What is Munchausen syndrome. The same Munchausen

– a borderline mental disorder manifested in persistent malingering various diseases. The purpose of the simulation is not material benefits, but attention from others. Patients with Munchausen syndrome lie to doctors, take unnecessary medications, artificially induce vomiting, self-harm, etc. Diagnosing the disorder is very difficult, since patients constantly turn to different doctors, hide their medical history and stubbornly deny malingering. Treatment of Munchausen syndrome is also difficult; patients usually categorically refuse psychiatric care. As a rule, assistance is limited early detection simulation, refusal of unnecessary procedures and operations.

General information

Munchausen syndrome is a borderline mental disorder, one of the types of hysteria. It manifests itself as persistent simulation of various diseases. It was first described in 1951 by British endocrinologist and hematologist Richard Asher. Munchausen syndrome got its name from the legendary Baron Munchausen, known for his ability to invent incredible stories. For some time the name was used to refer to all factitious disorders, but subsequently its interpretation became more narrow. Now Munchausen syndrome is called only an extreme form of simulation, in which imitation of the disease becomes the main thing in the patient’s life.

Throughout life, patients turn to many different doctors. A case was recorded where a patient with Munchausen syndrome suffered about 40 unnecessary abdominal operations and was hospitalized about 500 times in various clinics. It was previously believed that Munchausen syndrome develops more often in men, but now psychiatrists believe that women are more often affected. Presumably, patients with Munchausen syndrome account for 0.8-9% of total number patients seeking help from medical institutions. Treatment of this pathology is carried out by specialists in the field of psychiatry.

Causes of Munchausen syndrome

The reason for the development of Munchausen syndrome is the need for care and attention, which the patient cannot satisfy in other ways. Psychiatrists believe that many patients with Munchausen syndrome grew up in single-parent families, where one parent did not have the reserves and capabilities to meet the child’s needs for a feeling of closeness and security. Some patients had both a father and a mother, but grew up in an atmosphere of coldness, rejection and inattention to the emotional needs of the child.

The impetus for the occurrence of Munchausen syndrome, according to experts, is a serious illness that patients suffered in childhood. When the child got sick, the parents' attitude changed dramatically. The baby received the missing feeling of care and security, felt needed and important to others, finding himself in the center of attention of his parents and medical staff. This contributed to the formation of a pathological pattern of thinking and behavior: “in order to feel cared for, to feel important and needed, you need to get sick.”

Characteristic features of patients with Munchausen syndrome are unstable self-esteem, egocentrism, emotional immaturity, a tendency to fantasize, identity problems and impulsive behavior. The listed features do not allow a patient with Munchausen syndrome to create deep, stable intimacy. Relationships with close people (members of the parental family, partner, children) are either destroyed or do not bring inner satisfaction. Hungry for care and intimacy, patients with Munchausen syndrome begin to use an alternative, “forced” way of satisfying their own needs, simulating a particular disease.

Another reason for simulation is the need to increase self-esteem by turning to well-known specialists. If doctors diagnose a disease and begin to treat a patient with Munchausen syndrome, this becomes a reason for pride, “I am not being treated by anyone, but by the best.” If experts recognize the patient as healthy, he has a reason to blame doctors for their lack of professionalism and emphasize the uniqueness and complexity of diagnosing and treating his disease. In both cases, a patient with Munchausen syndrome presents himself as a heroic person with a difficult fate and a person experienced in medical matters.

Patients with Munchausen syndrome carefully study special medical literature. They are well aware of the symptoms and features of the course of the simulated disease, therefore, unlike patients with other hysterical disorders, they very accurately recreate clinical picture diseases. IQ is normal. Sometimes patients with Munchausen syndrome have a good education, but due to psychological immaturity, maladaptive behavior and a tendency to dwell in a fantasy world, they cannot occupy a worthy social position. Some patients wander.

Symptoms of Munchausen syndrome

Patients can feign any somatic, less often mental illness. The choice of disease is determined by the patient’s awareness of clinical manifestations a particular pathological condition, the ability to simulate objective symptoms (for example, the presence of anticoagulants to provoke bleeding or laxatives to cause diarrhea) and the availability of doctors of a particular profile.

In studies of Munchausen syndrome, descriptions of feigned fever prevail unknown etiology, hemoptysis, vomiting and diarrhea, however, psychiatrists note that currently, due to the increase in the number of narrow specialists, the list of simulated diseases has expanded. For example, if there is a dermatologist’s office near a patient with Munchausen syndrome, the patient may feign symptoms skin disease, if the patient can easily get an appointment with a cardiologist, he develops symptoms of myocardial infarction, etc.

Many patients with Munchausen syndrome repeatedly feign emergency conditions, for example, perforation of a stomach ulcer and other similar problems requiring urgent surgical intervention. A large number of scars can be found on the body of patients with Munchausen syndrome. Some have had a finger or limb amputated. In the presence of external evidence of repeated visits to medical institutions, patients hide their medical history and try not to mention specific doctors in order to avoid detection.

