Are You Sick, or Do You Just Want Attention?

Are You Sick, or Do You Just Want Attention?

Most of us, in our youth, were probably asked this question in some form or another at least once by our parents; and most of us would probably admit to having faked being sick at least once in our lives. It is interesting, then, to note that there seems actually to be a pathology associated with this kind of behavior known as Munchausen syndrome.

What, technically, is Munchausen syndrome? According to the Merck Manual, it is "Repeated fabrication of physical illness - usually acute, dramatic, and convincing - by a person who wanders from hospital to hospital for treatment." (1) People suffering from this disorder will even go so far as to inflict physical harm upon themselves in order to get the attention they want. Generally, it is associated with a past history of severe neglect and abuse inflicted upon the subject. It is important at this point to differentiate between Munchausen and two other pathological behaviors for which it might be mistaken: unlike hypochondriacs, Munchausen sufferers are conscious of the fact that they are not genuinely sick (2); unlike malingerers (people who fake or induce the symptoms of illness for some external gain, such as the prescription of painkillers (3)) the behavior of an overwhelming majority of Munchausen sufferers cannot be attributed to conscious motives. (1)

A far more alarming variant of this disorder, known as Munchausen syndrome by proxy, has also been documented. In these cases, the subject fabricates the existence of physical illness in another person, usually the subject's child. The same sorts of behaviors occur - faking or simulating the symptoms of illness, resorting to physical harm in order to induce those symptoms. Even though the parent - the Munchausen sufferer - will always appear to be deeply concerned for the child's welfare, her actions will not infrequently result in the child's being severely deformed or even dying. (2) Both variants of this disorder are highly uncommon.

At present, people with either Munchausen syndrome or Munchausen syndrome by proxy are seldom, if ever, treated with drugs. Standard methods of management and treatment include early recognition of the disorder and years of intensive counseling; many doctors believe that the disorders are not treatable, inferring from the nature of the disorders that giving the subject medical attention would in fact heighten the severity of their pathology. (2) Munchausen syndrome and Munchausen syndrome by proxy are rarely treated successfully.