Hello, I am canna and welcome back to diagnosing a killer
What are you turning this off?
Shit!
So, we are back with another quick mental breakdown.
This one is probably only 20 minutes, 25.
It's not going to be super long, but it is really interesting.
So I wanted to talk about it.
We have talked about this in passing in certain cases,
and we've kind of mentioned it just because we think it's super interesting.
So we're going to talk actually in depth about it.
So today we are going to be talking about Munchenhausen syndrome.
Or is it Munchhausen?
I must say Munchenhausen.
Munchenhausen.
So, if that sounds really German, it's because it is.
So they have actually renamed this disorder.
The actual name for it is called Faktisches Disorder.
So it's called Faktisches Disorder, also known as Munchhausen.
It was named after Baron von Munchhausen.
That was actually pretty good.
Baron.
No, I think it's Baron von Munchhausen.
Damn, that is a super German name.
I love that.
He was an 18th century German officer,
and he was known for embellishing the stories of his life.
That's what that faktisches comes from.
He was a fucking liar.
I love that.
And Munchhausen syndrome involves the falsification of physical or psychological signs
or symptoms with no obvious reward.
Not to be confused with somatic symptom disorder,
which is in the DSM-5, in that patients are aware that they're exaggerating,
or a hypochondrasis, where sufferers of hypochondrasis
actually believe that they have the disease.
Faktisches disorder is when you falsified the disease,
but you know that you don't have it.
Whereas hypochondriacs think that they really have it.
They do, okay.
They're not falsifying on purpose.
Now, the prevalence of faktisches disorder is unknown,
since the disorder involves deception.
And in hospital settings, it's estimated that up to 1% may meet criteria for faktisches disorder.
It's more common in women and healthcare workers, which I thought was interesting.
You said in a hospital?
In hospital settings.
It's estimated that up to 1% of patients in hospitals...
Have it?
It's estimated that they meet criteria.
What?
Wow.
I mean, if you find yourself in a hospital bed for a long period of time,
it's not out of the realm of possibilities to think that some people would kind of come to like that attention,
and that constant comfort and care.
Interesting.
In fact, faktisches disorder imposed on another,
aka, Munchhausen syndrome by proxy, which we'll also talk about,
almost all perpetrators are female, and more than 95% of those are the mother of the victim.
I know.
It makes you like jeevs.
So for the prognosis, faktisches disorder usually has first onset in early adulthood,
and it often follows a hospitalization for medical or psychiatric reasons.
So again, you go and you get taken care of and seen by someone who their job is to make you comfortable and happy and content.
Some people kind of realize, oh, like, this is a way to get attention.
Individuals often have a history of multiple hospital admissions
and are often willing to undergo invasive procedures.
Like, okay, I had hip surgery in December of 2019, I think, or 2020,
and it was terrifying for me, and I was terrified to go under the knife, so to speak.
Like, these people kind of like welcome that.
Well, it's like a drug, you would think, you know, that they have like a certain tolerance,
and then you're like, wow, that amount of attention felt really good.
What if I do something more extreme?
The attention is going to be greater and the more rewarding it feels.
And like, if I have open arms or a dream in the hospital for months,
and they have to take care of me then, you know.
The overall prognosis is generally poor when confronted.
The majority of individuals will deny their behaviors and very few will seek treatment,
which is odd because you'd think that you'd want the treatment,
but they don't want to admit that they have a problem,
they just want to be taken care of and believed that they have this disease or disorder.
Now, for factitious disorder, impose on another, again, Munchausen by proxy.
It usually begins after an initial hospitalization of the individual's child
or other dependent for legitimate reasons.
For the victims of Munchausen by proxy, for example, children,
the mortality rate can be between 6 to 22%.
And for the victims, poisoning and suffocation are the most common forms of harm.
Oh, that's awful.
Now, there's a couple of different criteria that you need to meet
in order to be diagnosed with factitious disorder.
So, criterion A is falsification, deliberately feigning of physical or psychological signs or symptoms,
or induction of injury or disease associated with identified deception.
So, you're faking an illness, mental or physical,
or you're inducing an injury on yourself or a sickness.
Criterion B, the individual presents himself or herself to others as ill and paired or injured,
so you're just pretending, you're telling people that you are ill,
you're telling people that you are suffering from cancer when you're not.
Criterion C, the deceptive behavior is evident even in the absence of obvious external rewards.
So, you're not gaining anything, not anything like physical.
You're not gaining any physical gifts or rewards or even more attention,
but you're still doing it, you're still trying to get that.
And then criterion D, the behavior is not better explained by another mental disorder,
such as delusional disorder or another psychotic disorder.
Early stage medical conditions is one of those differential diagnoses.
Clinicians suspecting factitious disorder should always rule out early stage medical conditions
because they want to make sure that you're not actually suffering from something
before they just say, yeah, you're faking it.
Sematic symptom disorder, like I said earlier, there may be excessive attention and treatment seeking
for perceived medical concerns, but there's no evidence that the individual is providing false information
or behaving deceptively.
So, they want the attention for the medical condition, but they think that they actually might have it.
They're not trying to fake it to get the attention, but they like the attention from thinking.
And especially when you realize how rare it actually is,
and of course you don't want to really want to walk into a situation and be like,
clearly this is a fictitious disorder.
