Update: October 2018 It would seem there is no such person who
wants to hurt, and even longer and more serious, and even without removing
from it a material benefit (to get insurance or exemption from
work, win court). Children who do not want to go to school and
invent various manifestations of the disease, do not count. It’s about
adults who simply “sleep and see” themselves in a hospital bed,
or in extreme cases at the bed of a heavy patient (the case of extreme
for a particular person with a serious condition). Such people
psychiatrists call Munchhausen patients, they are dangerous in
first of all for yourself, because sometimes the damage to yourself
specifically, life threatening and in some cases lead to
According to statistics, Munchhausen syndrome is diagnosed.
0.8 – 9% of officially registered patients, but how many
is a person with this disorder not considered? And in the majority
cases, the disease is observed in women (95%).
Definition and history of the term
Munchhausen syndrome is called a mental disorder,
included in the group of simulative (simulated) states –
disorders To facilitate the concept of the term, you must separately
describe the simulation and somatoform disorders.
If the patient mimics the signs of a disease, and
for a specific purpose (to avoid punishment, evade service or
work) – this is called a simulation.
Somatoform disorder also applies
to mental disorders, and all manifestations are related to real
deterioration, that is, mental disorder results in
somatization. The patient has symptoms of somatic
plan (for example, chest pain, constricting or cutting
character that suspects angina), but in
the results of diagnostic procedures (ECG and other) signs
cardiac pathology absent.
Munchhausen’s Syndrome is located on the border between simulation and
somatoform disorder (borderline state). That is all
manifestations of a particular disease are real and
confirmed by additional diagnostic methods, however
the symptoms of the disease are specifically caused by the patient (mutilation),
but not for profit, but for attention, care and
Thus, Munchhausen’s syndrome is called borderline
mental impairment that manifests itself as an imitation of the disease with its
real symptoms. The goal for these patients is to conduct
extended medical examinations, hospitalization and treatment and
even surgery to attract increased
attention to his own person.
Synonyms of this pathology:
- professional patient;
- Munchhausen’s neurosis;
- operational maniac;
- mimicking disorder;
- hospital addiction syndrome.
History of origin
This pathology did not receive its name from the name
the discoverer of this mental disorder some
Munchhausen, and in honor of the literary character. Many of us
are familiar with the works of Rudolf Raspe, in which the main character –
Baron Munchhausen was described as a pathological lie, inventing
all sorts of stories – tales in which he allegedly participated. Patients
With this syndrome, too, constantly invent fiction about
existing diseases to attract attention, but their
symptoms are very real and caused by the patients themselves.
In the medical literature, you can often find an erroneous opinion.
about the origin of the name of this disorder – in honor of the Russian
officer, baron IKF von Munchhausen, a German by birth,
who was known for his fantastic tales of
The name of the disease was suggested by an English endocrinologist –
hematologist Richard Asher. He first described in a medical journal in
1951 the behavior of patients who exaggerate or cause
in painful manifestations.
What leads to the development of pathology
The basis of this mental pathology is the usual, it seemed
would desire – to draw attention to his person. But what kind of person
does not want attention and care? Unlike normal people, patients
with this disorder, attention is sought at all costs,
up to the medication in high dosage and application
injuries. Since Munchhausen syndrome is a rare disease,
then the reasons for its development have been little studied, and look for the roots of pathology
follows deeper in childhood.
It is currently believed that Munchhausen’s neurosis can
observed in people with personality disorders or schizophrenia
(sluggish or mild form).
Making a diagnosis of “Munchhausen syndrome” to a person is based
primarily on the absence of acute psychosis or signs
schizophrenia. Intentionally injuring yourself can be one of
проявлений психоза/schizophrenia. For example, a person is able
severe mental disorder – psychosis, deliberately tearing itself
hair, cutting skin, etc., not in order to attract attention and
to bring care and comfort punish. Otherwise
case of any intentional injury or
somatic symptom on the background of complete health (for example, diarrhea,
as a side effect of the drug) is considered to be
benefit of Munchhausen syndrome.
