The Munchausen syndrome (also referred to as "artificial disorder", from French artificiel 'artificial' , also luminary killer syndrome , English factitious disorder ) is a mental disorder in which those affected invent or cause physical complaints themselves and mostly plausible and present dramatically.
Compared to patients with similar disorders such as conversion syndromes , somatization and hypochondria , patients with Munchausen syndrome are rare and much more difficult to detect. They are mostly middle-aged men. Recent long-term studies have shown that menopausal women also suffer from Munchausen syndrome more often. Furthermore, the syndrome occurs more frequently in people with pronounced identity disorders or self-esteem deficits in personality disorders of the borderline , narcissistic or antisocial type.
It is typical to visit numerous doctors and hospitals with varying, arbitrary, but pronounced symptoms (e.g. abdominal pain, neurological complaints such as headache, loss of consciousness and "seizures"; lung and stomach "bleeding"), a high frequency of complex apparatus Examinations and operations as well as usually quick doctor and hospital changes as soon as the treatment request is not met or a practitioner suspects (“ hospital hopper syndrome ”).
The gain in illness is the acquisition of medical attention (medical examinations, hospital admission, diagnostic and therapeutic procedures up to and including unnecessary surgical interventions). People are prone to self-harm or poisoning to prove their illness, and they often require serious medical examinations and interventions that can cause or worsen the simulated disease. Doctors run the risk of becoming “accomplices” of self-harm and being sued for damages for their negligent assistance .
The aim and motive of those affected is often to get affection and compassion from doctors, nursing staff, family members or via the Internet. Further possible motifs, see below. Patients usually switch doctors immediately as soon as the possibility of mental illness is raised; they evade psychiatric referrals and examinations. As a rule, patients also evade psychotherapeutic treatment.
Patients with Munchausen syndrome often suffer from other mental disorders such as self-harm , borderline personality disorders or aggressive personality disorder . According to the specialist literature (Eckhardt), the artificial disorder (the Münchhausen syndrome) is understood as a form of self-harming or self-harming behavior in the context of borderline personality disorder. Most patients also have pronounced identity disorders or self-esteem deficits. Munchausen syndrome is similar to the historical diagnosis of Pseudologia phantastica ( Anton Delbrück , 1891).
As with the borderline personality disorder, unfavorable psychosocial growth conditions (possibly also real trauma ) in childhood and adolescence are discussed as the cause of the disorder (detailed description by Eckhardt).
Munchausen proxy syndrome
A special form is the Munchausen syndrome by proxy , also Munchausen by Proxy Syndrome or advanced Munchausen syndrome ( English Munchausen by proxy syndrome (MbPS), factitious disorder imposed on another ). It occurs when people (predominantly women, mothers) have a close relative (= proxy), usually a child, but also e.g. B. inflict artificial symptoms of illness or physical injuries to the partner, a sick person or person in need of care, damage them medically (e.g. through incorrect or polymedication, poisoning with medication, drugs, toxic substances, withholding necessary medication or medical measures, malnutrition) , aggravate existing diseases and / or prevent their recovery in order to look after and care for the victims (" symptom carriers ") seemingly loving and self-sacrificing and avoid unnecessary, dangerous and / or harmful medical procedures (diagnostics and / or therapies (by doctors and / or the perpetrator himself)). Possible motifs include a. Attention, interpersonal and social recognition (by partners, doctors and clinic staff, social environment, media), emotional and material affection and support, appreciation in the caring role, compensation for deficits in self-esteem , helper syndrome , dependency of the victim, power and control, "symbiotic Relationship ”, emotion control, compensation of inner emptiness and states of tension and hidden acting out of anger and aggressive impulses are discussed.
The “classic” form of Munchausen proxy syndrome is “a combination of physical and emotional abuse and medical neglect in which one parent (statistically almost only mothers) harms children [and fakes disease symptoms, artificially created or exaggerated] by exposes them to unnecessary, dangerous and / or harmful medical procedures (diagnostics and / or therapy). ”It is a subtle form of child abuse that can lead to the death of the victim.
In the even rarer form of Münchhausen by Adult Proxy Syndrome , basically the same thing happens as between mother and child, only between two adults, which is considered to be even more difficult to diagnose. For example, a partner could play the role of a self-sacrificing caring woman towards the partner and the outside world and ensure that her partner does not get well, depends on her and remains dependent (in a helpless, " child-like " relationship) (for possible motives, see above ) .