Often, patients with Munchausen syndrome consult a doctor at the end of a shift or call ambulance at night time. Some patients try to choose young, inexperienced specialists - this behavior reduces the risk of exposure (an inexperienced or tired doctor may not pay attention to inconsistencies in the patient’s story or misinterpret the symptoms, mistaking the simulation for the real picture of the disease). Others, on the contrary, come to see the “luminaries of medicine” in order to gain a reputation for patients with incredibly difficult case. If suspicions arise, both of them categorically deny the simulation. Possible manifestations of aggression.

Munchausen syndrome via representative

Munchausen syndrome through a representative or delegated Munchausen syndrome is a type of mental disorder in which patients simulate an illness not in themselves, but in another person. Children usually act as representatives younger age, less often - old people and disabled people. In all cases, the victim becomes a person who is unable to tell others about the patient’s actions. Delegated Munchausen syndrome is more often observed in mothers. Less commonly, this disorder affects wives of disabled people, nurses in pediatric departments, and caregivers caring for disabled people in specialized institutions.

Typically, patients with delegated Munchausen syndrome feign bleeding, vomiting, diarrhea, infectious diseases, fever, choking, allergies, poisoning and sudden infant death syndrome. For the appearance of corresponding symptoms, patients with Munchausen syndrome use various techniques: giving the victim unnecessary medications or not giving necessary ones, exceeding the dose of the drug, obstructing breathing by covering the mouth and nose with hands, a pillow or a plastic bag, deliberately delaying calling an ambulance, etc. .

Such actions allow patients with delegated Munchausen syndrome to recreate a picture of the victim’s serious condition, and then take certain measures to save her in order to look like a hero, a rescuer and a caring person in the eyes of others. Repeated acts of violence have a negative impact on mental condition And physical health children of patients with Munchausen syndrome. The outcome of the simulation can be death or chronic somatic disease.

Due to the image of the “selfless savior,” delegated Munchausen syndrome remains undiagnosed for a long time. People around them keep silent about their suspicions because they cannot prove anything, they are afraid of making a mistake and being accused of slander. If another co-worker or family member does decide to voice suspicions, the person with delegated Munchausen syndrome interprets such actions as malicious persecution, assumes the position of the victim, attunes others accordingly, and receives additional benefits from once again being the center of attention.

Diagnosis and treatment of Munchausen syndrome

Making a diagnosis presents significant difficulties, since patients are well familiar with the symptoms of the simulated diseases and extremely convincingly imitate various pathological conditions. The diagnosis of Munchausen syndrome is made based on examination results and data additional research, indicating the absence of somatic pathology. During the diagnostic process, doctors sometimes have to contact medical institutions where a patient with Munchausen syndrome was previously treated, independently restoring the objective history of the patient’s life and illness. In a number of Western countries, they even create special databases with data from such patients, but this measure is not always effective, especially when simulating emergency conditions.

Patients with Munchausen syndrome usually categorically refuse psychiatric treatment. The exception is acute crisis conditions, during which the patient begins to feel helpless and tries to openly seek support from a psychologist or psychiatrist. Specialized assistance for Munchausen syndrome, as a rule, is limited to qualified diagnosis, timely exclusion of somatic pathology, prevention of unnecessary procedures, surgeries and pharmacotherapy. For delegated Munchausen syndrome the most important task becomes the isolation of the victim to preserve his physical and mental health.

Illustration copyright malerapaso/Getty Images Image caption This condition was first identified in 1977. (This and other photos show models not related to this story)

When medical workers at the hospital named after. Carlos van Buuren in the Chilean city of Valparaiso confirmed their fears; the child, who was three and a half years old, had already been hospitalized five times and had undergone more than one course of antibiotics - and this in just nine months.

The boy - let's call him Mario - kept returning to the ear, nose and throat department of this children's clinic with the same problem: strange discharge from both ears, accompanied by small inflammatory nodules in the tissue of the ear canal, and these nodules prevented doctors from examining his eardrum .

The official diagnosis was “inflammation of the middle ear,” but no one could explain what caused it.

The child tolerated antibiotic treatment well, but the illness returned as soon as he was discharged from the hospital.

Also, for unknown reasons, he was somewhat delayed in development.

“At three years old, he could hardly walk and spoke very little,” says surgeon Christian Papuzinski, who was part of the team of doctors who treated Mario in the otolaryngology department of this children's hospital.

Three Suspicious Ingredients

Mario's case is real. Details of this clinical case were published in 2016 in a Chilean medical journal Revista de otorrinolaringología y cirugía de cabeza y cuello("Journal of Otolaryngology and Head and Neck Surgery").

Illustration copyright Other Image caption Biopsy showed granulomatous inflammation in the child's external auditory canals

Papuzinski and the team of doctors treating the boy began to have suspicions for various, unrelated reasons.

First of all, due to the lack obvious reason that would explain why the symptoms ear disease are returning.

This case also had some unusual clinical phenomena: the presence of pathogens (microorganisms) that are not usually found in ear diseases, as well as unexplained sores.

