In patients with this syndrome, presentations vary. However common presentations include the following [7]:

• Laparotimophilia migrans (desire for a laparotomy)
• Hemorrhagica histrionica (excessive bleeding)
• Neurologica diabolical (curious fits)
• Cardiopathia fantastica (false heart attacks)
• Consumption of drugs to present side effects (betablockers to bring about bradycardia etc.)
• Inability of wounds to heal as a result of interference or contamination
• Gastrointestinal disorders, with diarrhoea and vomiting being the major ones
• Self-mutilation
• Malnutrition and anemia
• Skin discoloration as a result of coloured dye usage
• Extensive history of unexplained illness with several changes of medical personnel
• Showing of above average knowledge or a disease or inability to give off details of their illnesses
• Inconsistencies in medical history
• Hostility and excessive drama
• Exaggerated answers to questions
• Multiple operative scarring
• Inability to show physical signs common with a condition they are supposedly suffering from

In almost all of these patients, a common occurrence is going on the internet to gather information about a disorder in a bid to mislead the medical personnel. This further increases difficulty in diagnosis.

• Falling

  She was readmitted in May 2003 with left globe rupture, allegedly following a domestic fall. No extraocular trauma was found. She developed ocular phthisis 6 months postoperatively. [ncbi.nlm.nih.gov]

  They are unaware of this form of abuse that claims the life of nine percent of children that fall victim to it. [allpsych.com]

  Trained to trust their patients’ self-reports, even competent and conscientious physicians can fall victim to these deceptions. READ >> Pages [psychiatrictimes.com]

  " - Cicero Munchausen syndrome (MS) is a grave mental disorder that falls under a class of conditions, known as factitious disorders, that are either self-inflicted or made up by an individual. [medindia.net]

  Her mother, Dee Dee Blanchard, had a feeding tube inserted into Gypsy Rose's abdomen even though she could eat perfectly normally, forbade her from having sugar, shaved her head, and forced her to take certain medications that made all of her teeth fall [insider.com]

• Malingering

  Hypochondria and malingering Munchausen's syndrome is different than hypochondria (health anxiety) or malingering. Hypochondria is a psychiatric disorder where a person has a fear of illness. [www2.hse.ie]

  Unlike individuals who engage in MALINGERING, people with factitious disorder and Munchausen syndrome are not primarily seeking external gains such as disability payments or narcotic drugs—though they may receive them nonetheless. [Munchausen.com]

  Both factitious disorder and malingering seem to be significantly under- and misdiagnosed. [hindawi.com]

  Main observations that point towards malingering and factitious disorders [revistanefrologia.com]

  READ >> The Case of Factitious Disorder Versus Malingering October 30, 2009 Patients who exaggerate, feign, or induce physical illness are a great challenge to their physicians. [psychiatrictimes.com]

• Surgical Procedure

  Reconstructive surgical procedures may be required to correct the acquired deformities. The difficulty in Munchausen syndrome lies essentially in early recognition of the psychiatric syndrome. [ncbi.nlm.nih.gov]

  Occasionally, a patient will persuade a doctor that they need an unnecessary surgical procedure. They may ingest substances or inject themselves with a chemical or other substance, or injure themselves to induce illness. [medicalnewstoday.com]

• Unconsciousness

  It is unclear what they gain beyond medical attention for their suffering, and their motivations and quest for attention are largely unconscious and obscure. Patients may have an early history of emotional and physical abuse. [merck.com]

  Psychoanalysis is a type of psychotherapy that attempts to uncover and resolve unconscious beliefs and motivations. CBT helps a person identify unhelpful and unrealistic beliefs and behavioural patterns. [nhs.uk]

  Conversion Unconscious Unconscious The DSM-IV recognizes the following types of FD: FD with predominantly psychological signs and symptoms FD with predominantly physical signs and symptoms FD with combined psychological and physical signs and symptoms [ncbi.nlm.nih.gov]

  Some of the common signs that indicate that someone may have overdosed on stimulants include: Fast breathing and heartbeat Very large pupils Chest pain Muscle cramping Seizures or shaking High fever Dizziness Unconsciousness Convulsions Seizures Cardiovascular [harboroaks.com]

  After the car accident, she had briefly gone unconscious but suffered no amnesia. Her CT scan at the time showed no abnormalities. [listverse.com]

