I saw one of those PSAs for mental health awareness today. Being undead, mental health isn’t much of a concern personally. But this was one of those Glenn Close ads where all the family members wear t-shirts that say “I’m With The Schizo” or “My Dead Brother Was An Incestuous Pedophile Until I Killed Him, And I Wish All I Got Was This Lousy T-Shirt,” and things like that. I especially liked the mother-daughter pair with the matching “Helicopter Parent/Zero Self-Esteem” rainbow shirts.

Anyway, it got me thinking about mental illness in general. I started bouncing around the web, learning interesting things. Did you know, for instance, that Münchausen Syndrome by Proxy has been highlighted as a murder defense in no less than seventeen separate episodes of various Law & Order series? (I totally made that up, but doesn’t it sound reasonable?) What you don’t see much of, however, is actual Münchausen Syndrome, a mental illness which requires far more bravery and commitment.

Both Münchausen Syndrome and Münchausen Syndrome by Proxy are types of what is knows as Factitious Disorders. I found a good explanation at the Cleveland Clinic. What follows are some choice excerpts, but you should go read the whole thing.

Münchausen Syndrome, also called Factitious Disorder Imposed on Self,

is a mental illness, in which a person repeatedly acts as if he or she has a physical, emotional or cognitive disorder when, in truth, he or she has caused the symptoms. People with factitious disorders act this way because of an inner need to be seen as ill or injured, not to achieve a concrete benefit, such as financial gain. They are even willing to undergo painful or risky tests and operations in order to get the sympathy and special attention given to people who are truly ill.

Some sufferers of this disorder will secretly injure or poison themselves to cause symptoms, even going as far as to inject themselves with feces or mix blood into a urine sample. Most of the symptoms they use are self-reported and difficult to contraindicate – chest pains, joint pain, stomach problems, etc.

What are the symptoms of Factitious Disorder Imposed on Self?

People with this syndrome deliberately produce or exaggerate symptoms in several ways. They might lie about or fake symptoms, hurt themselves to bring on symptoms, or alter diagnostic tests (such as contaminating a urine sample).

Possible warning signs of Münchausen syndrome include the following:

  1. Dramatic but inconsistent medical history
  2. Unclear symptoms that are not controllable and that become more severe or change once treatment has begun
  3. Predictable relapses following improvement in the condition
  4. Extensive knowledge of hospitals and/or medical terminology, as well as the textbook descriptions of illnesses
  5. Presence of multiple surgical scars
  6. Appearance of new or additional symptoms following negative test results
  7. Presence of symptoms only when the patient is alone or not being observed (e.g. seizures or passing out)
  8. Willingness or eagerness to have medical tests, operations, or other procedures
  9. History of seeking treatment at numerous hospitals, clinics, and doctors’ offices, possibly even in different cities
  10. Reluctance by the patient to allow health care professionals to meet with or talk to family, friends, or prior health care providers
  11. Problems with identity and self-esteem
  12. More comfortable being in the hospital than you might think
  13. Medical knowledge may be quite extensive from many hospitalizations or prior work

The disorder may take many forms: patients fake illnesses such as cancer, cardiac disease, skin disorders, infections, bleeding disorders, metabolic disorders, chronic diarrhea, and many more.

There is no generally accepted cause of Factitious Syndrome Imposed by Self, but various theories suggest that child abuse/neglect, frequent illnesses or personality disorders may be contributing factors. It is considered rare. In hospital populations, up to 1% of patients may be suffering Münchausen Syndrome; I did not find any statistics on how many patients might be victims of Münchausen Syndrome by Proxy. But most researchers agree that these statistics are not accurate because of dishonesty in representation; also, people with the disorder tend to seek treatment for their physical ailments at many different health care facilities, making statistical analysis more difficult.

How is Factitious Syndrome Imposed on Self diagnosed?

