Feigning illness to gain attention
Intentional physical injury and unconscious motivation are key elements in people with a factitious disease.
Some individuals will go a long way to gain others’ sympathy or attention. When taken to the point of “intentionally producing (or feigning) disease in oneself to relieve emotional distress by assuming the role of a sick person,” it is called factitious disease.
Take the case of a woman who came to the Baylor University Medical Center (BUMC) in Texas, USA after having been to several other hospitals. Doctors had not been able to find out what was wrong, and she was in danger of dying from bacteria in her blood.
One of the doctors on the case decided to secretly search her personal possessions when he suspected that the woman was inducing her own illness. In her purse he found syringes and a Petri dish with growing bacteria colonies, with which she had been injecting herself.
When asked if she was harming herself, the patient burst into tears. She admitted to having the bacteria, but denied injecting herself. She wanted the doctors to keep looking for the cause of her problems.
This is one of six case studies presented in a BUMC study on factitious disease.
Perplexing and difficult to discover
Munchausen syndrome is an extreme form of factitious disease, when individuals have a psychological need to repeatedly conjure up illnesses and seek diagnostic tests, treatment or operations. It is a rare psychiatric disease, and one that is challenging for physicians to detect.
Patients with this disease are adept at simulating authentic symptoms and faking illness- even sometimes fabricating medical records.
“Patients put a lot of creativity into appearing sick to meet their need for support and care from health care personnel,” says Anne-Kari Torgalsbøen. She is an Associate Professor in Clinical psychology at the University of Oslo (UiO), who is has become interested in this type of psychiatric disorder. “The goal isn’t to get well, just the opposite- the patient is always looking to generate new illness occurrences,” she says.
Doctors, on the other hand, must be hard pressed to doubt the truth of a patient’s words, since the traditional physician-patient relationship is a cooperative and complementary relationship based on mutual trust.
“It’s so difficult to imagine that someone purposely wants to inflict harm on themselves and fool us,” says Torgalsbøen.
People suffering from Munchausen syndrome can have many reasons for harming themselves. Some do it to relieve emotional pain by replacing it with a more concrete, physical pain. They want to be seen, but don’t know how to ask for recognition in the usual ways. And their motivation is driven by the need for attention.
Unlike hypochondriacs, who truly believe they are sick, Munchausen syndrome patients are being consciously deceptive, even though they often do not know why they are doing it. Factitious disease is also distinct from malingering, in which a person intentionally produces symptoms for material gain, such as money or avoidance of work.
According to the BUMC report, “the main tangible emotional gains that patients receive from assuming the sick role are believed to be sympathy, warmth and nurturance; a heroic image for tolerating illness so bravely; and control over their lives.”
Kind, empathetic doctors and nurses provide a haven for these needs.
An estimated one percent of patients in the United States may have Munchausen syndrome, but the figures are highly uncertain. In Norway there is no research on the disease. From other countries there are several case studies, but little systematic research.
A survey of 751 patients in Italy showed that three of the patients had Munchausen syndrome. This is more than researchers thought they would find. The dark figures are probably large.
Underlying emotional problems
Munchausen syndrome by proxy is a similar and tragic behaviour, wherein a parent causes some medical affliction in their child, forcing the child to undergo recurring hospital treatments.
In the most serious Norwegian case, a mother was suspected of trying to kill her child. Torgalsbøen says that the child was brought to the hospital with supposed breathing difficulties. “There was reason to believe that the mother had held a pillow over the child’s mouth and nose until it almost stopped breathing. This type of abuse of a defenceless child is a criminal act,” she says.
It’s easy to get angry at these people who are so manipulative. But severe emotional problems underlie their actions, says Torgalsbøen. “Emotionally healthy people wouldn’t do this.”
She says that individuals who injure themselves or others feel compelled to repeat the abuse over and over. They can’t stop themselves, because their need for support and sympathy is so great. It’s a kind of release. This dependence has a lot in common with drug addiction.
According to UiO Psychiatry professor and author Ulrik Malt, people with Munchausen syndrome generally don’t admit that they constantly try to fool others into believing that they are sick. They don’t recognize their behaviour as a cry for help.
Many causes can precipitate the disorder. Often some form of childhood trauma comes into play. “Attachment to parents or other close people has been poor. They have not experienced security, respect or recognition. As adults, they are frequently solitary, even when people are around,” says Malt.
But researchers still have a lot to learn about factitious disorders, and so there is also disagreement about how they arise.
Malt belongs to the psychoanalytic tradition that believes that the disease is an unconscious result of needs that were suppressed in childhood.
He sees this compulsive behaviour “as a way to relieve an internal pressure, to get the care that they did not get as children. They have an experience of pain that they are unable to put into words.”
Read the Norwegian version of this article at forskning.no
- Adria C. Savino and John S. Fordtran: Factitious disease: clinical lessons from case studies at Baylor University Medical Center. Baylor University Medical Center Proceedings 2006; 19.
- Anne-Kari Torgalsbøen: Når behovet for oppmerksomhet og sympati overgår morsfølelsen: En litteraturgjennomgang av Münchausen syndrome by proxy. Tidsskrift for Norsk Psykologforening, vol 45, nr 4, 2008.
- Marc D. Feldman and Charles V. Ford: Patient or pretender: Inside the strange world of factitious disorders. John Wiley and Sons Inc., New York 1994.
- Muhammad R. Baig et.al.: Factitious disorder (Munchausen’s syndrome) in oncology: case report and literature review. Psycho-Oncology, online 14. juli 2015. DOI: 10.1002/pon.3906.
- Ulrik Fredrik Malt et.al.: Lærebok i psykiatri, kapittel 26. Oslo, Gyldendal akademiske forlag 2014.
- Wikipedia: Baron Munchausen