In the practice of a psychiatrist, almost everything happens: intriguing, funny, sad, annoying. Over time, you get used to different forms of madness. But there are things that are impossible to get used to. Even we, psychiatrists, have an irrational fear of the incomprehensible, a 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 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,” sprinkled in medical terms, and 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.
Difficulty of diagnosis
It is difficult to make a correct diagnosis for a person with Munchausen syndrome. The patient's lies are always thought out in advance, the tricks are carefully planned, and artistry reaches such a level that everyone around him believes in the authenticity of the symptoms described. It is particularly difficult to make a diagnosis in the case of delegated syndrome.
The following can alert the health worker and lead him to believe that the patient has a mental disorder:
- repeated and too frequent visits to doctors;
- discrepancy between the described symptoms and examination results;
- too good knowledge of terms;
- discrepancy between some symptoms and others (there are mutually exclusive conditions that doctors may know about due to their experience and not be taken into account by patients who are guided only by theory);
- the patient’s attempts to manage the treatment process;
- reviews from relatives about the person’s real condition;
- excessive hysteria;
- obsessive requests for hospitalization and surgery.
The difficulty in determining ways to solve the problem in this case is that the doctor cannot refuse help to the patient simply by referring to his suspicions regarding the presence of a psychological disorder.
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, surgery, etc. The syndrome is named after the character in the literary works of Rudolf Erich Raspe (1737–1794) (and not at all a real historical person - the 18th century Russian cavalry officer of German origin, Baron J. C. 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.”
Features of the treatment of Munchausen syndrome
Getting rid of this problem is a difficult task, because even with prescribed therapy, the possessed person will try to coordinate the recommendations of doctors.
Independent actions to get rid of the problem
People who decide to start their lives anew using their own strength must adhere to the following rules:
- Choosing one doctor
. With this change in consciousness, it is not recommended to create a route map for a large number of specialists. Such a daily routine will not solve the problem, but will only aggravate its consequences. You should find a doctor who is sympathetic to the patient and has experience working with “non-standard” patients. - Finding new friends
. Life experience shows that a sociable person is the least susceptible to depression and the manifestation of any mania. In this case, it is best to make acquaintances with optimists who, without fanaticism, monitor their physical condition. - Finding a new hobby
. You can distract yourself from the desire to show your pain by doing something unusual. In this case, you can choose knitting, modeling, drawing and even unique ways of spending your leisure time. Recently, making sculptures from unusual objects (nails, tires and bottles), working with metal and many other modern manifestations of art have become very popular. - Healthy lifestyle
. As you know, in a strong body there is a vigorous spirit. If you want to get rid of the habit of talking about non-existent diseases, you can purchase a gym membership. In this case, at first it is recommended to seek help from a trainer who professionally organizes joint classes. - Volunteering
. Passion for charitable and social activities will help the imitator to distract himself from the desire to once again feel sorry for himself. It is not necessary to devote the rest of your life to this pastime, but during the year it is recommended to take care of those who need it. - New pet
. One lover of abdominal operations, which were performed on her 42 times, almost paid for her simulation with her life. She was brought back from the edge of the abyss by a cat, whose affection helped the woman get rid of Munchausen syndrome.
Expert advice for dealing with Munchausen syndrome
It should be remembered that you cannot cope with this pathology solely on your own. It is necessary to organize joint work with the doctor as follows:
- Regular consultations
. One conversation is not enough for Munchausen syndrome. At first, you should visit a doctor 2-3 times a week, eventually reducing these visits to one session for 7 days. - Family therapy with a specialist
. People with such a pathology very often do not have close contact with their relatives because they are completely selfish. It's time to build a relationship with them by offering to attend doctor's appointments together. - Psychological trainings
. Initially, it is recommended to take part in those events where a large number of people are involved. A month after attending such trainings, you can look for a small group with interesting people to communicate with. - Non-confrontational approach
. The reverse method often works effectively even in critical situations. The patient’s complaints should be responded to with complete readiness to help him. It is necessary to stipulate that physiotherapy and massage will help with his illness.
Attention! In particularly severe cases of this disease, hospitalization in a special facility may be necessary. When a threat is made against family members, the inadequate person must be isolated from the chosen victim.
How to treat Munchausen syndrome - watch the video:
Treatment of Munchausen syndrome is not a momentary process. The main thing is to convey to the simulator that there is a serious problem in his life. This must be done with maximum correctness, because imitators are often prone to outbreaks of aggression towards themselves and their immediate environment.
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 are caused by traumatic factors) in 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.
Predisposing factors
The etiology of the disease is currently not completely clear. There are circumstances that, taken together, can affect a person’s psyche in such a way that the disease in question begins to develop. The main ones:
- low self-esteem;
- psychological complexes;
- a real somatic illness suffered in childhood, during which adults provided overprotection and increased attention;
- psychological trauma;
- sexual violence;
- unrealized desire to become a doctor;
- serious stress;
- experiences experienced in childhood regarding the death of a loved one due to illness;
- hysterical personality;
- egocentrism;
- lack of parental attention in childhood.
Each of the factors individually does not lead to the development of mental disorders, but the superposition of several of them on top of each other can cause the appearance of pathology and provoke the progression of the disorder.