And finally, the fact that Mario clearly improved as soon as he was away from home.

Papuzinski says that after the boy spent two months in the clinic, doctors began to suspect that his mother might have been putting some kind of irritating substance in his ear.

The idea of ​​this arose during the first biopsy, when doctors noticed that the child, upon entering the hospital, immediately began to recover, the surgeon recalls.

“We came to the conclusion that there may be some kind of family factor that we did not take into account. And one of the factors could be some kind of mistreatment of the child,” says the doctor, who admits that he has never encountered such a case before .

But after the representatives social service and a child psychiatrist examined the child, this hypothesis was rejected.

The mother denied any abuse of the child, Papuzinski said.

And until the very end she continued to deny everything.

"Very Worried Mother"

It seemed that Mario's mother was truly worried about her son's health.

“She was very worried. She always accompanied him, always arrived ahead of time and spent almost 24 hours a day in the hospital,” recalls the Chilean surgeon.

During his nine-month treatment period, Mario spent more than 80 nights in this children's hospital.

Seven months after his first appointment, the truth accidentally came out.

Illustration copyright JLBarranco/Getty Images Image caption The boy spent more than 80 nights in hospital during his nine months of treatment

The mother of a child who was lying in the same room as Mario accidentally saw his mother injecting him with some kind of drug without the knowledge of the doctors.

The doctors recorded in the clinical history that Mario's mother threatened the woman to keep quiet. When doctors asked her directly about this, Mario’s mother denied everything.

Then they called the police, who searched Mario's mother and found syringes hidden in her clothes and under her son's bed.

With evidence in hand, the doctors turned to the prosecutor's office. The prosecutor's office issued a warrant prohibiting the mother from approaching the child, who began to recover quickly and was soon discharged from the hospital.

Doctors were able to examine Mario for the first time eardrums and make sure that he did not have any ear disease.

Doctors also noted a significant improvement in the child’s communication with other people.

Rarely diagnosed syndrome

It turned out that it was not the child who was actually sick, but his mother: she had delegated Munchausen syndrome, which was identified by psychiatrists at the same hospital.

This factitious mental disorder was first described in 1977 by British pediatrician Roy Meadow.

Illustration copyright Nadezhda1906/Getty Images Image caption Delegated Munchausen syndrome is considered a form of child abuse: in approximately 7% of cases it leads to the death of the child

Delegated Munchausen syndrome is a form of Munchausen syndrome in which a person feigns the symptoms of a disease in order to attract sympathy, compassion, admiration and attention from doctors.

In the case of delegated syndrome, the person who is responsible for someone - most often the child's mother or guardian - fabricates the symptoms of the disease, often even causing physical harm to the child.

This is considered a type of child abuse, which very often goes undiagnosed by doctors or responsible persons, sometimes for months or even years.

According to the Chilean medical team, approximately 7% of such cases are fatal.

Media in different countries the world wrote about the most famous cases that led to the death of children and the subsequent imprisonment of parents.

Adults suffering from this mental disorder may go to extremes in seeking attention from doctors: they may inject blood, urine, or even feces into the child to make the child sick, or give some kind of medication that will cause the child to vomit or have diarrhea, or will result in the child undergoing a biopsy or surgery.

As doctors write in the case of Mario, the real cause of this syndrome is unknown, but in their opinion, this disease is too rarely diagnosed, because doctors usually do not suspect the parents of child patients.

Many clinical cases indicate that in the vast majority of cases the perpetrator is the mother, and Chilean doctors confirm this in 75% of cases.

Why are they doing that?

In fact, Munchausen syndrome and its delegated form have been little studied.

Experts in the field believe that those who have themselves suffered from violence, abuse or abandonment as children are at risk of developing this mental disorder.

Clinicians also assume that patients who engage in self-harm or harm others do so to gain sympathy, attention, or admiration for their ability to cope.

Illustration copyright szefei/Getty Images Image caption Delegated and ordinary Munchausen syndrome are not yet very well studied

On the other hand, even if they have suspicions, it is not easy for medical staff to directly demand an explanation from patients in whom they suspect Munchausen syndrome.

There is a certain risk here: if the patient begins to be questioned with bias, they will be on guard, begin to make excuses, or completely disappear to start looking for help in another hospital where they are not yet known.

In the case of Mario, this is what happened: he was sent to the Valparaiso hospital from another hospital, which he had been to more than once and where the doctors were never able to make a diagnosis.

Another danger may be wrongly blaming the patient with all the ensuing consequences.

"It's a very difficult situation," Papuzynski says.

British pediatrician Roy Meadow, who first described the syndrome, found himself in an ambiguous situation himself after appearing as a witness in several trials against parents who were wrongly accused of killing their children.

"Normal life" with grandma

In Mario's case, the court judge family matters decided that the boy should be given to his grandmother to raise.

Illustration copyright FatCamera/Getty Images Image caption After the mother was diagnosed with the syndrome, the child quickly recovered

As Dr. Papuzinski says, these changes very quickly had a positive impact on the health of the child, who began to walk well, his speech improved, he began to communicate more with his peers and was able to attend school.