The hypothesis put forward by psychiatrists explains the reason for the development
diseases with some serious problems in childhood. I.e
the patient was deprived of the love and attention of the parents, but
suddenly got one and the other only in the case of getting into the hospital
or in any other medical situation.
As a result, a distorted image is formed unconsciously or vaguely.
logical chain: pain (severe symptoms) – medical
staff (doctors, sisters, nurses) – care, attention, careful
examination – even more attention. I.e у человека с данным
Disorder distorts ideas of empathy, sincerity, and
High risk of this mental pathology is inherent.
- childhood psychotrauma:
- past sexual abuse;
- severe illness in childhood and its treatment (increased care,
- death of a loved one from severe illness in
- low self-esteem, inferiority complex;
- unsatisfied desire to become a doctor;
- hysteroid psyche;
- personality disorders – emotional infantilism,
psychological immaturity, no self-esteem;
- incomplete families (children of single mothers, fathers – widowers);
- superficial attitude of parents to the child in childhood
(inattention of parents, lack of time to caress);
- serious stress in the past (I want pity, care,
Case of psychiatry
In psychiatric literature, the history of the patient is often found
Wendy, which is interesting not only the characteristic manifestations
mental illness, but also a complete cure of this
The described patient was hospitalized in her entire life.
about 600 times, and in 42 cases she underwent surgical
operations. Wendy very reliably described the signs of their
invented diseases, so artistically portrayed their symptoms,
that even experienced doctors believed her unconditionally.
Later, when the patient got rid of the disease, she told
doctors about your life by trying to analyze the reason that
led to mental disorder. Wendy’s childhood was hard
She experienced neither love from her parents, nor care and warmth.
In addition, in her childhood there was the fact of sexual abuse.
The only episode the patient recalled with warmth was
case of appendicitis. It was with the onset of the disease that the girl got into
the hospital where she was operated on and then received care. Nurse,
caring for a child, sincerely worried about the girl and
cared for her. It was then that Wendy and felt
happy and loved
Having matured, the patient found solace, attention and care only
in people in white coats. But hospital travel ended
for two reasons. First, the next surgical
the intervention ended with a serious complication, threatening death.
And, secondly, to die at that particular time at one time
the girl did not want at all, since her life appeared
a being to whom she was very dear, who loved her sincerely, and
which she herself loved very much – her cat.
There are 2 types of the disease:
- actually, or the so-called individual syndrome
- delegated Munchhausen syndrome (the most dangerous).
In turn, this pathology is classified by clinical
- acute abdominal type (love for abdominal operations);
- hemorrhagic type;
- type with neurological symptoms.
Later, the main varieties of the disease were joined and
others (dermatological, pulmonary and other).
Symptoms of Munchhausen syndrome are numerous and different.
diversity, which is largely determined by the level of awareness
clinical picture of a disease, availability
specialist of a certain profile, the ability to dream,
имитировать болезненные проявления, возможностью вызвать
signs of illness (for example, to provoke bleeding can only
in the presence of drugs that thin the blood, and cause diarrhea – with
the presence of laxatives).
You can list the diseases that mimic the Munchhausen
infinitely. The most “favorite” patient pathology:
- gastric ulcer and gastrointestinal bleeding;
- dermatological diseases (rash, ulcers, scratching);
- diseases of the cardiovascular system (angina, heart attack
- diseases of the intestine (especially rectum) and stomach
- diseases of the bronchopulmonary system (pulmonary tuberculosis
- acute surgical pathology (appendicitis, intestinal
obstruction, adhesive disease);
- tumors, including the brain.