• Fever of Unknown Origin

  Common illnesses or symptoms that caregivers take MSP victims to the doctor for include: Failure to thrive Nausea and vomiting Diarrhea Seizures Breathing difficulty and asthma Infections Allergic reactions Fevers of unknown origins Other illnesses that [familydoctor.org]

  Aduan, et al.,32 described several cases of children of both genders who presented with fevers of unknown origin and histories of thermometer manipulation. [ncbi.nlm.nih.gov]

  The highest incidence was reported by neurologists and dermatologists.[5] Studies suggest that up to 9% of hospitalised patients have a factitious disorder.[6] 9.3% of patients presenting with fever of unknown origin were found in one study to be suffering [patient.info]

  The National Institute for Allergy and Infectious Disease reported that 9.3% of patients referred for fevers of unknown origin had factitious disorder. [minddisorders.com]

  For example, of patients referred for evaluation of fever of unknown origin at the US National Institute for Allergy and Infectious Disease, 9.3% had factitious disorder. [emedicine.com]

• Hemoptysis

  Abstract Although the differential diagnosis of hemoptysis is extensive, consideration of a factitious cause is rarely contemplated. Factitious hemoptysis is uncommon in children. [ncbi.nlm.nih.gov]

  Munchhausen syndrome should be considered in patients presenting hemoptysis of obscure etiology. Key words: Munchhausen syndrome. Factitious hemoptysis. [scielo.br]

  Patient 3 A 30-year-old white man was admitted to the hospital because of hematuria and hemoptysis associated with pleuritic chest and back pain. [nejm.org]

• Abdominal Pain

  Because of complaints of severe bilateral lower abdominal pain, the patient was given sedatives and meperidine (Demerol). [jamanetwork.com]

  Symptoms and Signs Patients with factitious disorder imposed on self may complain of or simulate physical symptoms that suggest certain disorders (eg, abdominal pain suggesting an acute surgical abdomen, hematemesis). [merck.com]

  Alcohol withdrawal can be broken down into three stages: Stage 1: Anxiety, insomnia, nausea, and abdominal pain characterize this stage, which begins 8 hours after the last drink. [americanaddictioncenters.org]

  At first, Lindsay presented to different hospital emergency rooms with abdominal pains. However, she would become too scared to follow through with her charade and leave before she was admitted. [foxnews.com]

• Fracture

  Tong, Fracture characteristics to distinguish between accidental injury and non-accidental injury in dogs, The Veterinary Journal, 199, 3, (392), (2014). [doi.org]

  Fractured eye. Doctors gave her Percocet, which eventually became OxyContin as a way to numb the physical and emotional pain. After years of this, she decided to go to a methadone clinic and stop misusing the drugs. [tonic.vice.com]

  Benzodiazepines and the risk of falling leading to femur fractures. Dosage more important than elimination half-life. Arch Intern Med. 1995;55:1801–7. 24. Hemmelgarn B, Suissa S, Huang A, Boivin IF, Pinard G. [aafp.org]

• Muscle Weakness

  weakness, vertigo and mental confusion. 11 Studies of the psychomotor effects suggest that benzodiazepines slow reaction time and impair driving skills, increasing the risk of motor vehicle crashes in patients who are taking these agents. 12 MEMORY IMPAIRMENT [aafp.org]

  Disadvantages of acamprosate are that it: Has side effects including muscle weakness, nausea, stomach cramps, dizziness, headache, and itchiness. Shouldn’t be taken by people who have kidney problems. [luxury.rehabs.com]

• Anger

  If you have a loved one with the above -said symptoms do not allow your anger or frustration to interfere. Instead, make sure you offer support by seeking medical help. [medindia.net]

  Location form switch Find a Condition form switch Find a Specialist Search by town, region or postcode and/or Condition Addiction Treatment Adjustment Disorder Affective Disorders Agoraphobia Alcohol Rehabilitation Alzheimer's Disease Amphetamine Addiction Anger [priorygroup.com]

  In particular, family members should be educated about healthy ways for the patient to express his or her anger. [emedicine.medscape.com]

• Denial

  […] et al. (2012)[17] F NP Mother Unemployed chronic medical problems Toxin application to skin Denial F NP Mother Medical office receptionist Intravenous injection unknown substance Denial Singh A et al. (2013)[22] M NP Son NP Fluid administration in context [journalofhospitalmedicine.com]