Mario's mother can see him in the presence of a third party and is currently receiving psychiatric help so that in the future she may be able to raise her son again.

According to the surgeon who treated Mario, the boy now lives a normal, healthy life and shows no signs that he suffered from the actions of his mother.

Once a year he comes for a regular medical examination at the hospital where he once lay.

The name of such a disease was first used by Dr. Asher Richard, who established its presence in his patients in 1951. For Munchausen syndrome people constantly visit medical institutions unnecessarily, mislead their loved ones and medical staff of clinics. This condition is caused by severe emotional disturbances. As a rule, patients with this diagnosis have good knowledge in the field of medicine.

Also some of them have psychological persuasion skills thanks to which it is easy to convince doctors to conduct a serious examination, complex treatment non-existent disease. Deception in in this case- conscious, and motivation is subconscious. Often this syndrome manifests itself in parents who impose imaginary diseases on their children, subject them to diagnosis, deliberately causing harm to health and life. This psychological disorder is based on a person’s need for attention, care, and close connection with their children and loved ones.

Causes

The causes of Munchausen syndrome may overlap; only a professional psychologist, psychoanalyst, or neurologist can determine them.

The main causes of the syndrome are:

• an urgent need for attention, understanding, care, which a person cannot satisfy by other methods;
• childhood spent in a single-parent family, in which one of the parents was not able to fully spend time with the child due to increased employment or reluctance to take part in the educational process;
• youth spent in an atmosphere of emotional insecurity;
• suffered in childhood serious illnesses;
• problems with self-esteem;
• egocentrism;
• past sexual abuse;
• the presence of relatives who have suffered serious illnesses in the past;
• psychological immaturity;
• lack of self-esteem;
• experienced stress;
• an unrealized dream of becoming a medical worker;
• serious personality disorders.

In addition, a person with this syndrome is much more comfortable being in a medical facility than in his own home among loved ones. This is where he feels protected.

Symptoms

The symptoms of Munchausen syndrome are very varied. This and simulation of somatic or mental illness associated with an obsessive desire to undergo testing, risky surgical interventions, and constant complaints of poor health and weakness and, as a consequence, the need to constantly be under the supervision of doctors in a hospital setting.

Most patients have serious problems in communication, especially with loved ones, feel the need to communicate exclusively with health workers. For them, they stage entire dramatic performances telling about the incurable diseases and suffering that such an imaginary patient experiences.

Patients with Munchausen syndrome are often unmotivatedly aggressive, their mood constantly fluctuates from depressive-suicidal to a state of complete apathy.

They often suffer from heavy bleeding caused by consuming large amounts of medicines or chemical substances, used without permission.

Often people who never find support from their loved ones leave home, begin to wander, even to the point of complete asocialization.

The main diseases that patients with the syndrome simulate:

• migraine;
• skin diseases;
• problems of the cardiovascular system;
• problems of a proctological or gastroenterological nature;
• diseases of the respiratory system;
• severe diseases (tumors), etc.

Classification

The main types of this disorder:

• Individual Munchausen syndrome, as a result of which the patient invents a disease in himself and requires increased attention to his person.
• Delegated syndrome, in which parents force their children to pretend or deliberately cause certain disorders in children.

Diagnostics

It is not always possible to determine the presence of Munchausen syndrome in a person after the first examination. Often such patients, feeling suspicious on the part of the doctor, abruptly leave medical institution and turn to another specialist. Without finding support at home, the patient may go missing. Diagnosis of the syndrome should be carried out delicately, with the direct participation of a professional. The patient must be examined by a neurologist. A consultation with a psychotherapist will also be required, and the patient’s relatives should also participate in it.

Treatment

Therapy in this case is not easy. Effective ways Unfortunately, there is no cure for the complete cure of the patient. But there are a number of recommendations that should be followed.

To treat the syndrome it is necessary regular consultations with a psychotherapist, as well as family consultations with a psychologist and participation in psychological trainings. The attending physician will certainly prescribe medications to correct the associated mental disorders. If necessary, temporary hospitalization in a psychiatric hospital will be offered.

Sometimes experts use the so-called “ non-confrontational approach”, in which the patient is actually “treated” for a non-existent disease (unless the treatment involves taking drugs). Massage, physiotherapy, etc. can be used.

• communicate with people more often;
• find a new activity or hobby to take your mind off anxious thoughts;
• lead a healthy lifestyle, minimize health risks;
• travel;
• engage in social and volunteer activities.

Prevention

Unfortunately, effective preventive measures with this disease does not exist. Patients who are deprived of attention from loved ones, lonely people, especially the older age category, are advised to communicate with people more often and have a pet that can brighten up loneliness.