Psychological portrait of the patient
All “barons” are inherent behavior and character
expressed to a greater or lesser extent:
- rich fantasy;
- hysteria – drawing attention;
- high intelligence;
- a good education;
- infantilism – emotional and psychological immaturity;
- egocentrism turning into delusions of grandeur;
- inadequate self-esteem (reduced or overestimated);
- obsession with the idea – proof of some
- tendency to hypochondria and vagrancy;
- inability to socially adapt (patients are often single,
do not have a family, and in the presence of excellent professional knowledge is not
moving up the career ladder);
- pathological deceit;
- deep knowledge of medicine (specifically for “his”
- lack of attention and communication;
- feeling of “uselessness”.
Signs indicating pathology
Patients imitate any disease, but more often somatic.
Every visit to the hospital with the desire of hospitalization
carefully thought out and prepared. Such patients as
usually cause an ambulance, and do not go to the clinic to
reception Moreover, the ambulance call is made either at night or in
holiday, as most patients consider
(unreasonably) that these duties are given to young and
inexperienced doctors who fail to recognize their simulation. If a
the patient decided to visit a clinic doctor, then he makes a visit
at the end of the working day when the doctor is already tired, inattentive and
guaranteed to be led by the patient. If a желанная
hospitalization did not take place, the patient turns to another doctor,
and preferably to another hospital. About their “hospital voyages”
Munchhausen prefer not to talk, or are silent about
the names of the doctors who were examined and about
Another favorite way to attract attention is
visiting doctors with regalia (I will be examined by the “light of medicine”,
since my case is very complicated). If a же специалист не
confirms the disease being mimicked, then it serves as a wonderful
the reason for the patient to scandal, write complaints to various
instances, charges of medical workers for illiteracy,
The alarming symptoms in adults Munchhausen:
- frequent cases of hospitalization:
- sudden deterioration that is not confirmed
additional examinations (analyzes, instrumental
- pitiful tales of their health problems;
- excessive desire to operate;
- unspecified symptoms, (feudal: diarrhea combined with
numbness of the limbs and others);
- urgent drug requests (usually
- constant controversy with honey. workers (wrong treatment,
wrong dosage, poor diagnosis);
- good awareness in medical terminology.
Types of pathology
Acute abdominal or laparotomophilia
The patient “gives” signs of acute abdomen (muscle tension
abdominal, peritoneal symptoms). The skin of the abdomen is speckled
numerous scars after operations. Blood tests not
confirm acute abdominal pathology.
Hemorrhagic or hysterical bleeding
Patients periodically bleed, or
natural or artificially created. To this end, the sick
or drink anticoagulants (gastric bleeding), or cause
self cuts (damage to the gums – imitation of pulmonary hemorrhage).
And they can use the blood of animals.
Imitation of acute transient neurological symptoms
(seizures and paralysis, fainting and migraine, paresis and instability
gait). Patients с данным типом расстройства нередко убеждают
Doctors need a brain surgery.
Intentional skin damage (scratching, rubbing or
masks) before the occurrence of purulent and non-healing ulcers.
Imitation of signs of myocardial infarction, angina, ventricular
fibrillation. Common among mental patients not
confirmed by ECG results.
Imitation of pulmonary tuberculosis or other bronchopulmonary
Patients намеренно глотают инородные предметы (иглы, ложки,
гвозди) с целью проведения operations.
Characterized by a set of different symptoms, but in accordance with
profile of the hospital where the patient is going. A kind of mimicry
for a specific hospital.
Rare type, characterized by casuistic
cases. For example, perforation of the membranes of the last
weeks of pregnancy to cause labor pains.
Recently appeared variety. Manifested in psychopathic
patients who are “addicted” to certain drugs (drugs,
analgesics). Such Munchausenes are haunted by the doctor who treated them and
require to prescribe them medication or re-operation.
Distinctive complaints: constant weakness and pain, frequent vomiting.
Delegated Munchhausen syndrome
This is the alarming and monstrous form of this mental
frustration. Dangerous disease is not suffering himself
Munchhausen, and the man whom he made his victim. Other
the names of the disorders are syndrome Munchhausen by
power of attorney or Munchhausen syndrome
intermediary / representative. As the name implies, the victims of the “barons”
unprotected people (small children who cannot yet
speak, disabled and old men). Munchhausen parents act
(often mother), guardians and wives of disabled people, and sometimes medical
In fact, it is a severe form of abuse of a ward, as
usually with a child. One parent artificially and at the same time
skillfully induce and induce symptoms of the disease in the baby.
