Most of us hate being sick. You feel terrible. You often look terrible. And sometimes the treatments are worse than the disease. So, would anyone actually pretend to be sick when they're really not?
Yes, say experts. Patients with factitious disorders do just that.
"People with factitious disorders, including
Munchausen's syndrome
, the most severe type of factitious disorder, feign or produce illness in themselves for internal gratification," says Marc Feldman, MD, co-editor of
The Spectrum of Factitious Disorders
and professor of psychiatry at the University of Alabama in Birmingham. They will deliberately lie about symptoms or hurt themselves to appear sick, he says, because they have a psychological drive to assume the sick role.
The attention and caring from loved ones and medical professionals temporarily soothes their psychological drive to make themselves sick. Once that attention is gone, however, they often feel the need to lie all over again to regain the attention. They differ from someone who fakes an illness to get a tangible goal like disability payments or a day off from work. This person is called a malingerer. The motivation for people with factitious disorders is all internal. They also differ from
hypochondriacs
, who are unaware that they are making up symptoms.
The range of faked symptoms that some disturbed individuals will undertake is enormous. People will heat up a thermometer so it looks as if they have high fevers. They will inject themselves with dangerous foreign substances, or writhe on the floor in a mock seizure. Dr. Feldman describes a woman who claimed she had
breast cancer
. She shaved her head and lost 60 pounds by dieting to look convincing to her sympathetic friends. People who display this extreme degree of malingering or faking an illness are often said to have Munchausen's syndrome.
Munchausen's syndrome is a severe and chronic form of factitious disorder. It only affects about 10% of all people with factitious disorders. However, the Munchausen's patient is the one we usually read about in the media. People with Munchausen's syndrome may frequently travel from city-to-city, telling tall tales about their illnesses. They may manufacture a host of illnesses over the years. One of Dr. Feldman's former patients first said she had deaf-mutism, then
multiple sclerosis
, then
quadriplegia
, then multiple personality disorder. People with Munchausen's syndrome will even undergo surgery or painful treatments just to continue their charade.
Some experts think factitious disorders and Munchausen's syndrome are similar to
obsessive-compulsive disorder
(OCD) or addictive behaviors where people feel internally compelled to do things they know are not always right. For example, people with OCD may wash their hands 20 times an hour even though they know that their hands cannot really be dirty after such vigorous cleansing. A gambling addict may gamble until his life savings are gone. Like people with OCD or addictive behavior, says Dr. Feldman, people with Munchausen's syndrome know that their behaviors may expose them to the dangers of unnecessary medical treatments or surgery, but they feel unable to resist the unhealthy behavior.
Diagnosing Munchausen's syndrome can be tricky.
"It's quite difficult at times to be alert to the possibility that someone is a Munchausen's patient," says Dr. Don Lipsitt, clinical professor of psychiatry at Harvard Medical School. In a busy emergency department or a quick office visit, doctors often don't detect the deception, he says. Usually, once a Munchausen's patient is hospitalized for a while, the doctors realize that the stories don't match up with the medical findings. When confronted, however, the patient usually flees the hospital to find another unsuspecting health professional in another city.
People with mild factitious disorder, on the other hand, can be hard to discover. They often just exaggerate the symptoms of an illness they already have. "The simplest [lies] are probably ignored or not even detected," says Dr. Lipsitt.
Dr. Feldman treats people with Munchausen's syndrome and factitious disorders by giving them the unconditional caring they want. He sets up regular appointments for the person with both a psychiatrist and a general medical doctor.
Dr. Feldman describes a woman who was hospitalized over 800 times. After appropriate therapy for Munchausen's syndrome, she stopped playing sick.
"There is no reason anymore for doctors, therapists, or counselors to wring their hands and say there is nothing we can do," he says. Munchausen's syndrome and factitious disorders are known and treatable diseases that can sometimes be cured. Most psychiatrists, however, regard Munchausen's syndrome as a condition with a poor prognosis for improvement or cure.
