Munchausen syndrome - signs and therapy

The pathological lying
The Münchhausen syndrome refers to fictitious diseases. Affected persons fake a medical role, thereby harming their health and thus force doctors to take care of them. They provoke symptoms that could only be treated in hospital - if they were real.

contents

• malingerers?
• The invented diseases
• The staging
• The disarming
• Behavior and causes
• Artifact diseases
• The Münchhausen Representative Syndrome
• therapy

malingerers?

We pretend to pretend something as a simulation. Are people who suffer from the syndrome but simulants? In the medical sense, they are not. A simulant knows what he is doing and is mentally healthy; For example, he goes to the doctor for alleged back pain, to do some work for a few weeks, or manipulates the thermometer to avoid going to school. He does not harm himself, but he gets himself an advantage.

Feigning fever is a common phenomenon in Münchhausen syndrome. Image: Gina Sanders - fotolia

However, those who suffer from this disorder are injured themselves, they hurt themselves to show the symptoms of the invented disease; he is mentally ill. Although he controls his deception, he executes it compulsively - in a pathological sense.

The invented diseases

Affected persons deceive illnesses in almost every area of ​​the body: cecal inflammation as well as diarrhea, gastrointestinal ulcers as well as heart problems. They develop discomfort on the spine, motor failures, uncontrolled emotional outbursts, headaches, but especially skin diseases: abscesses, boils, eczema or infected wounds.

Bladder infections, pain in the lower abdomen. They present disturbances of the menstruation, joint pain, muscle tension as well as circulatory complaints and pulmonary embolism.

At times, they provide the explanation for their "suffering" and simulate drug withdrawal, alcohol addiction, dizziness or depression. However, the presentation of mental symptoms rarely belongs to the syndrome; Patients want to go to the hospital and not into therapy.

The staging

Munchausen patients particularly like to come to a clinic at the time of the emergency service and describe their "complaints". They have studied the relevant medical literature incensively and can therefore present the symptoms convincingly. They also know about the course of "their" illness and bring a credible narrative of the disease process.

The medical practitioner is overwhelmed by the, mostly serious illnesses that the patient plays. As a rule, he examines the patient and then sends him to the respective specialist ward. That's exactly what the swindler wants.

Firstly, sufferers develop a clinical picture in a sophisticated way; if the doctor hesitates because it is unclear what it is about, he is secondly obliged to clarify the ambiguity; thirdly, those disturbed manipulate to such an extent that a doctor unfamiliar with the syndrome hardly thinks of deception.

They pour acid on the skin, rubbing and squeezing it, twisting arms and legs until they show bruising and lymph congestion; they inject saliva or rinse water under the skin to appear with a real infection at the doctor.

They artificially produce a fever, taking anticoagulants to inhibit blood clotting - wounds that feed themselves. They take thyroid hormone to hyperthyroidism, inject insulin to hypoglycemia, and artificially increase blood potassium.

They even stage cardiac and pulmonary complaints by swallowing blood to cough up blood. Women with this condition are deceiving vaginal bleeding with blood or obliterating the mucous membranes. Men and women simulate blood damage to the rectum and urethra. Urine samples are faked by feces, for example.

Concerned counterfeit urine samples to simulate diseases. Picture: tunedin - fotolia

Patients are particularly successful when they have a real operation behind them. They then manipulate wound healing by rupturing the scars or by infecting the wound with wounds.

In extreme cases, the patients harm themselves to a great extent. For example, a sufferer had a post-knee wound that did not heal. The doctors operated again, but the wound still did not heal. The infection spread to the bone, and the doctors had to amputate the lower leg. Only much later did it become clear that the patient had caused the inflammation himself.

The disarming

These delusions usually only work for a short time. The doctors first look at a variety of causes, sometimes they even carry out medical interventions. But after a thorough analysis, the fake flies up.

Patients often expose themselves by their behavior: with zeal they not only allow interventions, but they demand them, while "normal" patients fear them more and only tolerate them, because the doctor explains them the need. The dodgers even show an increased pain tolerance.

But while they are really hungry for the treatment of their "disease," they are indifferent to the outcome and the healing process. In the case of "normal" patients the situation is reversed: they feel uncomfortable with the treatment, but they are happy when the wounds heal and they go home.

Munchausen patients do not openly show that they do not want to be fired, but it becomes clear that they are not enthusiastic.

Behavior and causes

Munchausen patients break off their relationships, travel constantly, especially from one hospital to another, they lack social roots and they often stray aimlessly around.

To the manipulated diseases come lies stories about the own biography, origin and illness - as with borderliners. In fact, the Münchhausen syndrome is now counted among the Borderline Formenkreis. Patients give false names and addresses and falsify medical records. As a result, they make a name for themselves at hospitals and health insurance companies.

Sometimes such troubled people even show dissocial behavior or slip into crime; many are dependent on medication. Child abuse is common in their lives, including incest, addicted parents, criminal fathers and drinking mothers.

Munchausen sufferers often suffer from other mental disorders, including extreme narcissism, classic borderline syndrome, some even show schizophrenic psychosis.

The suicidal risk is high; Self-injury can also cause permanent damage - from mutilations and physical disabilities to poisoning and mental disorders. They can even lead to death if, for example, the victim causes sepsis affecting vital organs.

Likelihood of confusion exists with (harmless) simulations, neuroses and psychoses. Hypochondriacs also show a similar behavior, but differ significantly: they do not lie, but firmly believe in an ominous disease that keeps them under control.

Munchausen syndrome is also distinguished from disorders in which people openly injure themselves - forms of borderline, the post-traumatic stress syndrome, eating disorders and drug disease.

