What Is Munchausen Syndrome?

Baron Munchausen was an eighteenth-century army captain known for his "tall tales.” While his exaggerated stories about wild adventures have entertained generations of people, today many in the medical field recognize his last name for different reasons. Munchausen syndrome describes people who consciously make up or exaggerate their own symptoms to appear sick or injured. It’s more accurately called “factitious disorder imposed on self.” It’s a mouthful, but it’s the more current and official name for this clinical diagnosis. 

Munchausen syndrome is different from:

• Malingering: This is when people consciously make up symptoms or illnesses to gain something, such as disability benefits, money, or housing. Experts don’t consider malingering a mental illness.  

• Hypochondria: This is a mental illness where someone is preoccupied with having a serious illness, or getting one in the future. Its official name is “illness anxiety disorder.” People with this disorder believe that they’re ill, whereas people with factitious disorder know they are not.   

Still confused? Let’s dive deeper into this unusual mental health condition — and how to support someone who could have it. 

What are the symptoms of Munchausen syndrome?

Munchausen syndrome can show up in some surprising ways. In extreme cases, someone might fake a skin problem by deliberately cutting themselves or drawing on themselves with ink. They might cause a urinary infection by self-injecting bacteria. The goal is to mimic — or even cause — the symptoms of an actual mental or physical health condition.

Here are some more typical examples of symptoms that may be exaggerated in people with Munchausen: 

• Skin rashes

• Chest pain

• Diarrhea

• Bloody urine

• Infections

• Seizures

• Vomiting

• Weakness

• Abdominal pain

• Joint pain

Sometimes the “symptoms” are more extreme. They may result from someone taking medications — like insulin, thyroid hormones, or blood thinners — to cause real abnormalities, like:  

• Hypoglycemia (low blood glucose levels)

• Abnormal hormone levels 

• Easy bruising and bleeding

Other extreme behaviors include:

• Causing skin wounds, or deliberately opening healing wounds

• Injecting feces and bacteria

• Forging medical records or lab results

• Coaching others to lie for them 

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What causes Munchausen syndrome?

It’s not clear yet what causes factitious disorder. Researchers have not found a clear neurological or genetic cause. It’s possible that playing the “sick role” has some psychological benefit. But the truth is that we don’t know why Munchausen’s makes people act the way they do. 

There’s some evidence that Munchausen syndrome could be linked to:

• Feelings of gratification in the sick role because it keeps loved ones close

• Recent hospitalization, as symptoms often start there

• History of trauma (abuse, sexual, neglect) and early losses (deaths, sickness, abandonment)

• History of childhood institutionalization and troubles forming emotional attachments

• Unfulfilled desires for attention, or problems coping with stress (which the behaviors alleviate)

Some have theorized that a feeling of enjoyment when duping physicians motivates people with Munchausen syndrome. But others have found that most people with Munchausen’s truly want to get well, and fear often prevents them from letting go of behaviors.

Risk factors for Munchausen syndrome

While there’s no clear cause for factitious disorder, there are some risk factors. Risk factors are common traits, characteristics, and experiences that may make it more likely for someone to have a certain condition, like Munchausen syndrome. 

Risk factors include for Munchausen syndrome include: 

• Having a history of trauma

• Working in a healthcare setting

• Having direct intravenous access for a medical reason

• Having a mental health condition, such as depression, suicidality, anxiety, schizophrenia, or a borderline personality disorder

• Experiencing bereavement

• Not being married

• Having family conflict

• Being female

• Being 30 to 40 years old

How common is Munchausen syndrome?

Munchausen syndrome affects about 1 in 100 people in the general population. It’s even more common in people who get treatment in a psychiatric hospital, where it affects  8 in every 100 who are admitted.

Diagnosing Munchausen’s syndrome

It can be very difficult to diagnose this disorder. People with factitious disorder can often convince other people — even healthcare professionals — that their false symptoms are actually genuine. This can make it hard to see that factitious disorder is the real culprit. 

For someone to get a diagnosis of factitious disorder, they need to match the description in the Diagnostic and Statistical Manual (DSM-5-TR). The DSM-5-TR is a guidebook that healthcare professionals use to diagnose mental illnesses.

According to the DSM-5-TR, people with factitious disorder:

• Make up (or “fake”) physical and psychological signs and symptoms

• Present themselves to others as sick or injured 

• Don’t get any obvious “rewards” from being sick (like getting out of work or receiving money)

• Don’t have a different mental illness that’s causing their symptoms, like schizophrenia or substance use

How is Munchausen syndrome different from Munchausen by proxy?

These are two separate — but related — mental health conditions. Here’s the difference:

• Munchausen syndrome: Its official name is “factitious disorder imposed on self.” People with this condition deceive others into believing they themselves are sick. 

• Munchausen syndrome by proxy: Its official name is “factitious disorder imposed on another.” People with this condition deceive others into believing someone else close to them is sick — usually someone under their care, like a child or spouse.  

Need additional information? You can read more about the similarities and differences in our GoodRx article about Munchausen by proxy.

Treating Munchausen’s syndrome

There’s no one single treatment that experts recommend for Munchausen syndrome. But good communication, clear boundaries, and therapy all have the potential to help. 

Here are some approaches that can help to manage Munchausen syndrome:

• Ensure good communication. The family and loved ones of someone with Munchausen should call the person’s medical provider to fill them in. This reduces the risk they will order unnecessary (potentially dangerous) tests.

• Take a nonjudgemental approach. It’s important to approach a person with Munchausen syndrome without judgment. Using a gentle approach that avoids confrontation can help encourage them to get help. 

• Consider therapy. Consulting a psychiatrist or psychologist may be helpful for some people with factitious disorder. Types of therapy that may be especially helpful include cognitive behavioral therapy and psychotherapy that uses the “ACCEPTS” model.

• Set boundaries. It’s also important for family to set healthy boundaries with the person to avoid personal and familial financial strain and stress.

• Designate a “team quarterback” for care. Choose one healthcare provider to take charge and be the gatekeeper for care. 

• Have a crisis action plan. People with Munchausen are at increased risk of psychiatric disorders and suicide. Plan ahead, so you know how to help a friend or family member who’s having a mental health crisis. 

• Consider a support group. Support groups can be helpful for people with Munchausen syndrome — as well as for their friends and family members. 

Why trust our experts?

Written by:

Claire Wilcox, MD

Claire Wilcox, MD, has 20 years of experience in her field. She was an associate professor at the University of New Mexico, where she is currently a part of the adjunct faculty.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

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