Complaints are stated by the mother / father, who causes systematic
damage. Parent or guardian, watered or administered to the ward
unnecessary drugs, exceed the recommended dosage of drugs,
deliberately stifled (pillow, hand, plastic bag), not
rush to call an ambulance, and even injected into the body of a child
foreign objects (in the stomach, colon, lungs). Why is it
do parents / guardians need Munchhausen? To attract attention,
to create a halo of holiness and image of caring and attentive
parent. As soon as the child falls into the hands of medical professionals
parents immediately begin a “dramatic struggle for the health of the baby.”
Moreover, in the event of the death of a child, the mother or father undertakes a long
litigation against “werewolves in white coats”.
According to statistics, among all children with sudden death syndrome
(this is definitely not a diagnosis, but rather a diagnostic
garbage) about 35% were victims of the “barons”.
Characteristic symptoms in a child
If a жертвой «барона» стал ребенок, у него имеются следующие
- survey data do not confirm the presence of the disease or its
- retention of complaints, despite the diagnosis, and sometimes
- a rare disease that is made in the primary diagnosis;
- mother dissatisfied with the absence of pathology, confirmed
- the parent is well versed in medical topics;
- symptoms disappear in the absence of the mother;
- treatment does not bring a positive result;
- the mother does not want to leave the child even for a short time;
- a phrase from an experienced doctor: “for the first time I encountered a similar
by chance. “
The delegated form of the disorder is characterized by another
curious sign. The clinical picture of severely flowing
the child’s illness disappears as soon as he masters the speech.
For patients with this form of disorder characterized by:
- lack of attention;
- conflicts in the family, lack of understanding and care;
- dissatisfaction with life;
- the desire to be someone needed, which translates into hyper-drug;
- депрессивные frustration.
Unfortunately, delegated Munchhausen syndrome is rare
detected. It is difficult to suspect a mental disorder
caring, attentive and sincerely worrying about the health of his
mother’s baby. In addition, the parent or guardian knows that in the case of
the occurrence of suspicion by others in the application
Trust intentional damage, it is unlikely they will be announced.
But if the suspicions are still publicized, patients with this
form of the disorder treat them as malicious prosecution,
colleagues / loved ones are accused of defamation and thus again find themselves
in the spotlight.
Case of psychiatry
A mother came to the clinic with a one year old baby in her arms. The words
women in the urine of the baby was present with blood. During the ongoing
The survey was a woman nearby, trying to help (or
hinder?) doctors. The mother of a sick child even has tubes of blood and
urine itself wore to the laboratory. The results obtained confirmed
that blood is actually present in the patient’s urine, although
the child did not make an impression of the patient, and other tests
were within normal limits. But one day a nurse discovered how
the inconsolable mother punctures the finger with a needle and squeezes the blood into a test tube with
This is one of the easiest and most timely cases.
delegated Munchhausen syndrome. Similar caring mothers
bring the child to disability, and sometimes to death. In psychiatry
There are many cases of repeated deaths of children in one and
the same mother, and even the death of the mother she killed
Treatment больных с синдромом Мюнхгаузена представляет собой
difficult task, and treatment standards have not yet been developed.
The difficulty lies in the categorical refusal of patients from
psychiatric treatment, conflicts with psychiatrists and
dissatisfaction with their work, issuing instructions and making demands.
Only a small percentage of “barons” voluntarily agree to
General recommendations for patients
- to devote to the problem of one doctor, to build with him
- broaden your social circle (make friends, buddies,
try to “get over” with friends)
- get carried away by a new occupation / hobby;
- adhere to a healthy lifestyle;
- become a volunteer or public figure;
- to get a pet.