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Biology 103
2003 Second Paper
On Serendip

Are you sick, or do you just want attention?

Lara Kallich

Most of us, in our youth, were probably asked this question in some form or another at least once by our parents; and most of us would probably admit to having faked being sick at least once in our lives. It is interesting, then, to note that there seems actually to be a pathology associated with this kind of behavior known as Munchausen syndrome.


What, technically, is Munchausen syndrome? According to the Merck Manual, it is "Repeated fabrication of physical illness - usually acute, dramatic, and convincing - by a person who wanders from hospital to hospital for treatment." (1) People suffering from this disorder will even go so far as to inflict physical harm upon themselves in order to get the attention they want. Generally, it is associated with a past history of severe neglect and abuse inflicted upon the subject. It is important at this point to differentiate between Munchausen and two other pathological behaviors for which it might be mistaken: unlike hypochondriacs, Munchausen sufferers are conscious of the fact that they are not genuinely sick (2); unlike malingerers (people who fake or induce the symptoms of illness for some external gain, such as the prescription of painkillers (3)) the behavior of an overwhelming majority of Munchausen sufferers cannot be attributed to conscious motives. (1)


A far more alarming variant of this disorder, known as Munchausen syndrome by proxy, has also been documented. In these cases, the subject fabricates the existence of physical illness in another person, usually the subject's child. The same sorts of behaviors occur - faking or simulating the symptoms of illness, resorting to physical harm in order to induce those symptoms. Even though the parent - the Munchausen sufferer - will always appear to be deeply concerned for the child's welfare, her actions will not infrequently result in the child's being severely deformed or even dying. (2) Both variants of this disorder are highly uncommon.


At present, people with either Munchausen syndrome or Munchausen syndrome by proxy are seldom, if ever, treated with drugs. Standard methods of management and treatment include early recognition of the disorder and years of intensive counseling; many doctors believe that the disorders are not treatable, inferring from the nature of the disorders that giving the subject medical attention would in fact heighten the severity of their pathology. (2) Munchausen syndrome and Munchausen syndrome by proxy are rarely treated successfully. (1)


Current research has not been able to determine any biological basis for Munchausen syndrome, due to its extreme infrequency and the fact that when it has been determined by doctors that an inpatient at a hospital has the disorder or is the victim of abuse by someone with the disorder, that person usually flees. So what can be said of this disorder? I would like to advance my own thoughts on the subject here:


Munchausen syndrome seems to me to be reminiscent of two other, much more documented mental illnesses: antisocial personality disorder and dependent personality disorder. People with antisocial personality disorder - sociopaths, as they are more commonly known - are unable to distinguish "right" or "good" behavior from "wrong" or "bad" behavior; they seem to have little concern for anyone's personal safety, including their own; they are often impulsive and pathological liars; furthermore, they frequently seem to exhibit no remorse for any of their actions that might have had negative consequences. (4) Munchausen sufferers seem to exhibit many of these same characteristics to varying degrees, most notably the pathological lying aspect. Furthermore, it has been hypothesized that Munchausen sufferers, similar to sociopaths, might get a distinct measure of satisfaction from successfully fooling doctors into thinking that they are sick. (5) The parallel continues in Munchausen syndrome by proxy subjects, as these people exhibit a disregard for or inability to comprehend the effects that their actions have on the children that are their victims. People with dependent personality disorder, as one might imagine from the name, are characterized by "a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation." Notably, people suffering from this disorder have a tendency to go to great lengths to receive the attention they desire. (6) This particular symptom is also, as we can see from the above characterization, one of the most salient features of Munchausen syndrome. It would be, I believe, a very rewarding and enlightening task to study Munchausen syndrome with these two other disorders in mind. Of course, it is important to remember that very little is known for sure about Munchausen, and so the majority of theories advanced about it are more conjecture than anything else; the thoughts I have presented must be construed more as questions than statements.

References

1. the Merck Manual entry on Munchausen and Munchausen by proxy

2. an overview article on Munchausen and Munchausen by proxy

3. Dr. Marc Feldman's website on factitious disorders

4. Internet Mental Health's information database on antisocial personality disorder

5. Internet Mental Health's information database on dependent personality disorder

6. an account of a woman who recovered from Munchausen syndrome

Related Reading

a recovered Munchausen patient's first-hand account of the illness

an account of a doctor's encounter with a Munchausen sufferer (skip to the section titled "A Case of Munchausen")

an account of a person suffering from factitious bereavement

a detailed description of Munchausen syndrome by proxy


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