Monday, December 5, 2011

Medical Mondays: Münchausen Trifecta!


Today, Laura Diamond, Sarah Fine and I are tackling a topic together. It's called Münchausen syndrome.

It's a psychiatric, factitious disorder whereby people fake illnesses for attention and sympathy.

Ever heard of it? It's named after Baron Von Münchausen (1720-1797), who told many fantastic and untruthful tales about his adventures. His stories were later told in a novel by Rudolf Erich Raspe, and also in a 1988 film, The Adventures of Baron Von Munchausen. (Remember Uma Thurman as the Goddess Venus?)

Sarah Fine is going to tackle Münchausen's by Proxy, which occurs when parents sicken their own children to get attention as the "concerned parent."

Laura Diamond is going to tackle the psychiatric aspects of Münchausen's syndrome.

And I'll tackle some of the medical aspects of Münchausen's.

First of all, Münchausen's is different from malingering.

Malingering is when people fake their illness for secondary gain. Secondary gain can include money (for a lawsuit), getting out of military duty, getting out of prison for the "nicer" environment of the prison hospital, getting out of school (see Ferris Bueller's Day Off), getting out of prison ("I swear I was crazy when I killed that guy!"), getting prescription drugs, etc. Also, see my vomiting chicken blood post.

It's also different from Somatoform Disorders, when people have physical symptoms without any overt abnormalities on tests. These people aren't faking their suffering.

In Münchausen's, the person fakes an illness because they find the attention of medical personnel and the medical environment comforting and pleasant. From the doctor's side of this, it can be extremely frustrating.

Here's a story that I heard when I was a medical student.

A man came to the hospital with excruciating abdominal pain. He was at a party the night before when he clinked glasses with guests. After drinking his champagne, he realized his glass had broken during the toast and splinter-sized shards were at the bottom of his glass. He was convinced he'd swallowed some splinters.

Though normally glass should be seen on an X-ray, tiny shards might be missed. He had an endoscopy, which revealed nothing. He was ready to have an exploratory surgery to remove the possible glass shards from his gut when my attending (who I believe was a rotating resident at the time) said, "Hey. You look very familiar. Didn't you come to the ER at another hospital with the same problem last month?"

The patient immediately left and never came back.


Yes, he was willing to have an unnecessary, major surgery. And needle pokes, and endoscopies, and radiation. But he also got a load of concerned doctors, nurses, and staff who thought, "This poor man! He needs our help!"

Here's another one.

A woman came in with fevers and signs of a blood bacterial infection gone out of control. After antibiotics and an ICU stay, she recovered. There was no obvious cause for the infection, and doctors were confused as to why several types of bacteria grew in her blood. (Normally in blood infections, there is just one bacteria involved.)

After a second bout of sepsis with multiple bacteria, the hospital staff suspected Munchausen's. The patient was then observed surreptitiously injecting herself intravenously with a liquid mixture made from her own feces.

And on, and on, and on. There are thousands of stories like these, sadly. People injecting themselves with insulin to get hypoglycemic; people rubbing dirt and spit into their wounds to prolong a hospital stay...sounds impossible? It's not. I've seen a bunch of them myself.

Many patients with Munchausen's will go to several doctors and/or hospitals for treatment ("doctor hopping"). They may move to different states so they can do it again, or change their names. And they're willing to undergo unnecessary, even dangerous, evaluations to do so and put their very lives at risk.

From the medical side, the key to finding out someone has Munchausen's is part science, and part luck. Doctors have an obligation to make sure there truly isn't a dangerous medical condition before they blame something on Munchausen's--because that kind of accusation is extremely serious. But when the data doesn't add up (like the multiple bacteria in the blood, above) or suspicious behavior is found, then we suspect Munchausen's. I have heard that video cameras can be used to prove cases of Munchausen's by proxy, but I'm not sure about regular Munchausen's.

It can be particularly difficult to diagnose if the patient already has real medical problems, and/or has educated themselves about certain illnesses--how they present, what "alarm" words to use to make doctors sit up and take notice.

Can you imagine what's it's like to have Münchausen's? Can you imagine having one of your characters with this syndrome?

If you've got a fictional medical question, let me know! Post below or email me at
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Also, don't forget to stop by Laura Diamond's Mental Health Mondays and Sarah Fine's The Strangest Situation for great psychiatric and psychological viewpoints on all things literary. :)

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58 comments:

Laura Pauling said...

Fascinating but sad. Those people probably are lonely and doctors and nurses can be nice. I think I've seen that on ER too!

