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Tests and diagnosis
By Mayo Clinic staffDiagnosing Munchausen syndrome is often extremely difficult. People with Munchausen are experts at faking many different diseases and conditions. And often they do have real and even life-threatening medical conditions, even though these conditions may be self-inflicted.
A health care professional who suspects Munchausen syndrome may check medical records, try to talk to family or friends, or even search the person's hospital room for injected materials or hidden medications, although this raises ethical concerns.
If you suspect your loved one has Munchausen syndrome, you may be surprised by the doctor's approach in making a diagnosis. Direct accusations of Munchausen syndrome are likely to make the affected person angry and defensive, causing them to abruptly end a relationship with a doctor or hospital and seek treatment elsewhere. So your loved one's doctor is likely to try to create an "out" that spares your loved one the humiliation of admitting to faking symptoms.
For example, the doctor may reassure your loved one that not having an explanation for medical symptoms is legitimately stressful, and suggest that the stress may in fact be responsible for some physical complaints. Or, the doctor may ask your loved one to agree that, if the next one or two medical treatments don't work, they will explore together the idea that there may be a psychological cause for the illness. Either way, the doctor will try to steer your loved one toward care with a mental health provider.
Munchausen syndrome is diagnosed as a type of factitious disorder. To help determine if someone has Munchausen syndrome, mental health providers conduct a detailed interview and also run tests for possible physical problems.
To be diagnosed with factitious disorder, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.
For factitious disorder to be diagnosed, three criteria must be met, including:
- Intentionally faking or producing symptoms
- A motivation to be seen as sick
- The motivation isn't for financial or legal reasons, such as collecting a settlement
- Factitious disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed March 24, 2009.
- Eisendrath, SJ. Factitious disorder (including Munchausen's syndrome). In: Ferri FF. Ferri's Clinical Advisor 2009. St. Louis, Mo.: Mosby; 2008. http://www.mdconsult.com/das/book/body/128035876-3/821157946/1701/215.html#4-u1.0-B978-0-323-04134-8..50009-4--subchapter1_4547. Accessed March 24, 2009.
- Hamilton JC, et al. Factitious disorders and malingering. In: Gabbard GO. Gabbard's Treatments of Psychiatric Disorders. American Psychiatric Association; 2007. http://www.psychiatryonline.com. Accessed March 24, 2009.
- Purcell TB. Factitious disorders and malingering. In: Marx JA, et al., eds. Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo.: Mosby; 2006. http://www.mdconsult.com/das/book/body/128035876-4/821158282/1365/348.html#4-u1.0-B0-323-02845-4..50117-7--cesec4_5748. Accessed March 24, 2009.
- Factitious disorder and malingering. In: Hales RE, et al., eds. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Arlington, Va.: American Psychiatric Association; 2008. http://www.psychiatryonline.com. Accessed March 24, 2009.
- Lipsitt DR. Factitious disorder and Munchausen syndrome. http://www.uptodate.com/home/index.html. Accessed March 24, 2008.
- Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. March 26, 2009.
