Munchausen by Internet aka the Bonnie Combs Disorder

August 14, 2014

Introduction

Munchausen's syndrome is a psychological and behavioural condition where someone pretends to be ill or induces symptoms of illness in themselves.
Munchausen's syndrome is also sometimes known as factitious disorder.
In people with Munchausen's syndrome:
  • they intentionally produce or pretend to have physical or psychological symptoms of illness
  • their main intention is to assume the 'sick role'; have people care for them and be the centre of attention
  • there is no practical benefit for them in pretending to be sick - for example, claiming incapacity benefit
Munchausen's syndrome is named after a German aristocrat, Baron Munchausen, who became famous for telling wild, unbelievable tales about his exploits and past.

Types of behaviour

People with Munchausen's syndrome can show different types of behaviour including:
  • pretending to have psychological symptoms - for example, claiming to hear voices or claiming to see things that are not really there
  • pretending to have physical symptoms - for example, claiming to have chest pain or stomach ache
  • actively seeking to make themselves ill - such as deliberately infecting a wound by rubbing dirt into it
Some people with Munchausen's syndrome may spend years travelling from hospital to hospital feigning a wide range of illnesses. When it is discovered they are lying, they may suddenly leave hospital and move to another district.
People with Munchausen's syndrome can be very manipulative and, in the most serious cases, may undergo painful and sometimes life-threatening surgery, even though they know it is unnecessary.

What causes Munchausen's syndrome?

Munchausen's syndrome is a complex and poorly understood condition and it is still unclear why people with the condition behave in the way they do.
Some experts have argued that Munchausen's syndrome is a type of personality disorder. Personality disorders are a type of mental health condition where an individual has a distorted pattern of thoughts and beliefs about themselves and others. This leads them to behave in ways most people would regard as disturbed and abnormal.
Another theory is that the condition may be the result of parental neglect and abandonment, resulting in feelings of childhood trauma which causes them to fake illness.

Who is affected

There appear to be two distinct groups of people affected by Munchausen's syndrome:
  • women who are 20 to 40 years of age, who often have a background in healthcare, such as working as a nurse or a medical technician
  • unmarried white men who are 30 to 50 years of age
It is unclear why this is the case.
It is not known exactly how common Munchausen's syndrome is. Some experts believe it is under-diagnosed because many people with the condition succeed in deceiving medical staff. It is also possible that cases of Munchausen's syndrome may be over-diagnosed because the same person could use different identities.

Symptoms of Munchausen's syndrome

There are several warning signs someone may have Munchausen's syndrome.
Someone with the condition may:
  • make frequent visits to hospitals in different areas
  • claim to have a history of complex and serious medical conditions with little documentary evidence to support this (people often claim they have spent a long time out of the country)
  • have symptoms that do not correspond to test results
  • have symptoms that get worse for no apparent reason
  • have a very good medical knowledge
  • receive few or no hospital visitors (many people with Munchausen's syndrome adopt a solitary lifestyle and have little contact with friends or family)
  • be willing to undergo often painful or dangerous tests and procedures
  • report symptoms that are vague and inconsistent, or report a pattern of symptoms that are 'textbook examples' of certain conditions
  • tell highly unbelievable and often very elaborate stories about their past, such as claiming to be a decorated war hero or that their parents are fantastically rich and powerful

Patterns of behaviour

There are four main ways that people with Munchausen's syndrome fake or induce illnesses. These are outlined below.
  • Lying about symptoms. They often choose symptoms that are difficult to disprove, such as having a severe headache or pretending to have a seizure (fit) or to pass out.
  • Tampering with test results. For example, they may heat a thermometer to suggest a fever or add blood to a urine sample.
  • Self-infliction. They may cut or burn themselves, poison themselves with drugs or an overdose of medication, or eat food that has been contaminated with bacteria.
  • Aggravating pre-existing conditions. For example, they may rub dirt or dog faeces ('poo') into wounds to cause an infection or reopen previously healed wounds.

Munchausen's by internet aka the Bonnie Combs Disorder

A relatively new condition has been labelled Munchausen's by internet. This is where a person joins an internet support group for people with a serious health condition, such as cystic fibrosis or leukaemia, and then claims to have the illness themselves.
While these actions may only be confined to the internet, they can have an incredibly destructive effect on support groups and online communities. People with genuine health conditions have reported feelings of betrayal and anger upon discovering they have been lied to.
One expert on Munchausen's by internet has compiled a list of warning signs that indicate someone may be affected by the condition:
  • Their posts and messages seem to contain large chunks of information that appear to have been directly copied from health websites, such as NHS Choices.
  • They report experiencing symptoms that appear much more severe than most people would experience.
  • They claim to have near-fatal bouts of illness followed by a miraculous recovery.
  • They make fantastic claims which they later contradict or which others disprove at a later date. For example, they may claim to be attending a certain hospital that does not actually exist. 
  • They claim to have continual dramatic events in their life, such as loved ones dying or being the victim of a violent crime, particularly when other group members have become a focus of attention.
  • They feign an attitude of unconcern when they talk about serious problems, probably to attract attention and sympathy.
  • Other 'people' claim to post on their behalf, such as a parent or partner, but they use exactly the same pattern of writing.

Causes of Munchausen's syndrome

There is little available evidence about possible causes of Munchausen's syndrome because many people with the condition refuse to co-operate with psychiatric treatment or psychological profiling.

Theories

There are two main theories about the root cause of Munchausen's syndrome. The condition may be the result of:
  • emotional trauma (deeply upsetting experiences) that occurred during a person's childhood
  • a personality disorder: a mental health condition that causes patterns of abnormal thinking and behaviour
It could be the case that both theories are interrelated to some extent. A person with a traumatic childhood can often go on to develop a personality disorder in later life.
The two theories are discussed in more detail below.

Childhood trauma

Some experts have suggested that many cases of Munchausen's syndrome may be the result of parental neglect and abandonment, resulting in feelings of childhood trauma.
As a result of this trauma, a person may have unresolved issues with their parents that cause them to fake illness. They may do this for a number of reasons, for example because they have:
  • a compulsion to punish themselves (masochism) by making themselves ill because they feel unworthy
  • a need to feel important and be the centre of attention
  • a need to pass responsibility for their wellbeing and care onto other people
There is also some evidence to suggest that people who have had extensive medical procedures, or received prolonged medical attention during childhood or adolescence, are more likely to develop Munchausen's syndrome when they are older.
This may be because they associate their childhood memories with a sense of being cared for. As they get older they try to obtain the same feelings of reassurance by pretending to be ill.

Personality disorders

There is some evidence that many people with Munchausen's syndrome have a personality disorder.
Personality disorders are a type of mental health condition where an individual has a distorted pattern of thoughts and beliefs about themselves and others. This leads them to behave in ways most people would regard as disturbed and abnormal.
One theory is that there may be people with Munchausen's syndrome who have an antisocial personality disorder that causes them to take pleasure in manipulating and deceiving doctors. They may see doctors as authority figures and by tricking them it may give them a sense of power and control.
Another theory is that some people with Munchausen's syndrome have an extreme form of what are known as cluster B personality disorders. A person with a cluster B personality disorder struggles to regulate their feelings and often swings between positive and negative views of others. (The most common type of cluster B personality disorders is borderline personality disorder).
It could be that the person has an unstable sense of their own identity and also has difficulties establishing meaningful relationships with others. So playing the 'sick role' allows them to adopt an identity that brings with it unconditional support and acceptance from others. And admission to hospital gives that person a clearly defined place in a social network.

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