Forecast

At first glance, it may seem that Munchausen syndrome is not serious, since it does not affect a specific organ or system. In fact, people who have a great need for the attention and care of relatives risk not only their health, but also their lives. Often in this category of patients comorbid mental disorders develop: obsessive ideas, depressive states, loss of interest in life. As a result a person suffering from Munchausen syndrome experiences the following complications:

• problems communicating with people;
• job loss;
• financial difficulties;
• loss of performance as a result of injuries;
• organ diseases, even disability, due to the intake of severe toxins and a large number of medications for other purposes;
• alcohol and drug addiction;
• getting into an unfavorable social environment;
• death.

Parents who deliberately harm the health of their children are prosecuted, deprived of parental rights, and sent for psychiatric treatment.

An experienced psychotherapist should provide comprehensive assistance for such a disease. You may need consultations with a neurologist, psychologist, or family doctor, who will work together to determine accurate diagnosis, recommend treatment and will regularly monitor the person’s condition.

Found a mistake? Select it and press Ctrl + Enter

Munchausen syndrome is considered a mental disorder. People suffering from Munchausen syndrome usually act as if they have a real physical or mental problem, although in fact they are not sick. This kind of behavior doesn't happen just once. A person with Munchausen syndrome often and deliberately behaves as if he or she is sick.

Munchausen syndrome used to be its own disorder, but according to r Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), it is now called factitious or self-inflicted disorder. This is a mental disorder in which people deliberately create, complain, or exaggerate the symptoms of an illness that does not actually exist. Their main intention is to take on the sick role so that people care about them and they are the center of attention.

Diagnostic criteria

Diagnosing Munchausen syndrome can be very difficult because of all the dishonesty associated with the disorder. Doctors must first rule out any possible physical or mental illness before considering a diagnosis of Munchausen syndrome. Additionally, to diagnose Munchausen syndrome (a factitious self-inflicted disorder), the following four criteria must be met:

1. Simulation of physical or psychological signs or symptoms or induction of injury or illness associated with the identified deception.
2. The person appears to others as sick, weakened, or injured.
3. Deceptive behavior is obvious even in the absence of obvious external rewards.
4. The behavior is not better explained by another mental disorder such as delusional disorder or other psychotic disorder.

Symptoms

The main symptom that appears in a person suffering from factitious mental disorder (Munchausen syndrome) is the deliberate production, distortion and/or exaggeration of symptoms (physical or psychological) when the person is not actually sick. Such people may suddenly leave the hospital and move to another area or city when it is discovered that the disease was made up. People with Munchausen syndrome can be extremely manipulative, as the disorder's core symptom involves deception and dishonesty.

Additional symptoms may include:

• desire to be seen by others as sick or weak;
• falsification of a medical record indicating illnesses;
• physically hurting oneself to cause injury;
• actions aimed at deliberately harming oneself in order to cause illness (for example, consuming toxic substances with the aim of causing an acute gastrointestinal reaction).

Behavior

Because a person affected by a factitious self-inflicted disorder will intentionally try to cause illness or injury, below are some examples of behaviors you may observe in a person who may be diagnosed with this disorder:

• exaggeration of actual injury, which may lead to additional and unnecessary medical intervention;
• complaints about neurological symptoms(such as seizures, dizziness or), the presence of which is difficult to determine;
• reporting suicidal thoughts after an event (for example, the death of a child), even if there was no death and/or the person does not even have a child;
• manipulation laboratory analysis(for example, by adding blood to the urine or taking medications) to produce a falsely abnormal result.

Munchausen syndrome versus “Munchausen syndrome by proxy”

Munchausen syndrome and " Munchausen syndrome by proxy", also called Munchausen syndrome by proxy or third person classified as factitious disorders.

There is one major difference between people who self-inflict a factitious disorder and people who suffer from a factitious disorder imposed by another person. This difference is related to who a person falsely identifies as sick. With Munchausen syndrome, a person imagines himself or herself to others as sick, while with Munchausen syndrome by proxy, a person imagines another person as sick or injured.

This “other” person, who may be a child, another adult, or a pet, is considered the victim. Thus, a person affected by Munchausen syndrome by proxy may also be guilty of criminal behavior if his or her actions are based on abuse.

Causes

The exact cause of this disorder is not known. Due to the hoax surrounding Munchausen syndrome, it is also unknown exactly how many people are affected by it (but the number is expected to be very low). The onset of symptoms usually occurs in early adulthood, often after hospitalization for medical reasons. Unfortunately, it is a complex and poorly understood disorder.

One of the main theories of what causes this mental disorder is a history of childhood abuse, neglect or abandonment. The person may have unresolved parenting issues due to trauma. These problems can, in turn, cause a person to pretend to be sick. People may exhibit these behaviors because they:

• want to feel important, needed and to be the center of attention;
• want to punish themselves by making themselves sick (because they feel unworthy);
• want to transfer responsibility for their well-being and care to other people.

Another theory regarding the cause of Munchausen syndrome is that the person has a history of frequent or long-term illnesses requiring hospitalization (especially if this occurred in childhood or adolescence). The rationale behind this theory is that people with Munchausen syndrome may associate their childhood memories with feelings of being cared for. As adults, they may try to achieve the same sense of comfort and confidence by pretending to be sick.