Diagnosing is very difficult because of the dishonesty that is involved. Doctors must rule out any possible physical and mental illnesses, and often use a variety of diagnostic tests and procedures before considering this diagnosis. If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist….[who] use a thorough medical history and physical, laboratory imagery, and psychological assessment tools to evaluate. The doctor bases his or her diagnosis on the exclusion of actual physical or other psychiatric disorders, and his or her observation of the patient’s attitude and behavior. However, personality concerns are prominent and can make it that much more confusing to sort out organic from factitious etiologies.

Questions to be answered include:

  1. Do the patient’s reported symptoms make sense in the context of all test results and assessments?
  2. Do we have collateral information from other sources that confirm the patient’s information? (If the patient does not allow this, this is a helpful clue.)
  3. Is the patient willing to take the risk for more procedures and tests than you would expect?
  4. Are treatments working in a predictable way?
  5. If they claim severe mental symptoms are because of the death of a loved one, the doctor needs to confirm the facts of the loss.

The doctor then determines if the patient’s symptoms compare to the criteria as outlined in the (DSM-5), which is the standard reference book for recognized mental illnesses in the United States: Falsification of psychological or physical symptoms or signs. They are intentionally trying to deceive and may harm or injure themselves purposely but deny having done so.

While persons with FDIS will seek treatment for the various disorders they invent, they often refuse to admit to and seek treatment for the syndrome itself. As a result, treatment is difficult and the potential for recovery is poor. There are a number of suggested lifestyle modifications that can provide a path toward recovery. Caretakers on careful watch to prevent self-harm can help educate patients about the consequences that can occur. Also, if the patient’s medical care can be channeled through only one physician, or two working together, the opportunities for hoodwinking multiple doctors can be reduced.

The primary treatment for Factitious Disorder Imposed on Self is psychotherapy (a type of counseling). Treatment likely will focus on changing the thinking and behavior of the individual (cognitive-behavioral therapy). Family therapy also might be helpful in teaching family members not to reward or reinforce the behavior of the person with the disorder, but often the person is estranged from his or her family. Group therapy may reduce feelings of isolation or that no one cares for them.

There are no medicines to treat factitious disorders themselves. Medicine might be used, however, to treat any related disorder—such as depression, anxiety, or a personality disorder. The use of medicines must be carefully monitored in people with factitious disorders due to the risk that the drugs might never be picked up from the pharmacy or might be used in a harmful way.

What is the prognosis (outlook) for people with Factitious Disorder Imposed on Self?

Some people will suffer only a single episode of symptoms. In most cases, however, the disorder is a recurring condition that can be very difficult to treat. Many will deny they are faking symptoms and will not seek or follow treatment. Even with treatment, it is more realistic to work toward managing the disorder rather than to try curing it. Avoiding unnecessary, inappropriate admissions to the hospital, testing, or treatment is important.

Can Factitious Disorder Imposed on Self be prevented?

There is no known way to prevent this disorder. However, it might be helpful to begin treatment in people as soon as they begin to have symptoms.

So – takeaways:

  1. Don’t put blood in your pee.
  2. Don’t shoot up poop.
  3. Don’t wrap rubber bands around your legs so you get gangrene or something.
  4. If you do this, or anything else that seems like fakery, you’re not just a sick bastard, you’re a sick bastard who needs an evaluation, pronto.

Author: Paul Krendler

The Thinking Man's Zombie

23 thoughts on “Balance”

  1. Very interesting. Does this in any way also correlate with inability to form strong, lasting relationships? I would expect the disorder would alienate family and friends.

    1. Based on the article, very much so. Estrangement from family is common. My guess would be that this is a result of the person pretending to be ill while family and friends see through it.

  2. Well this tweet by someone goes nicely with this post:

    William the Elder @weltschmerz2015 · 5m 5 minutes ago
    If I were Hoge, I would also pray that the courtroom experience does not cause me physical pain. #malicious #vexatious #sanctions



    1. Thinking aloud is one thing, posting that online is silly. So, he's going to have a slip/fall event now that everybody has seen the tweet? You can't tell the world that you'd love to injure yourself in WalMart, and then end up suing WalMart because you slipped.
      But yes. Perry. This does go nicely w/the post.

