What many people know as 'Munchausen Syndrome' is actually called 'factitious disorder.' In this lesson, we'll look a little closer at the history of factitious disorders and the differences in them and malingering.
When she was a little girl, Danica's brother Frank got very sick. Danica's parents took Frank to many doctors, and everyone in their small town paid him visits when he was in the hospital. People kind of forgot Danica, and she became a wallflower. Her brother got all the attention and love, and Danica was left to take care of herself while her parents took care of Frank.
Now Danica is all grown up and living on her own. But she still feels like a wallflower and doesn't think other people give her enough attention. The only exception is when she herself is sick. If she goes to the doctor or hospital, the doctors and nurses give her attention and take care of her. Not only that, but last year she was in the hospital for a couple of days, and her parents came to visit her and take care of her.
In order to keep getting this attention, Danica makes herself sick. She eats food that she knows will make her vomit, and once or twice, she's taken drugs that will cause symptoms. Danica might be suffering from a factitious disorder, a psychological disorder that involves making yourself sick or pretending to be sick.
Factitious disorders used to be called Munchausen's Syndrome. There are several types of factitious disorders, which vary slightly but have a lot in common. Let's look a little closer at the general category of factitious disorders.
Factitious vs. Malingering
Like many other factitious patients, Danica is making herself sick for attention and care. Her friend Davey is also making himself sick but for very different reasons. Davey joined the Army Reserves to help pay for his college; he never thought he'd be called up. But recently, he was called up to go into combat. Davey intentionally shot himself in the foot in order to be discharged from his duty.
Danica and Davey are essentially doing the same thing - making themselves sick or hurt - but there is a key difference in their conditions: Davey's motivation for his actions is clear if you know his situation. Davey is malingering, which occurs when a person fakes or makes him or herself sick for a clear motive. Malingering is not considered a psychological disorder. Contrast Davey to Danica: If Danica shot herself in the foot in order to go to the hospital, but had no other motive, she would be displaying the symptoms of factitious disorder.
The motive for malingering in many patients is economic benefit or to avoid legal punishment. Some malingering patients, for example, feign physical or mental illness in order to get a lighter sentence after they have committed a crime. Other motivations for malingering include to gain access to drugs, to be excused from school or work and to collect money for a disability. And like factitious disorders, a person can actually make themselves ill or they can fake or exaggerate symptoms.
In Davey's case, he has actually made himself sick (shooting his own foot) in order to get out of military service. If a doctor knows about Davey's situation with being called up and Davey's unwillingness to serve, it is relatively clear that Davey has caused his injury to get out of military service.
Contrast that to Danica: Even if a doctor knew about her childhood, there still isn't a clear, measurable motive for Danica making herself sick. Sure, we can guess that she is doing it for attention, but that's a much more nebulous benefit. Essentially, the difference between the two is that malingering involves clear motives for gain, whereas factitious disorders do not.
Factitious disorders have been around for most of medical history. Galen, a famous doctor from ancient Rome, wrote about patients who faked or produced symptoms of illness. An advice book for courtiers in Elizabethan England encouraged malingering in order to get out of having to do something one did not want to do and to garner sympathy.
In the 18th century, a German nobleman named Baron Munchausen told tall tales about his adventures at war. His tall tales became even taller when recounted by other writers, so that a quasi-fictional character based on him became synonymous with someone who exaggerates or lies.
In the middle of the 20th century, an English doctor named Richard Asher took the legend of Baron Munchausen and used it to describe patients who fake or exaggerate symptoms of illness. He was the first to use the term 'Munchausen Syndrome.' Later in the 20th century, Munchausen Syndrome was renamed factitious disorder, which is how it is known today.
Factitious disorders involve making yourself or someone else sick. Factitious disorders are sometimes confused with malingering. However, malingering involves making yourself sick in order to gain financial or another type of benefit, whereas factitious disorders do not have an obvious benefit. Factitious disorders, which used to be called Munchausen Syndrome, have a long history that goes all the way back to ancient Rome.
After watching this lesson, you should be able to:
- Explain the differences between a factitious disorder and malingering
- Discuss key points of the history of factitious disorders, or Munchausen Syndrome