This diagnosis is relatively rare and, according to ICD-10 , is currently classified under artificial disorders , subtype “unspecified simulated disorder” (F 68.1) and physical abuse (T 74.1). However, simulated disorders as such are described as " probably the most common unrecognized mental illness ". The diagnostic conceptualization of the Munchausen proxy syndrome ( Munchhausen by proxy syndrome and Munchhausen by adult proxy syndrome ) for the planned inclusion of the diagnosis in the future ICD-11 is currently still being discussed.
- Münchhausen proxy syndrome - further aspects v. a. to child abuse
- Disease gain
- Selfharming behaviour
- William McIlroy - A Well-Documented Case of Munchausen Syndrome
- Henrik Uwe Peters: Dictionary of Psychiatry and Medical Psychology. 3rd, revised and expanded edition. Urban and Schwarzenberg, Munich et al. 1984, ISBN 3-541-04963-4 .
- Ralph-Martin Schulte (Ed.): Intracorporeal foreign bodies and Münchhausen syndrome. Game types, motivation and complications of self-harm. W. Zuckschwerdt, Munich et al. 1988, ISBN 3-88603-231-0 .
- Annegret Eckhardt: The Münchhausen Syndrome. Forms of self-manipulated disease. Urban and Schwarzenberg, Munich et al. 1989, ISBN 3-541-11821-0 (At the same time: Marburg, University, dissertation, 1987).
- Annegret Eckhardt: Artificial disturbances. In: Deutsches Ärzteblatt . Vol. 93, No. 24, 1996, pp. 1622–1626, ( digitized version (PDF; 201.2 kB) ).
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The specialist literature describes the transition from Münchhausen syndrome to Münchhausen deputy syndrome and vice versa as flowing:
- Roy Meadow: Munchausen syndrome by proxy: The hinterland of child abuse. In: The Lancet . Vol. 310, No. 8033, 1977, pp. 343-345, doi: 10.1016 / S0140-6736 (77) 91497-0 .
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- D. Roth: How "Mild" is Mild Munchausen Syndrome by Proxy. In: Israel Journal of Psychiatry and Related Sciences. Vol. 27, No. 3, 1990, , pp. 160-167.
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- Toni Single, Richard Leigh Henry: An unusual case of Munchausen syndrome by proxy. In: Australian & New Zealand Journal of Psychiatry. Vol. 25, No. 3, 1991, doi: 10.3109 / 00048679109062646 . , pp. 422-425,
- CN Bools, BA Neale, SR Meadow: Co-morbidity associated with fabricated illness (Munchausen syndrome by proxy). In: Archives of Disease in Childhood. Vol. 67, No. 1, 1992, pp. 77-79, doi: 10.1136 / adc.67.1.77 .
- CN Bools, BA Neale, SR Meadow: Follow up of victims of fabricated illness (Munchausen syndrome by proxy). In: Archives of Disease in Childhood. Vol. 69, No. 6, 1993, pp. 625-630, doi: 10.1136 / adc.69.6.625 .
- Abdul Kader Souid, Ken Korins, David Keith, Stephen Dubansky, P. David Sadowitz: Unexplained Menorrhagia and Hematuria: Case Report of Munchausen's Syndrome by Proxy. In: Pediatric Hematology and Oncology . Vol. 10, No. 3, 1993, , pp. 245-248, doi: 10.3109 / 08880019309029491 .
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- Judith A. Libow: Munchausen by proxy victims in adulthood: a first look. In: Child Abuse & Neglect. Vol. 19, No. 9, 1995, doi: 10.1016 / 0145-2134 (95) 00073-H . , pp. 1131-1142,
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- Michelle Bryk, Pamela T. Siegel: My mother caused my illness: The story of a survivor of Münchausen by proxy syndrome. In: Pediatrics . Vol. 100, No. 1, 1997, pp. 1-7, doi: 10.1542 / peds.100.1.1 .
- Klaus M. Keller, Meinolf Noeker, C. Hilliges, Hans-Gerd Lenard, Michael J. Lentze: Münchhausen-by-proxy-Syndrom. In: Monthly Pediatrics . Vol. 145, No. 11, 1997, pp. 1156-1162, doi: 10.1007 / s001120050211 .
- Kenneth W. Feldman, Robert O. Hickman: The Central Venous Catheter as a Source of Medical Chaos in Munchausen Syndrome by Proxy. In: Journal of Pediatric Surgery. Vol. 33, No. 4, 1998, doi: 10.1016 / S0022-3468 (98) 90329-3 . , pp. 623-627,
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