Sarah said...

Oh, the stories, especially that last one ... *shudders* Great post, Lydia, and great idea for a topic for all of us to cover!

Dianne K. Salerni said...

Hi, Lydia! I popped over from Sarah's blog to read your take on the disease. Is this condition more prevalent than Munchausen by Proxy?

The proxy version of this disorder has of course been used fictitiously in The Sixth Sense and another mystery novel I read (maybe an Alex Delaware mystery). This is probably because it makes for a more hate-able villain. But I was wondering if the self-infliction is more or less common? (Just curious.)

salarsenッ said...

Wow, those were interesting stories! I just hopped over from Sarah's blog. I love how the three of you are teaming up about this subject. Fabulous job!

shelly said...

Great Info! Hypochondria goes alnong with it doesn't it?

Natalie Aguirre said...

Such a sad disease. It's so weird thinking of how people would make themselves sick because of their disease. Glad the doctors figured it out before they did surgery on the first guy.

Old Kitty said...

It's a kind of very scary mental illness and I can only imagine what these souls go through. Although I find it very hard to understand the cases where children are harmed deliberately by the sufferer (Munchausen by proxy). Thanks for another fascinating medical post! Take care
x

Connie Keller said...

It's really hard for me to imagine anyone wanting to be in a hospital. Yuck. But people do amazing/ridiculous/dangerous things for "love" and attention all the time.

Alex J. Cavanaugh said...

Now that is a twisted condition! Who on earth would want to stay in a hospital? Well, mentally sick people I guess.

Stina Lindenblatt said...

I definitely don't have it. I hate going to the hospital, and I hate having to take my kids there because I'm afraid they'll just get sicker from something they picked up at the hospital.

And let's face it, after spending 3 months in NICU with my son, can you blame me for not wanting to hang out at the hospital? :D

Coleen Patrick said...

I hate being sick and definitely do not enjoy being in the hospital, or surgery! So I can't even imagine purposefully injecting myself with something or wanting to have surgery. Reinforces for me that the brain is pretty amazing--and this would make for a very interesting creative ride if one of my characters had these psych ailments.

Another super cool post!

Talli Roland said...

I remember first reading about this in a Mary Higgins Clark novel when I was a teen. I couldn't believe a parents would injure their child for attention.

L.G.Smith said...

I've seen cases described where mothers deliberately make their children sick to gain sympathies from others. Just so, so sad. I can't imagine what mental state you'd have to be in to do that to someone else or even to yourself. It could make for a very interesting character to write about, though. Talk about conflict!

Slamdunk said...

Good stuff Lydia. I think the Mrs.'s most popular lecture is on this topic--the students can't seem to get enough.

Little Ms. Fun said...

omg, that's awful! Especially to subject your children to suffering just to get attention as the parents. Horrible.

Em-Musing said...

Is Somatoform Disorder the same as psychosomatic? When I was younger, I had bouts of unexplained stomach aches and headaches. Thankfully my doctor knew to ask me what was going on in my life...and ha...once I spilled my guts and shed some tears...the symptoms went bye bye. I still don't know how my mind did that. Wish it would manufacture an agent.

Suze said...

Someone in my family faked being on her death bed for attention two summers ago ...

Bossy Betty said...

I am fascinated by this syndrome. I should probably see a medical professional about this fascinating. Shouldn't I? Maybe more than one....

Karen Lange said...

Very sad. It is a shame that this actually has a name - as far as so many people going to great lengths for attention. As always, thanks for the info!

julie fedderson said...

This has to be one of the most frustrating diagnoses I see. Sad to think some are so desperate for human interaction that they would resort to such extremes. Also frustrating in terms of unnecessary costs in an already taxed medical system.

DL Hammons said...

I've heard of this before, and as sick as it is, it's also fascinating.

Matthew MacNish said...

Oh my god - that woman with the needle! Wow. People are so fascinating.

L.C. Frost said...

Holy cow. So. Fascinating. Thanks so much for taking the time to explain this, Lydia! Always love your Medical Mondays. ^_^

Carolyn Abiad said...

Gosh! And here I am, avoiding the doctor so I don't have to deal with insurance forms in triplicate...

Linda Gray said...

So fascinating! I read Laura's post first and asked her a question, which I see is actually answered by Sarah's post! Thank you, Ladies, for exploring these interesting topics for us!

Stephanie D said...

It boggles the mind how people can do this and saddens me...especially when children or other people are the targets.

Meredith said...

