Munchausen syndrome is the most chronic and severe form of factitious disorder. Individuals with this psychiatric illness devise numerous ways to induce illness or injury, deceiving and gaining the attention of medical personnel and family and friends. The term “Munchausen” originates from an 18th century German officer, Baron von Munchausen, who was known to make up exaggerated stories about his life. Richard Asher wrote the first article naming the disorder in 1951.
The condition is considered rare because it is infrequently documented. However, it is by definition a secret disorder, and most cases are never discovered by medical professionals. One of the primary risk factor is a history of childhood abuse and/or neglect, often combined with the experience of positive attention when sick or injured.
The reasons why childhood abuse can lead to Munchausen syndrome are complex. When children are severely abused, they often internalize blame and feel unworthy and unloved. One way to feel loved and noticed is to be sick or injured. While causing one’s own sickness or injury would never occur to most children, it can feel like a viable option to victims of abuse who are starved for love and nurturance.
Munchausen syndrome is thought to be extremely hard to treat. In fact, most people with the disorder do not pursue treatment. If they do seek help, they have difficulty trusting and working with mental health clinicians. This reticence is to be expected with people who have been badly mistreated in childhood. In Andrea’s case, as with many other child abuse survivor stories, the abuse took place over several years.
Little has been written about long-term psychotherapy with Munchausen patients, the subject of our book. In the context of an unusually strong therapeutic relationship, individuals with Munchausen syndrome can begin to overcome their compulsion to harm themselves. Such a relationship is not easily established through traditional, brief weekly psychotherapy. Clinicians may consider a less rigid model of therapy, making themselves much more accessible than usual.
The following links provide extensive information about the disorder: