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.