The Rise of Munchausen Syndrome

Experiences within the United States Healthcare System vary from person to person, depending on circumstances and severity of a person’s illness. Bias according to race and gender is cautiously monitored and is not considered a factor when treating a patient within the medical system, thanks to HIPPA laws that were enacted in the US in 1996.

HIPPA laws were set into place to protect patients' personal data from theft, and to assist hospitals to prevent discrimination. No person may be turned away from receiving health care from a public emergency department, or a public clinic, IF their needs are within that facility’s means and ability to provide healthcare. Poverty level, community status, education, gender identity, and race do not make a difference in the type of care that you will receive in any hospital within the United States. However, there are other legitimate factors that could prevent you from receiving proper help at a healthcare facility. A lack of space, lack of necessary equipment, lack of doctors who specialize in the type of care that you may need, and mental illnesses that cannot be addressed due to the difficulty of diagnosing them without long-term evaluation, such as Factitious Disorders.

Factitious Disorders are looked upon as being “serious” mental disorders that are not within the scope of public hospitals, or public clinics abilities to diagnose or provide treatment for. The public healthcare system’s doctors can only suspect a diagnosis of a Factitious Disorder and they can only assist by referring the patient to a psychiatric doctor. The possibility of a Factitious Disorder removes the liability from the hospital or public clinic, and the doctor, to provide any healthcare needs that a patient is asking for, based on the assumption that the patient’s illness is fictitious.

Factitious Disorders are very “rare” disorders because of their difficulty to record, according to research documented by the NIH and other accredited institutions. A Factitious Disorder is hard to diagnose due to the cunning ability of the patient to manipulate the healthcare system, lie to doctors and family members, and falsify and sabotage test results. The difficult steps involved in diagnosing Factitious Disorder is too complex and costly for any medical facility to carry out independently. A patient suspected of Factitious Disorder would need one or more years of evaluation by a specialized team of doctors composed of neurologists, psychotherapists, psychologists, and psychiatrists. Results would be dependent on close monitoring by the patient’s general practitioner, as well as the willingness of the patient to seek out help, while working together in unison with a select team of specialists. Commitment to communication and full transparency would be needed to recognize and track behavioral patterns indicative of Munchausen Syndrome.

Factitious Disorders are considered to be “very serious” disorders, because of the impact that they have on others. These forms of disorders are considered to be an “outrageous” financial burden on the public healthcare system, costing the United States public health industry an estimated $40 million dollars per year. Yet, Factitious Disorders is recognized as one of the least studied disorders labeled in the DSM5-TR.

Factitious Disorder, once known as Munchausen Syndrome, according to the Cleveland Clinic, is described as a factitious disorder imposed on self. Munchausen Syndrome by Proxy, recently renamed Factitious Disorder by Proxy, is diagnosed when a person lies about an illness, or causes an illness, that impacts someone whom that person is responsible for the care of. Malingerer, distinguished as NOT being a factitious disorder, and instead, is listed as a behavioral disorder, is defined as a person who consciously embellishes or exaggerates their illness for financial or other gain. The difference between patients with Factitious Disorders and Malingerers, is that people with Factitious Disorders will not shy away from risky surgeries, medications, and may even cause injury to receive medical care, while Malingerers are more likely to refuse surgery, medications, and most medical tests.

The elimination of Malingerers from being considered a mental health disorder, because the behavior is assumed to be based on gain rather than attention, suggests that people suffering from Factitious Disorders are not interested in any form of gain. However, the DSM5-TR claims that people with Factitious Disorders are seeking attention, which is a form of gain, and that they are aware of what they are doing to receive that attention. More, it is recognized that Factitious Disorder symptoms vary drastically between whether or not it is a man or a woman who is suspected of having the disorder. A man with Munchausen Syndrome has symptoms that typically comprises of excessive boasting, embellished stories, and chronic lying, while a woman’s symptoms consist mostly of constant complaints of chest pains, GI problems and abdominal pain with a pattern of “hospital jumping” in an attempt to find new doctors who will incite a dopamine rush, much like a thrill seeker does with a new adventure. The diagnosis of Factitious Disorder, itself, is extremely sexist and causes women to be turned away from life saving medical treatment, almost always ending in further injury of the patient, or premature and preventable death. This leads to a realistic assumption that, in most cases, Factitious Disorder may be a fictitious disorder. It’s possible that Factitious Disorder, in most cases, may be more of an accusation than an actual mental illness that can be properly diagnosed. There is no treatment for people with Factitious Disorder.