A story that was widespread in psychiatry is indicative. We are talking about a patient who, as a child, did not receive care, love and attention from her parents. Among other things, the girl was sexually abused at an early age. The patient felt her first sincere feelings for herself when she was placed on the operating table with a diagnosis of appendicitis. The nurse who looked after the girl showed genuine attention and care to her. All these facts together led to the idea that only by being sick can one earn love. From that time on, the patient began to invent symptoms, and she described them so realistically and got used to the role so well that health workers repeatedly believed her. During her life, the woman underwent dozens of operations and was hospitalized many times. It is noteworthy that after another surgical intervention, which led to complications, the girl gradually began to recover from her psychological illness. When a creature appeared in the woman’s life who began to love her unconditionally (a cat), the patient finally recovered.
How to recognize a malingerer?
In the classical view of psychiatrists, an important sign of the syndrome is a continuous stream of implausible complaints about the state of health, about excruciating pain that tears through the entire body, often with persistent demands to undergo a surgical operation to cure it. Richard Asher identified three main clinical types of the syndrome: 1. Acute abdominal type (laparotomophilia) - the most common. There are external signs of an “acute abdomen” and traces of previous laparotomies in the form of numerous scars. The Barons complain of severe abdominal pain and insist on immediate surgery. Additional diagnostic examinations indicate the absence of acute pathology. But if immediate surgery is refused, patients writhing in pain can immediately leave the hospital in order to be admitted to another hospital with an “acute abdomen” the same night. 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 of the body. 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 complaining of “very severe bleeding that is life-threatening.” Stigmatists belong to this type. 3. Neurological type .
In imaginary patients, acute neurological symptoms occur (paralysis, fainting, seizures, complaints of severe headache, unusual changes 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.
Signs of the syndrome
Recognizing the disease is difficult. It is impossible to do this in a 15-minute appointment with a therapist. Signs appear gradually, they can be identified and analyzed over a certain period of time.
Behavior
Substitution of clinical tests, often using the results of really sick people (relatives, neighbors).
A voluminous patient file, in which there are many conflicting complaints, very little or no completed treatment process. Constant visits to clinics, free and private. Ambulance calls to home are constant.
Wanting to get medical help and care, a person resorts to a variety of ways to get sick.
:
- tries to stay for a long time among a large crowd of obviously sick people (queuing for appointments, walking along the corridors of the hospital).
- deliberately uses household items and dishes of a chronically ill person, usually in his own family.
- deliberately introduces infection into any random wound (a scratch from a cat's claws, a cut, a burn from an iron).
- self-harm or takes high doses of medications.
Nature of complaints
They are general in nature, without specifics, and are very difficult to track.
These are abdominal pain, diarrhea, difficulty breathing, loss of consciousness, dizziness, weakness. The studies carried out do not reveal any symptoms. Often even the initial signs of the disease are absent.
Munchausen syndrome is a disease that should be treated by a psychiatrist.
Scientists have concluded that the brains of people with schizophrenia do not work the same way for everyone.
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 performed 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 sudden death syndrome - 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.
Diagnosis and treatment
Diagnosis of Munchausen syndrome is always difficult and time consuming. A psychologist or psychotherapist can make a diagnosis only after long-term observation. The patient's constant lies and peculiar behavior is a kind of game for him, into which he also draws the doctor. These are difficult patients who cannot be treated with compulsory methods - there are no legal grounds for referral for compulsory treatment.
Correcting behavior is only possible if the patient was “caught red-handed” or he voluntarily came to see a psychologist when he realized that he had “completely lied.” The percentage of such patients is extremely low.
Treating “barons” is a difficult task that requires a lot of time and patience on both sides. N There is no single technique that will help correct his behavior. However, some general recommendations for such patients can still be used:
- Establish contact and trust with one doctor;
- increase the circle of new friends, acquaintances;
- find a new hobby and like-minded people;
- lead a healthy lifestyle;
- start leading an active social life (volunteering, social service);
- Get a pet that will require a lot of attention.
Lack of attention is a modern problem, but we can cope with it. Drawing attention to yourself is not difficult, especially if you play “fairly” and do not manipulate at every opportunity.
"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 their child's short life. 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.
My recommendations
Psychotherapy and hypnosis are effective in treating patients with Munchausen syndrome at the initial stage. With the help of these methods, it is possible to change destructive stereotypes of human behavior.
After courses of psychotherapy and hypnosis, you can introduce the client to training groups. In the conditions of psychological training, a person feels attention to himself from the trainer and participants, and has the opportunity to work through his personal problems. Participation in a training group allows a person to make friends, overcome loneliness and depression, and get rid of psychological discomfort caused by loneliness and obsessive actions.
In addition to working with the client, psychological support is required for family members and loved ones. Consultations with a psychologist help loved ones understand and accept the patient for who he is. The psychologist gives valuable recommendations on how to interact with a sick person.
Specialists in helping professions need to remember that a disorder such as delegated Munchausen syndrome is a socially dangerous pathology. The victim of delegated syndrome must be separated from the ill parent or guardian. We need to work with children to relieve anxiety and prevent psychosomatic abnormalities. If the mother recovers, the family can be offered a course of classes with a psychologist to optimize parent-child relationships.