Professor Annegret Eckhardt-Henn, Head of the Department of Psychosomatic Medicine at Klinikum Stuttgart, sees the compulsive lying as an essential symptom, but considers the label of the lying baron to be wrong. According to her, they did not deliberately deceive the diseases like simulants. Eckhardt-Henn writes: "Those affected have an inner urge to inflict these injuries. You have to imagine that as if someone had an addiction. "

Pure Munchausen patients are very rare. They are characterized by emotional coldness, lack of commitment, lack of impulse control, and lack of guilt. They are aggressive and violent. Eckhardt-Henn says: "You break off relationships with the doctor as soon as he suspects."

Artifact diseases

Much more common than the real Munchausen syndrome are artifact diseases - a kind of Munchausen syndrome light.

This behavior is often developed by people working in the medical profession: nurses, medical assistants or x-ray assistants. In addition, women predominate here, while under the Munchausen syndrome especially men suffer.

Although the symptoms are similar, the patients are not dissocial, rarely involved in violent crime, and less often victims of child abuse or broken families.

On the contrary, those affected are usually firmly integrated into their family and their job. Self-harm that threatens life is the absolute exception. Artifact patients are better able to control their delusions, meaning they stay in a frame that does not jeopardize their professional lives.

They do not argue with the doctors in the clinic and walk less from hospital to hospital. Since many also come from medical professions, they know exactly at what point their behavior is noticeable. The number of unreported cases of such patients should therefore be high.

Nevertheless, these are not simulants. The psychological causes of Munchausen syndrome and artifact diseases are not yet fully understood. Presumably, it is a projection of their actual mental illness on the physical; They are looking for the frame of the hospital because they are ill and in need of treatment.

Patients with artifact disorders usually do not invent a fantasy biography. They usually fool you in a safer way, take laxatives, drugs with heavy side effects or mix blood in the urine.

Implicitly they express: "Help me," but would rigorously reject any diagnosis of a mental disorder and are not aware of this.

Anyone who was abused as a child, but could never pronounce it, is seriously hurt mentally. Expressing this on one's own body and forcing the professionals to deal with the disease appears as an unconscious cry for help. This becomes clear when "hospital hiking".

It can be considered a futile search for help for real injuries experienced in childhood; those affected may be really snubbed when the doctor tells them he can not find anything. They really are suffering.

The Münchhausen Representative Syndrome

This extended Munchausen syndrome is the most dangerous because defenseless third parties, namely children, are involved in the pathological delusion. Mothers manipulate their minor sons and daughters here and carry them with invented diseases to the clinic.

These mothers act on the doctors like mothers, so extremely caring. Even if the doctors determine that the child has no illness, they often suspect that the mother is just too worried.

Since there are actually such mothers who are afraid that the child will catch a cold, if it runs around outside, or if the child feels slightly uncomfortable, immediately run to the doctor, this suspicion is close. Excessive caring can itself take on morbid forms, often enough with mothers' loss-craving, or hidden aggression, the desire for control.

In the extended Münchhausen syndrome, mothers identify with their children to the same extent as over-worried mothers project their fears on the child, and so the extremely close relationship between them and their children is striking. In addition, they suffer from the Munchausen syndrome and transfer this even on her child.

Like the adults with this disorder, the child routinely undergoes painful surgery when the mother demands it. The mothers manipulate their children with the same cruelty as other sufferers themselves: they inject air into their son's veins, they shut their mouths and noses until they threaten to choke; they break their daughter's arms and legs, smear dirt in the wounds, drive to the hospital, where the doctors are surprised by the strange inflammations.

Such mothers are severely mentally ill, and they seem to ward off their own mental breakdowns through the painful procedures on their child. The projection here probably goes one step further than with the pure sufferers: While they use their invented physical suffering as a symbolic expression of their call for help for their emotional suffering, the mothers go one step further.

They are ill, namely mentally and in urgent need of treatment. But instead of damaging themselves, they harm the child, which becomes an expanded part of one's own mental space. These people do not perceive their children as separate individuals: The child becomes the abused object to make a "therapy" for the mother.

In the case of the Münchhausen Deputy Syndrome, the children are usually made ill by the mothers. Image: Tomsickova - fotolia

If such mothers are exposed, then they usually collapse mentally, get into psychosis and harm themselves now, to suicide attempts.

The extended Münchhausen syndrome is also part of the borderline spectrum, and as with classic borderliners, autoaggression easily tips aggression against others.

Overall, mothers are responsible for around 40% of child maltreatment, while the rate at Münchhausen is well over 90%. Most of them are single women or children whose fathers are rarely home.

In contrast to the classic Münchhausen syndrome, the abusive mothers are conspicuous-inconspicuous, even seem over-adjusted. They are constantly asking doctors about the results, often nurses or medical assistants.

They cause anemia by bleeding blood, they manipulate clinical thermometers or they falsify the medical records.

therapy

The dark figure is probably high, especially in the lighter cases. In the case of the extended syndrome, it is important to prevent serious damage, both physical and emotional, from third parties. Doctors and medical staff should therefore be systematically trained to detect suspicious behavior.

Mothers who have Deputy Syndrome need to be separated from their children. All those affected by the illnesses require a lengthy psychotherapy; but they are almost always resistant to advice. If there are already serious self- and foreign damages, there is hardly a way around a compulsory introduction.

Because it is a disorder that has its origins in traumatic experiences, it is not curable. However, the symptoms can be alleviated, for example, by behavioral therapy. Unfortunately, sufferers with a dissocial personality are largely immune to such treatments.

Legally, it is important to treat the fraudsters as ill, and that means moving them to a therapeutic institution instead of imprisonment. (Dr. Utz Anhalt)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)