  In majority of cases, confrontation of the patients leads to denials of manufacturing a disease. However, some of them will admit it. [symptoma.com]

  DUI services include: DUI evaluation Non-DUI investigate reports All levels of DUI classification Minimal risk Moderate risk Significant risk High risk Drivers' remedial education Denial letter consultation DUI evaluation services Individual and group [carle.org]

  Matthew, aged 50 I was a leader in my industry but I was in denial about the fact my life was unmanageable due to alcohol. [kusnachtpractice.com]

• Self-Mutilation

  The “patient”, always a confabulating, pathologic lyer, may even practice self-mutilation in order to prove pain. [whonamedit.com]

  Inability of wounds to heal as a result of interference or contamination Gastrointestinal disorders, with diarrhoea and vomiting being the major ones Self-mutilation Malnutrition and anemia Skin discoloration as a result of coloured dye usage Extensive [symptoma.com]

  Google Scholar Kapfhammer, HP, Rothenhäusler, HB, Dietrich, E ( 1998 ) Artifactual disorders—between deception and self-mutilation: Experiences in consultation psychiatry at a university clinic [in German]. Der Nervenarzt 69(5): 401 – 409. [dx.doi.org]

  Identity disturbance, unstable interpersonal relationships, and recurrent suicidal or self-mutilating behaviors are similar to those encountered in borderline personality disorder. [ncbi.nlm.nih.gov]

• Delusion

  Vomiting Excessive sweating Collapsing Cognitive symptoms: Hallucinations Poor concentration Lack of good judgment Experiencing breaks from reality Paranoia Psychosis Psychological symptoms : Anxiety Aggression and hostility Feelings of restlessness Delusions [harboroaks.com]

  The patient also presented only one psychotic episode characterized by a poisoning delusion, which can occur in this kind of personality disorder. [jneuropsychiatry.org]

  "It's almost like a delusion," said Morton. "It's somewhere in that firmly-held belief that you're going to get sick, or you are sick ... You're just ruminating thoughts, like oh my goodness this could be happening." [insider.com]

  Jaundice Coma Death Cognitive symptoms: Confusion Poor judgment Decreased ability to pay attention Short-term memory loss Psychosocial symptoms: Depression Anxiety Irritability Elation Relaxation Anger Addiction Psychological dependence Hallucinations Delusions [reboundbehavioralhealth.com]

  Potentially harmful medical care can range from a diagnostic search that subtly encourages and enables a caregiver's delusion through a full spectrum of invasive tests and medical or even surgical interventions. [doi.org]

• Addictive Behavior

  Much of her recent work has focused on the role mHealth technologies play in supporting addictive behavior change. [massgeneral.org]

  It is the compulsive nature of the behavior that is often indicative of a behavioral addiction, or process addiction, in an individual. [americanaddictioncenters.org]

  However, the behavioral addiction group scored higher on state anxiety2 than the chemical group, indicating that state anxiety might be more associated with behavioral expressions of addiction. [trends.hms.harvard.edu]

  One school of thought is that addictive behavior is learned and is not the result of a pathologic neurologic pathway. This article summarizes support for the learning model. [nejm.org]

  A standard treatment program at one of the dedicated technology addiction clinics in Singapore is based around cognitive behavioral therapy (CBT). Dr. [medicalnewstoday.com]

• Hematuria

  Outwater KM, Lipnick RN, Luban NLC, Ravenscroft K, Ryley EJ (1981) Factitious hematuria: diagnosis by minor blood group typing. J Pediatr 98: 95–97 Google Scholar 5. [link.springer.com]

  Unexplained Menorrhagia and hematuria occurred in a 13-year-old female with a mild inherited platelet disorder who had never experienced prior bleeding as a result of this disorder. [doi.org]

  Here the authors report a 16-year-old female with the complaints of bleeding from multiple and unusual sites, including hemoptysis, hematuria, bloody tears, and bloody nipple discharge, all of which are only witnessed by her mother. [ncbi.nlm.nih.gov]

  Patient 3 A 30-year-old white man was admitted to the hospital because of hematuria and hemoptysis associated with pleuritic chest and back pain. [nejm.org]