It's so sad. I hope those people get the psychiatric help that they need. This is fascinating!

Christina Lee said...

Nice trifecta, you guys!!! I'm most familiar with 'by proxy' so this was a nice recap for me!

Stephen Tremp said...

My wife does private duty home health care and I've helped with a few clients from time to time. People with mental disabiltiies or who have experiences severe head trauma (very rewarding work). I have seen several people acting out to gain attention. Usually they fake vomiting and drool and cough.

This seems to attract crowds, especially in Walmart, where people try to comfort them and give them attention. Its an act. but its better just to let it play out than try to stop it.

David P. King said...

I'm actually quite familiar with this one through my work. Spot on, too. Great post! :)

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Lenny Lee* said...

hi miss lydia! yikes! for sure i hate being sick. ack! its pretty sad for the ones that do that. i been at dr lauras post and now yours. what im wondering is what could of happened in someones life that they could need to do that. for sure they could need some help.
...hugs from lenny

Kerri Cuev said...

That is an odd syndrome. Wow, can you imagine a story with a character like this. It would be an interesting read.

Carrie Butler said...

It's horrible, but the first thing I thought of was the Scrubs PSA...

Anyway, great post! Very informative. :)

mooderino said...

Great post as usual. I've seen this one pop up on medical dramas from time to time. People are strange.

Theresa Milstein said...

I thought the glass story was bizarre until I got to the blood one. Yikes!

I love that you're taking the same illness from different angles - a holistic approach. Imagine writing a character with this disease?

Maurice Mitchell said...

Wow. That's crazy. I remember the "House" episode "Deception" where the patient had this. Great episode. Your stories are so crazy I wouldn't have believed them. Exploratory surgery?!

Jennifer Hillier said...

Yes, this is finally something I've heard of! It's fascinating, including Munchausen by Proxy.

A character afflicted with this would be an interesting one, indeed.

Ghenet Myrthil said...

So interesting! I've heard of this somehow. I can't imagine enjoying getting medical tests done. Yikes.

Julius Cicero said...

It's truly sad what lengths people will go to for attention or other points of interest. It also sounds like material for 'a perfect criminal' or Hannibal Lecter-type character.

erica and christy said...

Oh my goodness. I feel for those people who go to such great lengths and suffering for these reasons. christy

Krispy said...

I can't believe how far some people will go in these cases. Fascinating stuff!

A Lady's Life said...

So sad. Terrible behavior and yet There are many people like this.

LisaAnn said...

Oh my gosh, my jaw literally dropped at the fake glass and feces injection. How bizarre and terrible!

This post is beyond interesting. Thank you so much for posting this; my skin is crawling right now!

Jane Charles said...

I cannot imagine going through unnecessary surgery or injecting myself with anything (I don't even like my blood drawn), and I can't stand being in the hospital (I like my own bed). I really feel for the people who suffer from this.

Olga said...

I myself used to find Munchausen-like traits in myself as a child :)

Kelly Polark said...

Very interesting. A teacher I used to work with thought one of the moms of her student had Munchausen by Proxy. Weird stuff!

Angela Brown said...

I'm just floored by the very thought of sickening my child for attention. I've seen this played out on TV shows but it still boggles my mind.

Emy Shin said...

These are fascinating, and yet terrifying stories. I've known the lengths people might go to seek attention, but never considered medical attention.

Romance Reader said...

Hi Lydia,

I always love reading your Medical Mondays. And today's post is a learning one for me especially. Thank you.

Rachna Chhabria said...

Fascinating post,Lydia. Interesting disorder. The patients sound like hypochondriacs to me.

Julie Musil said...

Wow, this was so cool! Thanks so much for doing this, ladies.

Southpaw said...

I know these crop up all the time in books and movies especially the one parent/child one. It really is sad.

Cold As Heaven said...

Lots of weird deseases. I almost think it's just products of your fantasy >:D

Cold As Heaven

Susan Fields said...

What a fascinating topic. I think I read a Patricia Cornwell novel a long time ago about a parent who was harming her own child for the attention. So bizarre!

Cynthia Chapman Willis said...

I have heard some crazy stories related to this condition. It's interesting, but so sad, too. Thanks for clarifying this and offering more information about it.

lbdiamond said...

Great stories! We had a guy pretend to be a vet from Afghanistan. When we looked him up in the VA system, he didn't have any military connection whatsoever. O_o

Munk said...

I don't have to imagine it... I had to quit blogging so that I could follow my BvM passion.

Awesome post BTW... truth is truly stranger than fiction.

 
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