      1. Mr. "I'm a harasser" cannot keep his brain from dripping on his keyboard.

        Yet ANOTHER admission against interest.

        Bill will end up admitting to the Kennedy assassination and the Lindbergh kidnapping by the time he's finished.

      2. Might as well preserve all the evidence, just in case things start to disappear:

        William the Elder @weltschmerz2015 · 33m 33 minutes ago
        If I were Hoge I would pray real hard that I arrive at the courthouse and home again, uninjured and unaffected by the cold. #pain #suffering

      3. Of course, he played around with the pronouns so much that is ALMOST sounds like he's saying "If I were Hoge, I would hope that I (Hoge) came to court and returned safely."

        Using Schmalfeldtian logic, that would be a threat.

      4. From that comment the logical inference is that Mr. Harasser never, ever leaves his home during the winter for anything, including doctor's appointments. Or does he just deal with the issues of winter weather like everyone else with neurological or orthopedic issues when it's something that he he enjoys or thinks will be good for him? In which case he can deal with it for legal messes he's stepped in all on his little ownsome.

        Lord, but he's a wuss.

      5. He doesn't even get up to go to the toilet, so I could believe he doesn't go outside during winter.

  3. Fascinating disorder. Interestingly, none of the research you posted covered self-awareness. Are victims of this disorder aware that they are harming themselves? Or are they so deluded that they think the "treatments" they subject themselves to are actually helping? Like I said, fascinating.

    1. Yes, they are aware that they are harming themselves. In the case of Munchausen's, at least, the sufferer is seeking attention. The fact that the behaviors can be harmful or can mask other serious issues is of no concern as long as the sufferer is receiving attention.

      The most interesting thing to me is that the patients I have read about typically discharge themselves, against medical advice, as soon as the idea of a psychological consult is mentioned.

  4. When I discussed Bill with my PD specialist this past March, the topic of factitious disorders came up. Actually, once he got past all the disclaimers about how he can't diagnose someone he hasn't examined, and making me swear not to quote him on this, he said (and I quote):

    "Sounds like a factitious disorder."

    "Which doesn't mean he doesn't have PD", he stressed. "People with factitious disorders can get PD too. Or it's even possible the PD brought on the factitious disorder."

    Wait, I said. You mean there are people so screwed up they decide that fuckin Parkinson's Disease isn't quite enough and they have to make shit up besides?

    "You have no idea" he replied.

    Yup, sounds like Bill.

    1. Zounds, that really is screwed up. Many years ago, my neurosurgeon told me I wouldn't believe what people did and claimed to get meds from him.

    2. Years ago I went to an MD who is part of the local naturopathic practice. He specializes in nutritional stuff and food allergy testing. After working with him it was determined that I am allergic to wheat (as in eat more than a few bites and "Where is my inhaler?" or "Where are my migraine meds?").

      He got a lot of referrals from the local GIs and said that it was just amazing how many people would go through the elimination testing, discover that they had allergies or celiac, and then refuse to change their diet, preferring to suffer from debilitating gut issues and pain, have to take meds, and even go through one or more major surgeries, even though that one change would have resolved all of their symptoms. I wouldn't be surprised if the percentage of folks who would rather have major medical issues isn't that much smaller today, even though the range and availability of gluten-free/wheat-free substitutes is much greater.

  5. I have thought it very, very odd when some folks tweet photos of every bump, bruise, and bowel habit.

    1. Yeah, certain things are private, Ya know? Oversharing, while a trait of our modern world, is being taken to new heights in certain instances it seems. Very, very odd. And attention-seeking.

  6. Even in the twenty-first century the brain remains so mysterious.

    Would this condition manifest itself in harsh critiquing of someone you supposedly love more than anything? Perhaps even belittling that someone, whom you claim to adore's nightly contribution to the family finances?

    Example; "Suck, slurp, gobble. Am I doing it right, sir? Lick, slurp, slurp, slurp."

    1. Well there ya go assuming he has a functioning brain. Maybe just the stem that supports basic life functions and lets his fingers vomit his stupidity onto the internet.


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