Forecast

Factitious disorder, self-inflicted, is a habitual condition and is therefore very difficult to treat. People with this disorder will often deny that they have false symptoms, so they usually refuse treatment for the disorder itself. Because of this, the prognosis is usually poor.

Munchausen syndrome is associated with severe emotional difficulties. People are also at risk of health problems or death due to their deliberate actions to harm themselves. They may suffer additional harm from complications associated with frequent tests, procedures, and interventions. Finally, people diagnosed with Munchausen syndrome are more likely to high risk substance abuse and suicide attempts.

Warning signs

If you're concerned that someone you know may be affected by Munchausen syndrome, there are some warning signs you can look out for. The main sign is that the person always seems to complain and/or exaggerate symptoms of illness.

Additional warning signs may include:

• extensive knowledge of hospitals and/or medical terminology (including textbook descriptions of diseases);
• extensive but conflicting medical history;
• complaints of new symptoms after negative test results;
• personality and self-esteem problems;
• the person does not want doctors to meet or talk with family, friends or former medical professionals;
• ambiguous symptoms that cannot be controlled and become even more pronounced or change after starting treatment (according to him);
• willingness or desire to go to the hospital, as well as undergo medical tests, surgery and procedures;
• history of receiving treatment in several hospitals, clinics and doctors' offices (possibly in different cities).

Treatment

Although people with Munchausen syndrome may actively seek treatment for the numerous disorders they self-inflict, these people are typically reluctant to admit and seek treatment for the syndrome itself. People suffering from a factitious self-inflicted disorder deny that they are faking or inducing symptoms, so treatment usually depends on loved one who suspects that a person has this disorder, persuades him to get treatment and encourages him to adhere to the goals of treatment.

The main goal of treatment for Munchausen syndrome is to change a person's behavior and reduce abuse/overuse of medical resources. Treatment usually consists of psychotherapy (psychological counseling). During treatment sessions, the therapist may try to challenge and change a person's thinking and behavior (this is called cognitive behavioral therapy). Therapy sessions may also attempt to uncover and resolve any psychological issues that may be causing the person's behavior. During treatment, it is more realistic to force the person to work with the syndrome rather than try to cure it. Thus, the therapist may try to encourage these people to avoid dangerous medical procedures, as well as unnecessary hospitalizations.

Medicines are not usually used to treat Munchausen syndrome. If a person also suffers from anxiety or depression, a doctor may prescribe treatment. If this is the case, it is important to monitor these individuals closely due to the high likelihood of using these medications to intentionally harm themselves.

Gleb Pospelov about a unique mental disorder in which patients want to go under the knife

In the practice of a psychiatrist, almost everything happens: intriguing, funny, sad, annoying. Over time you get used to different forms madness. But there are things that are impossible to get used to. Even we, psychiatrists, have an inherent irrational fear the incomprehensible, fear of unnatural acts that violate the foundations of the existence of living things.

I'm talking now about deliberate self-harm or deliberately causing suffering to loved ones. And it’s especially scary when this is done by a person who is considered normal in all other respects.

Cut me completely

A simple example from practice. A couple of years ago I was invited to a consultation in the surgical department. I was introduced to a mournful middle-aged man. The patient held his stomach and moaned deliberately, swaying like a metronome. There were tears in my eyes.
- I beg you... It hurts me... If I die, it will be worse for you...
The surgeons smiled:
- Maybe you can be patient? Medicines will help, no need to cut! The patient ignored the entreaties. Gradually he turned to threats; the sadness on her face gave way to a grimace of anger.
- I have a direct phone number for the Ministry of Health! You've already had problems!..

The surgeons continued to smile. This was not the first time they saw the patient and performed diagnostic operations on him twice during the year. “Sick” was not sick at all. He turned out to be not a surgical patient, but a psychiatric patient diagnosed with Munchausen syndrome.

In this situation, it was not his life that needed to be saved, but rather the nerves, time and health of the doctors. All I had to do was objectively record the patient’s mental state and provide a conclusion - in order to protect my colleagues from the brewing conflict. It is useless to dissuade a patient with Munchausen syndrome. He doesn't strive to be healthy. He needs surgery, he wants to be cut open. It sounds crazy, but that’s the essence of the problem. And the patient doesn’t care that the doctor’s job is not cutting, but treating people. He is confident that the operation will help, and actively feigns pain and malaise, resorts to tricks and threats - just to get his way.

The “patient” understood this and did not want to talk to the psychiatrist; he clearly already had such experience. After much persuasion and explanations that they would not operate on him anyway without my examination, the man made contact. He assured me that he had a “surgical pathology”, poured out in medical terms, listed numerous “symptoms.” And the surgeons and I clearly understood: the symptoms that our client describes are mutually incompatible. This man has clearly read the medical literature, but in some things only a doctor is competent; experience cannot be replaced by teaching. As a result, our “sufferer” was discharged after a commission examination, with a recommendation for treatment by a psychiatrist. Although it is unlikely that he went to him. Such people rarely come to us on their own. They are encountered mainly by surgeons, less often by therapists. Psychiatrists are the enemy for people with this disorder. The story I just told is quite ordinary. The worst is yet to come. But first, I will dwell in more detail on what “Munchausen syndrome” is.

