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Tests and diagnosis By Mayo Clinic staff Diagnosing 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. Direct accusations of Munchausen syndrome are likely to make the affected person angry and defensive, causing him or her 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 Symptoms By Mayo Clinic staff Munchausen syndrome symptoms revolve around faking or producing illness or injury in order to meet deep emotional needs. People with Munchausen syndrome go to great lengths to avoid discovery of their deception, so it may

be difficult to notice that their symptoms are actually part of a serious mental disorder. Munchausen syndrome is not the same as inventing medical problems for practical benefit, such as getting out of work or winning a lawsuit. It also isn't the same as hypochondria. People with hypochondria truly believe they are sick, whereas people with Munchausen syndrome aren't sick, but they want to be. In Munchausen syndrome by proxy, someone makes another person ill in order to win sympathy. Usually, Munchausen syndrome by proxy involves a parent harming a child. Munchausen syndrome symptoms may include: Dramatic stories about numerous medical problems Frequent hospitalizations Vague or inconsistent symptoms Conditions that get worse for no apparent reason Eagerness to undergo frequent testing or risky operations Extensive knowledge of medical terminology and diseases Seeking treatment from many different doctors or hospitals Having few visitors when hospitalized Reluctance to allow health professionals to talk to family or friends Arguing with hospital staff Frequent requests for pain relievers or other medications How those with Munchausen syndrome fake illness Because people with Munchausen syndrome become experts at faking symptoms and diseases or inflicting real injuries upon themselves, it's sometimes hard for medical professionals and loved ones to know if illnesses are real or not. People with Munchausen syndrome make up symptoms or cause illness in several ways, including: Made-up histories. They may give loved ones, health care providers or even Internet support groups a false medical history, such as claiming to have had cancer or HIV. Faking symptoms. They may fake symptoms, such as

abdominal pain, seizures or passing out. Self-harm. They may injure or make themselves sick, such as injecting themselves with bacteria, milk, gasoline or feces. They may cut or burn themselves. They may take medications to mimic diseases, such as blood thinners, chemotherapy medications and diabetes medications. Preventing healing. They may interfere with wounds, such as reopening cuts. Tampering. They may manipulate medical instruments to skew results, such as heating up thermometers. Or they may tamper with laboratory tests, such as contaminating their urine samples with blood or other substances. When to see a doctor People with Munchausen syndrome may be well aware of the risk of injury or even death as a result of the self-harm they seek. Still, they are unable to control their compulsive behavior and are unlikely to seek help. If you think a loved one may be exaggerating or faking his or her health problems, it may help to attempt a gentle conversation about your concerns. Try to avoid anger, judgment or confrontation. Offer support and caring and, if possible, help in finding treatment People with this syndrome deliberately produce or exaggerate symptoms in several ways. They might lie about or fake symptoms, hurt themselves to bring on symptoms, or alter diagnostic tests (such as contaminating a urine sample). Possible warning signs of Munchausen syndrome include the following: Dramatic but inconsistent medical history Unclear symptoms that are not controllable and that become more severe or change once treatment has begun Predictable relapses following improvement in the condition Extensive knowledge of hospitals and/or medical terminology, as well as the textbook descriptions of illnesses Presence of multiple surgical scars Appearance of new or additional symptoms following negative test results Presence of symptoms only when the patient is alone or not being observed Willingness or eagerness to have medical tests, operations, or other procedures History of seeking treatment at numerous hospitals, clinics, and doctors offices, possibly even in different cities Reluctance by the patient to allow health care professionals to meet with or talk to family, friends, or prior health care providers Problems with identity and self-esteem

More comfortable being in the hospital than you might think Medical knowledge may be quite extensive from many hospitalizations or prior work There are many forms this disorder may take: feigning cancer, cardiac disease, skin disorders, infections, bleeding disorders, metabolic disorders, chronic diarrhea, and many more. How is Munchausen syndrome diagnosed? Diagnosing Munchausen syndrome is very difficult because of the dishonesty that is involved. Doctors must rule out any possible physical and mental illnesses, and often use a variety of diagnostic tests and procedures before considering a diagnosis of Munchausen syndrome. If the doctor finds no physical reason for the symptoms, he or she might refer the person to a psychiatrist or psychologist mental health professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use a thorough medical history and physical, laboratory imagery, and psychological assessment tools to evaluate a person for Munchausen syndrome. The doctor bases his or her diagnosis on the exclusion of actual physical or other psychiatric disorders, and his or her observation of the patients attitude and behavior. However, personality concerns are prominent and can make it that much more confusing to sort out organic from factitious etiologies. Questions to be answered include: Do the patient's reported symptoms make sense in the context of all test results and assessments? Do we have collateral information from other sources that confirm the patient's information? (If the patient does not allow this, this is a helpful clue.) Is the patient willing to take the risk for more procedures and tests than you would expect? Are treatments working in a predictable way? The doctor then determines if the patients symptoms point to Munchausen syndrome as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Test Revision (DSM-IV-TR), which is the standard reference book for recognized mental illnesses in the United States

Differential Diagnoses
Hypochondriasis Malingering Somatoform Disorders

http://my.clevelandclinic.org/disorders/factitious_disorders/hic_munchausen_s yndrome.aspx http://www.bbc.co.uk/health/emotional_health/mental_health/disorders_munc hausenssyndrome1.shtml http://www.mayoclinic.com/health/munchausen-syndrome/DS00965