  She had been seen there many times for depression, for psychotic behavior, and for hematuria (blood in the urine). [discovermagazine.com]

• Headache

  This can include having a severe headache, pretending to have a seizure or to pass out. Tampering with test results Heating a thermometer to suggest a fever or adding blood to a urine sample. [www2.hse.ie]

  There are 4 main ways people with Munchausen's syndrome fake or induce illnesses, including: lying about symptoms – for example, choosing symptoms that are difficult to disprove, such as having a severe headache or pretending to have a seizure or to pass [nhs.uk]

  These include: Lying about symptoms – for example, choosing symptoms difficult to disprove, such as having a severe headache or pretending to have a seizure (fit) to pass out. [metro.co.uk]

  Then she began complaining of headaches and mild weakness on the left side of her body. Her symptoms were so characteristic of an AIDS-related brain infection that I admitted her to the hospital. [discovermagazine.com]

  They may claim to have had cancer or some other major disease Feigning symptoms, for example, pain, seizures, headaches, or fainting. Symptoms may be carefully selected carefully and difficult to disprove. Hurting themselves. [medicalnewstoday.com]

• Dizziness

  […] enjoyed Engaging in reckless and risky behaviors Hyperactive and manic behavior Talking very rapidly Restlessness Stealing or borrowing money Physical symptoms : Decreased appetite Dilated pupils Elevated blood pressure Loss of coordination Headache Dizziness [harboroaks.com]

  Changes in appetite Decreased sex drive Digestion problems Dizziness Insomnia Mood swings Nausea Weight loss A Duke University study found that more than 95 percent of nearly 500 adult marijuana smokers who tried to quit suffered at least one symptom; [drugrehab.com]

  During this time span, apart from pain presentations, Patient A presented with dizziness, chest pain, abdominal pain, blood in the stool, and other constitutional symptoms. [ncbi.nlm.nih.gov]

  Disadvantages of acamprosate are that it: Has side effects including muscle weakness, nausea, stomach cramps, dizziness, headache, and itchiness. Shouldn’t be taken by people who have kidney problems. [luxury.rehabs.com]

• Amnesia

  One particular difficulty with GHB addiction recovery is that some people that have stopped taking the drug experience a form of amnesia that causes them to forget the dangers of the drug and relapse into using it. 4 People who are addicted to other drugs [withdrawal.net]

  After the car accident, she had briefly gone unconscious but suffered no amnesia. Her CT scan at the time showed no abnormalities. [listverse.com]

  Studies of the psychomotor effects suggest that benzodiazepines slow reaction time and impair driving skills, increasing the risk of motor vehicle crashes in patients who are taking these agents. 12 MEMORY IMPAIRMENT Benzodiazepines induce anterograde amnesia [aafp.org]

  Management of Acquired Opioid and Benzodiazepine Dependency One of the cornerstones in caring for critically ill children is to provide adequate and safe analgesia, sedation, amnesia, and anxiolysis by using both pharmacologic and nonpharmacologic measures [pediatrics.aappublications.org]

• Vertigo

  […] intoxicants include: Excessive drowsiness (if the person has consumed depressants like alcohol or opioids) Extreme agitation (if the person has been taking stimulants) Slurred or incoherent speech Mental confusion, memory lapses Poor balance and coordination Vertigo [altamirarecovery.com]

  […] as the elderly, who have decreased rates of metabolism or greater susceptibility to central nervous system depression. 8 Psychomotor symptoms include drowsiness, poor concentration, ataxia, dysarthria, motor incoordination, diplopia, muscle weakness, vertigo [aafp.org]

  Vertigo. Once the patient experiences these unwanted side effects, they’ll likely be deterred from drinking alcohol while on the medication. [luxury.rehabs.com]

• Ataxia

  It also may be noted in patients, such as the elderly, who have decreased rates of metabolism or greater susceptibility to central nervous system depression. 8 Psychomotor symptoms include drowsiness, poor concentration, ataxia, dysarthria, motor incoordination [aafp.org]

The first step in diagnosis is to keep in mind that even people with this disorder can have genuine underlying ailments they may not be aware of [8]. These must be ruled out first before Munchausen syndromes are investigated.

When signs of the syndrome are suspected, investigation must be kept to a minimum. However, basic procedures for responding to the symptoms of the patient and their signs generally need to be followed. During diagnosis, care should be taken to avoid giving patients room to interfere with samples.