In memory of Baron M.

Why is mental disorder called this? Munchausen syndrome is not a disease, it is a factitious disorder in which a person pretends to be sick, exaggerates or artificially induces symptoms of the disease in order to undergo medical examination, treatment, hospitalization, surgical intervention and the like. The syndrome is named after the character literary works Rudolf Erich Raspe (1737–1794) (and not at all a real historical person - the 18th century Russian cavalry officer of German origin, Baron I.K.F. von Munchausen!).

The term “Munchausen syndrome” was proposed by the English endocrinologist and hematologist Richard Asher in 1951, when he first described in the Lancet the behavior of patients who tend to invent or induce painful symptoms. This disease has synonyms: “occupational patient” syndrome, “hospital addiction”, “factitious disorder”. In the ICD-10 classification, the syndrome is classified under the heading “Intentional induction or simulation of symptoms or disabilities of a physical or psychological nature - so-called fake disorders.”

Who is lying and why

The reasons for this behavior are still not fully understood. The generally accepted explanation is that feigning illness allows these patients to receive attention, care and psychological support for which they have a great need, but are suppressed for various reasons. Munchausen syndrome is a borderline mental disorder. It resembles somatoform disorder (when real painful sensations caused by traumatic factors) due to the fact that the complaints are based on a mental problem.

But the key difference is that with Munchausen syndrome, patients deliberately fake the symptoms of a somatic disease. They constantly feign various illnesses and often move from hospital to hospital in search of treatment. It is not for nothing that a person with a similar behavioral stereotype in different countries is called in slang “professional patient”, “hospital flea”... However, this syndrome cannot be reduced to a simple simulation. Most often it is characteristic of hysterical individuals with increased emotionality. Their feelings are superficial, unstable, emotional reactions are demonstrative and do not correspond to the reason that caused them. Instead of confronting the conflict, they prefer to go into illness and hide from the problem, receiving attention, sympathy, indulgence, and others take on their responsibilities, which suits the imaginary patients quite well. Such hysterical types are characterized by increased suggestibility and self-hypnosis, so they can portray anything. When such a patient enters the hospital, he may copy the symptoms of his neighbors in the ward. These patients are usually quite intelligent and resourceful; They not only know how to fake the symptoms of illnesses, but also understand diagnostic methods. They can “control” the doctor and convince him of the need for intensive examination and treatment, including major operations. They cheat consciously, but their motivations and need for attention are largely unconscious. The age of the “Münchhausen” has no clear boundaries and can vary widely. Quantitatively, “Munchausen” constitutes from 0.8 to 9% of patients. Kirillova L.G., Shevchenko A.A., et al. The same Baron Munchausen and Munchausen syndrome. Kiev - International Neurological Journal 1 (17) 2008.

How to recognize a malingerer?

In the classical view of psychiatrists, important sign syndrome - a continuous stream of implausible complaints about the state of health, about excruciating pain that tears through the whole body, often with persistent demands to undergo a surgical operation to cure it. Richard Asher identified three main clinical varieties syndrome:

1. Acute abdominal type(laparotomophilia) - the most common. Marked external signs“acute abdomen” and traces of previous laparotomies in the form of numerous scars. The Barons complain about severe pain in the stomach and insist on immediate surgery. Additional diagnostic examinations they say there is no acute pathology. But if immediate surgery is refused, patients writhing in pain can immediately leave the hospital to be treated the same night “ acute stomach"to another hospital. Some, while seeking surgery, may swallow foreign objects (spoons, forks, nails, etc.). It should be noted that hysterical pain can be very difficult to distinguish from physical pain. Therefore, doctors, finding it difficult to accurately determine the cause, often decide to operate on the malingerer.
2. Hemorrhagic type(hysterical bleeding). Patients periodically experience bleeding from various parts bodies. Sometimes animal blood and skillfully applied cuts can be used for this, which gives the impression of natural injuries. Patients are admitted to the hospital with complaints of “very heavy bleeding life-threatening." Stigmatists belong to this type.
3. Neurological type. Imaginary patients experience acute neurological symptoms (paralysis, fainting, convulsive seizures, complaints of severe headache, unusual change in gait). Sometimes such patients require brain surgery. For obvious reasons, the Munchausens try not to end up in the same hospital twice. They go to various hospitals dozens, and sometimes hundreds of times! That is why in a number of Western countries, in many clinics, the names of the “barons” are included in a special list of scammers, with which the emergency doctor can always check.

Kirillova L.G., Shevchenko A.A., et al. The same Baron Munchausen and Munchausen syndrome. Kiev - International Neurological Journal 1 (17) 2008.

Munchausen syndrome “by proxy” or delegated

Now I'll tell you about the really scary side of the syndrome. About the deadly edge that a number of “barons” are capable of crossing, losing contact with reality.

