specialists to help treat the underlying mood or other disorder as well as to avoid countertransference.^[14] Therapeutic and medical treatment may center on the underlying psychiatric disorder: a mood disorder, an anxiety disorder, or borderline personality disorder. The patient's prognosis depends upon the category under which the underlying disorder falls; depression and anxiety, for example, generally respond well to medication or cognitive behavioral therapy, whereas borderline personality disorder, like all personality disorders, is presumed to be pervasive and more stable over time,^[15] and thus offers a worse prognosis.

People affected may have multiple scars on their abdomen due to repeated "emergency" operations.^[16]

History

The name "Munchausen syndrome" derives from

Here is described a common syndrome which most doctors have seen, but about which little has been written. Like the famous Baron von Munchausen, the persons affected have always travelled widely; and their stories, like those attributed to him, are both dramatic and untruthful. Accordingly the syndrome is respectfully dedicated to the Baron, and named after him.

— British Medical Journal, R.A.J. Asher, M.D., F.R.C.P.[20]

Asher's nomenclature sparked some controversy, with medical authorities debating the appropriateness of the name for about fifty years. While Asher was praised for bringing cases of factitious disorder to light, participants in the debate objected variously that a literary allusion was inappropriate given the seriousness of the disease; that its use of the anglicized spelling "Munchausen" showed poor form; that the name linked the disease with the real-life Münchhausen, who did not have it; and that the name's connection to works of humor and fantasy, and to the essentially ridiculous character of the fictional Baron Munchausen, was disrespectful to patients with the disorder.^[21]

Originally, this term was used for all

Munchausen by Internet is a term describing the pattern of behavior in factitious disorder imposed on self, wherein those affected feign illnesses in online venues. It has been described in medical literature as a manifestation of factitious disorder imposed on self.^[22] Reports of users who deceive Internet forum participants by portraying themselves as gravely ill or as victims of violence first appeared in the 1990s due to the relative newness of Internet communications. The specific internet pattern was named "Münchausen by Internet" in 1998 by psychiatrist Marc Feldman.^[22] New Zealand PC World Magazine called Munchausen by Internet "cybermunch", and those who posed online "cybermunchers".^[23]

A person may attempt to gain sympathy from a group whose sole reason for existence is to support others. Some^[who?] have speculated that health care professionals, with their limited time, greater medical knowledge, and tendency to be more skeptical in their diagnoses, may be less likely to provide that support.^[22][24][25]

In an article published in The Guardian, Steve Jones, speculated that the anonymity of the Internet impedes people's abilities to realize when someone is lying.^[26] Online interaction has only been possible since the 1980s, steadily growing over the years.^[27][28][29]

When discovered, forum members are frequently banned from some online forums. Because no money is exchanged and laws are rarely broken, there is little legal recourse to take upon discovery of someone faking illness.^[30]

Such dramatic situations can polarize online communities. Members may feel ashamed for believing elaborate lies, while others remain staunch supporters.^[22][31] Feldman admits that an element of sadism may be evident in some of the more egregious abuses of trust.^{[32][24][33][27]}

Other perpetrators react by issuing general accusations of dishonesty to everyone, following the exposure of such fabrications. The support groups themselves often bar discussion about the fraudulent perpetrator, in order to avoid further argument and negativity. Many forums do not recover, often splintering or shutting down.^[24][33]

In 2004, members of the blog hosting service LiveJournal established a forum dedicated to investigating cases of members of online communities dying—sometimes while online. In 2007 The LiveJournal forum reported that, of the deaths reported to them, about 10% were real.^[34]

See also

• List of Munchausen by proxy cases
• Hypochondriasis
• Psychosomatic illness

References

Bibliography

• Feldman, Marc (2004). Playing sick?: untangling the web of Munchausen syndrome, Munchausen by proxy, malingering & factitious disorder. Philadelphia: Brunner-Routledge.
  ISBN 978-0-415-94934-7
  .
• Fisher JA (2006). "Playing patient, playing doctor: Munchausen syndrome, clinical S/M, and ruptures of medical power". The Journal of Medical Humanities. 27 (3): 135–49.
  S2CID 40739963
  .
• Fisher JA (2006). "Investigating the Barons: narrative and nomenclature in Munchausen syndrome". Perspect. Biol. Med. 49 (2): 250–62.
  S2CID 12418075
  .
• Friedel, Robert O., MD (4 August 2004). Borderline Personality Disorder Demystified. Hachette Books. pp. 9–10.
  ISBN 978-1-56924-456-2.{{cite book}}: CS1 maint: multiple names: authors list (link
  )
• Davidson, G., et al. (2008). Abnormal Psychology - 3rd Canadian Edition. Mississauga: John Wiley & Sons Canada, Ltd. p. 412.
  ISBN 978-0-470-84072-6
  .
• Prasad A, Oswald AG (1985). "Munchausen's syndrome: an annotation". Acta Psychiatrica Scandinavica. 72 (4): 319–22.
  S2CID 40707
  .
• ISBN 978-0-465-03292-1
  .
• Staff, Mayo Clinic (13 May 2011). "Munchausen syndrome". Mayo Foundation for Medical Education and Research. Retrieved 11 April 2013.

External links

Look up factitious disorder imposed on self in Wiktionary, the free dictionary.

• Article in Discover magazine, July 1993, by Abigail Zuger