For instance, some of them may put blood in urine while others may interfere with charts. Also, some may ingest toxic substances or ingest themselves with toxic substances all in a bid to produce an abnormality.

Treatment requires collaborative effort of health care providers, social work, legal personnel and nursing [9]. The patient needs to be confronted gently with any suspicions in a supportive manner geared towards presenting the patient’s psychological distress as the main source of illness. Psychiatric treatments should also be offered to the patient.

In majority of cases, confrontation of the patients leads to denials of manufacturing a disease [10]. However, some of them will admit it. Many of them will get angry when confronted and will discharge themselves from a hospital in a bid to continue feigning illness elsewhere. This brings about the long history of changing medical personnel often seen during workup.

Due to the difficulty in tracking patients with Munchausen syndrome and the lack of follow-up studies, predicting prognosis is difficult [6].

Till date, no scientifically proven treatments have been brought forward.

Due to the fact that majority of people with this condition refuse to cooperate with psychiatric treatment or physiological profiling, there is very little evidence available regarding the possible causes of Munchausen syndrome. However, following research and years of study, several factors have been identified as possible cause of the Munchausen syndrome. They include the following [3]:

• Emotional trauma or illness during childhood (which usually led to regular medical attention at the time)
• Personality disorder 
• A vendetta against the authority or health professionals in a location. 

The exact incidence of this condition is not known but it has been classified as rare [4]. Studies show that only 0.2%-1% of medical inpatients show factitious disorders but 9.3% of patients with fever of unknown etiology have the syndrome. Also, figures show that 40% of people with brittle diabetes intentionally manipulated their diets so as to make their condition unstable.

The condition is seen mostly in the male sex and there is racial predilection as most of the patients are white. The typical age bracket at which this condition is seen is between ages 30-50.

The pathophysiology of the syndrome remains unclear [5]. Studies have not pointed at any brain defect or dysfunction as the reason for the disorder even though neurocognitive deficits as well hyperperfusion of the right hemithalamus have been suggested in some isolated cases. There is no evidence to show confirmation of the suspicion in a larger sample of cases. EEG scans have also not been specific for this disorder.

There is no proven way to prevent Munchausen syndrome.

Munchausen syndrome refers to a condition where an individual knowingly fakes, stimulates or induces an injury just to be treated like a patient.

There are no clear reasons why people do this. Some do it for the fun of it while others have an end target only known to them in mind.

The condition is seen mostly in adults and can only be treated when the patient is ready to listen to medical personnel and receive psychiatric therapy as well as general counselling. 

1. Asher R. Munchausen's Syndrome. Lancet. 1951;1:339-41.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Arlington, VA: American Psychiatric Association; 2013:324-6.
3. Mountz JM, Parker PE, Liu HG, Bentley TW, Lill DW, Deutsch G. Tc-99m HMPAO brain SPECT scanning in Munchausen syndrome. J Psychiatry Neurosci. Jan 1996;21(1):49-52.
4. Sutherland AJ, Rodin GM. Factitious disorders in a general hospital setting: clinical features and a review of the literature. Psychosomatics. Fall 1990;31(4):392-9.
5. Fliege H, Grimm A, Eckhardt-Henn A, Gieler U, Martin K, Klapp BF. Frequency of ICD-10 factitious disorder: survey of senior hospital consultants and physicians in private practice. Psychosomatics. Jan-Feb 2007;48(1):60-4.
6. Drob SL, Meehan KB, Waxman SE. Clinical and conceptual problems in the attribution of malingering in forensic evaluations. J Am Acad Psychiatry Law 2009; 37:98.
7. Gavin, H. On Feigned and Factitious Diseases, on the Means Used to Simulate or Produce Them, and on the Best Methods of Discovering Impostors. John Churchill, London 1843.
8. Kwon EJ, Dans M, Koblenzer CS, et al. Dermatitis artefacta. J Cutan Med Surg 2006; 10:108.
9. Park TA, Borsch MA, Dyer AR, Peiris AN. Cardiopathia fantastica: the cardiac variant of Munchausen syndrome. South Med J 2004; 97:48.
10. Chapman JS. Peregrinating problem patients; Munchausen's syndrome. J Am Med Assoc 1957; 165:927.