Munchausen syndrome by proxy, or “delegated” (eng. Munchausen Syndrome by Proxy, MSBP), is understood as a disorder when parents or persons in their surrogate intentionally cause painful conditions in a child or vulnerable adult (for example, a disabled person) or invent them to seek medical help.

Such actions are carried out almost exclusively by women, in the vast majority of cases - mothers or spouses. At the same time, persons simulating a child’s illness may themselves exhibit behavior typical of Munchausen syndrome. In English-language sources they are called “MSBP-personality”.

Those suffering from delegated syndrome provoke the onset of the disease in their victims in different ways. The imagined or induced illness can be anything, but the most common symptoms are: bleeding, seizures, diarrhea, vomiting, poisoning, infections, suffocation, fever and allergies.

Diagnostics is characterized by:

• disappearance of the child’s symptoms when the mother is not around;
• her dissatisfaction with the conclusion that there was no pathology;
• a very caring mother who, under false pretexts, refuses to leave her child even for a short time.
• Factitious diseases are very difficult to treat (after all, it is not profitable for the mother!), so child victims are subjected to a lot of unnecessary medical procedures, some of which can be dangerous.

“Barons” can cause irreparable harm to health and threaten the life of a child. According to a number of authors, victims of Munchausen syndrome by proxy were noted among children diagnosed with the syndrome sudden death- up to 35% of all cases observed by the authors over 23 years. Delegated Munchausen syndrome is very difficult to recognize, so it is not yet possible to accurately determine its prevalence.

Harm can be caused in any way that does not leave evidence: difficulty breathing (hand over mouth, fingers over nostrils; lying on baby; plastic wrap on face), withholding food or medications, other manipulation of medications (increasing dose, administering medications when needed) not necessary), deliberate delay in calling necessary medical assistance.

When the victim is on the verge of death (asphyxiation, seizure, etc.), his tormentor can take action to save him so that he is praised as the good hero who saved the patient's life.

"Good Samaritans"

Mothers who cause illness in their children often suffer from a lack of communication and understanding, and are often unhappy in their marriages. Some also suffer from other mental disorders. The vast majority (up to 90%) were themselves subjected to physical or mental violence in childhood.

If doctors discover the artificial nature of a child’s illness, the “Munchausens” deny their guilt even in the presence of serious evidence and refuse the help of a psychiatrist.

A nurse or nanny with delegated Munchausen syndrome may receive attention and gratitude from parents for the kindness she showed during short life their child. However, such a “benefactor” is only concerned with attention to herself, and has access to a huge number of potential victims.

Patients with delegated Munchausen syndrome realize that if others have suspicions, they are unlikely to voice them because they are afraid of making a mistake. The MSBP person will interpret any accusations as persecution, where she herself became a victim of slander and slander! Thus, the situation is used as an even more advantageous one to again be in the spotlight. It is very important to understand that the MSBP personality, like all patients with attention-seeking disorders, often inspires confidence by being “believable” and persuasive.

I want to be “needed by someone”...

Personally, I have only encountered the “proxy syndrome” a couple of times. Here's a pretty good episode.

A young woman was literally dragged to my appointment by her husband. The essence of the complaints boiled down to painful anxiety, a feeling of tension, mood swings, irritability, and constant fear for the health of his ten-year-old son.

A couple of years ago, the boy developed vision problems; a fairly harmless diagnosis was made. The patient became confident that the child was at risk of blindness. Contrary to the beliefs of oculists and relatives, the woman could not find a place for herself. She took the slightest opportunity to show her son to the “best specialist” and did not let him go to sports: “You’ll go blind!..”. She began to independently purchase and give her son eye medications, secretly from the family. She met any objections with hostility and accused her loved ones of callousness. Further more. It turned out that the mother was trying to get a referral for surgery from the ophthalmologists. For a boy, of course. At this point, the husband’s patience ran out, and he took his wife to a psychiatrist.

I spent a long time collecting information about the patient’s life. A woman with bright hysterical features, not stupid, but not fulfilled in life, who has not achieved “worthy” attention from others, on financial support loving husband... In general, everything fit well into the stereotype described earlier. In the conversation, the patient admitted that she was looking for an opportunity to become needed “at least for someone”...

In the described case, I, as a doctor, was lucky. The disease has not gone too far; the woman agreed to treatment. The situation was resolved successfully. But I was left with the same residue that I mentioned at the beginning. The feeling of dense horror, the frightening darkness of a sick soul, as if looking for a victim who can be affectionately strangled in her arms...

Now in our country (and many others) there is no the legislative framework to deal with such situations. In the case of Munchausen syndrome, the doctor is faced with lies and self-destructive behavior of the patient, who is trying to drag the doctor into his game. The problem becomes ethical: the doctor cannot count on open communication and honesty of such patients, and therefore cannot act in their interests.

“Munchausens” are always difficult patients: the diagnosis can be suspected, but it is impossible to establish it without a comprehensive examination and long-term follow-up. You can think about this disease when an experienced clinician says: “This is the first time I have encountered such a case!”