The introduction of Munchausen Syndrome diagnoses into the medical field, has a fascinating history. Munchausen Syndrome, also known as Factitious Disorder, was identified in 1951 by Richard Asher, a British physician. Asher used Baron Heironymus Karl Friedrich von Munchhausen’s famous ability to spin stories of his own life into elaborate, fictional romps into a category of mental illness. Munchhausen was well known for entertaining his dinner guests with wild and embellished tales of his time spent in the military. His tales were even more exaggerated by Author Rudolph Erich Raspe, who wrote a fictitious book about Munchhausen’s adventurous life. The popularity of the story of Munchhausen’s outlandish lies turned Munchhausen’s form of behavior into a slang, or slur, used by the general public, directed at people who excessively exaggerated, or lied about the truth for attention; thus, Munchausen’s Syndrome was born.

There’s not much written about Richard Asher’s reason behind his definition of Munchausen Syndrome, other than a Special Article that Asher wrote and published in the London based medical journal called The Lancet, on Feb. 10, 1951, pg. 339. The article was based on hospital staff’s rumors surrounding one 30-year-old male patient that had travelled far and wide, over the course of seven years, searching for a doctor who could help him. The man would arrive at a hospital, or monastery, carrying with him a bag full of hospital notes, telling supposedly embellished stories of his medical endeavors and experiences that he had suffered through, in his efforts to discover the cause of his agonizing pain and his unexplained rectal bleeding. None of his stories could be backed up due to a lack of records, or loss of records, within these hospitals, clinics and monasteries during this time period. The man would frequently arrive at hospitals, via a wagon, carried by a passerby who would discover the man unconscious and bleeding in a ditch. Upon recovery, the patient almost always claimed to have been on his way to a monastery to seek help. Dr. Asher described the stories of this man’s events as being similar to Munchhausen’s style of storytelling, causing Asher to title his article “Munchausen Syndrome”.

Upon reading Dr. Richard Asher’s article in The Lancet, a highly credited British medical journal, Dr. Asher’s colleagues and peers gave recognition and gratitude to Asher for adding a new term to the field of medicine. Many doctors strongly felt that some of their patients enjoyed manipulating people in power, such as doctors, like themselves, and they determined that this was a serious mental disorder that all doctors needed to be aware of. It must be noted, though, that Richard Asher was a general physician working in the field of endocrinology; he was NOT trained in psychology or psychiatry. Asher’s special article was mainly meant to be nothing more than an opinion piece. Richard Asher believed that medical articles were mostly dull and should be written with more flair, creativity and thinking in mind, rather than on pure scientific study using medical vocabulary that most layman couldn’t understand.

Not soon after its introduction, Munchausen Syndrome lost its popularity in the medical field due to its inability to be accurately diagnosed, and because of the harm it was causing to people with undefined illnesses. Munchausen Syndrome was retitled Richard Asher Syndrome. It appears that Dr. Richard Asher also lost faith in the validity of the diagnosis that he had discovered. Asher showed his criticism of the supposed widespread existence of Munchausen Syndrome that British doctors were claiming to witness, by placing a rebuttal in the British Medical Journal on December 6, 1958. Asher’s sarcasm could be clearly heard through his written words, as he accused Doctors J. C. Barker and T. G. Grygier of Munchhausen-like behaviors, themselves, that were used in their clinical studies of widespread Munchausen Syndrome.

Many medical researchers had already started to become suspicious of the diagnosis' validity due to the fact that it was based solely on one case of one 30-year-old man who had unexplained rectal bleeding over the course of seven years and statements taken by medically untrained hospital staff. Richard Asher’s original paper on Munchausen Syndrome, written in 1951, is only available online via medical university websites, and the full article can only be viewed by medical university doctors and researchers upon their request.

According to a research study in Norway, it has been determined that there has never been a single case of a properly identified diagnosis of Munchausen Syndrome in Norway, Germany, Italy, or the United States of America in a period of eight years, between 2008 and 2016. During the study, it was discovered that there were only a few documented cases of Malingerers Behavioural Disorder, that had been improperly diagnosed as Munchausen Syndrome. However, the practice of using a medical code in patient’s records, that defines the possibility of Munchausen Syndrome in troublesome patients, is widely used in today’s medical industry, and can be recognized in patient’s charts via the code ICD-10 diagnosis of F68.1. This code is often used to alert other doctors that the patient that is seeking care, is most likely seeking attention. In the eyes of the healthcare industry, the code acts as a preventative, and keeps patients from wasting a doctor’s time, resources and a hospital’s finances. The imminent health of a patient is not as concerning as the financial losses within our healthcare system.