Now, malingering is another one.
It's differentiated from factitious disorder by the intentional reporting of symptoms for personal gain,
an example of money or time off of work.
So, in contrast, the diagnosis of fictitious disorder requires the absence of obvious rewards.
So, primary gain would be...
I get what you're saying.
So, primary gain would be symptoms developed in order to assume the sick role to get medical attention and sympathy,
and the secondary gain would be symptoms developed for obvious external gain, like time off work or compensation for missing out.
I just can't come in today.
And lastly, a conversion disorder is a functional neurological symptom disorder.
It's characterized by neurological symptoms that are inconsistent with neurological pathophysiology.
Fictitious disorder with neurological symptoms is distinguished from conversion disorder by evidence of deception and falsification of symptoms.
So, it's just a little bit different.
And borderline personality disorder is also one of them.
So, I talked about Munchausen syndrome and Munchausen by proxy,
but we're going to go into by proxy just a little bit more,
because I feel like Munchausen is kind of cut and dry.
I gave you the criterion for that.
So, when someone has Munchausen by proxy or fictitious disorder imposed on another is what they call it,
they might act as though their child or dependent has a medical condition that needs attention.
If anybody has seen the show, The Act, Gypsy Rose, it's based on a true story.
Joey King is one of my favorite actresses, so it's a really good series if you haven't seen it, but it talks about that.
In this case, however, the child or dependent person isn't sick.
So, people with, I'm just going to call it FDIA because it's easier,
people with FDIA lie about an illness and another person.
This other person is usually someone in their care, often a child under the age of six,
but in some cases the dependent person can be another adult, disabled person, or an elderly person.
So, I thought this was interesting.
What is the motivation behind fictitious disorder imposed on another?
So, there may be different reasons, of course, why someone with this disorder might seek unnecessary medical treatment for a child or dependent,
but often people with this disorder have an inner need for their child or other dependent person to be seen as ill or injured.
It isn't done to achieve a concrete benefit like financial gain,
but it is often done in order to gain the sympathy and special attention given to people who are truly ill and their families,
i.e. getting on a plane early because you're in a wheelchair or because you have a disorder of some sort or a disability of some sort.
You're saying that they do want that to happen?
They see the...
It's the attention they get.
...rewards or the attention, of course, as someone that actually suffers from that get.
But not necessarily financial.
It's more of the reward of the attention.
It says, yeah, I misspoke.
It's not done to achieve financial gain.
They want the big check in front of a live audience.
They want the make-a-wish.
Yeah, exactly.
So, there are certain characteristics that are common in a person with Munchausenbhai proxy,
including being a parent, usually a mother,
but the person can also be the adult child of an elderly parent, spouse, or caretaker.
Sometimes being a healthcare professional or having medical knowledge,
it kind of sounds like Kristen Gilbert.
Kind of. She had a different diagnosis, but it was almost similar to this.
Well, then she burned that child too, remember?
She scalded that child with hot water.
Being very friendly and cooperative with the healthcare providers, of course,
appearing to be quite concerned.
Some might even seem overly concerned about the child or designated patient,
and possibly also suffering from a fictitious disorder imposed on self.
This is Munchausen syndrome.
Like if they were to harm themselves.
Yeah.
So, usually, I think what they're trying to say is that,
usually it starts out maybe as self-harm of Munchausen,
and then it can transfer into a by proxy.
I think what they're saying is that Munchausen by proxy,
you're likely to have Munchausen as well,
but it doesn't go the other way.
Like if you have just a Munchausen, you don't necessarily have a by proxy.
Like maybe you had Munchausen and then you had a baby,
and then it transfers.
Which I've heard cases of that as well.
And then the prevalence of Munchausen by proxy,
there's actually no reliable statistics, like I said with the other one,
and it is difficult to assess how common the disorder is,
because many cases go undetected.
However, estimates suggest that about 1,000 of the 2.5 million cases
of child abuse reported annually are related to it.
Wow.
Yeah.
I always think about that too.
I mean, you know, not to talk too much about it,
because you know, I have a big thing about talking about harming children
and things like that.
It's not something that I typically want to talk about.
And if it is in one of my cases, I usually just brush by it,
not out of being disrespectful to the victim,
but it's just, it's really hard content for me to talk about.
Yeah.
But yeah, I think we see that a lot,
is that, you know, a lot of these cases,
and I've seen quite a few of them, especially because of COVID
and people are having to raise their own children.
You know, instead of them being in school.
But with that, you know, we've had a lot of cases locally
that it seems that there has been abuse in the family,
maybe a Munchausen, by proxy type situation,
that it's just gone too far.
And you know, then they end up harming the child
and either permanently or they kill the child
and it's just really sad.
Yeah.
So what causes Munchausen syndrome?
I thought was interesting as well.
Several factors have been identified as possible causes.
These include emotional trauma or illness during childhood,
is often resulting in extensive medical attention.
As a result of the trauma,
a person may have unresolved issues with their parents
that cause them to fake illness.
They may do this because they have a compulsion
to punish themselves by making themselves ill
because they feel unworthy.
They need to feel important and be the center of attention,
or they need to pass responsibility for their well-being
and care onto other people.
So that's one.
Another one is personality disorder.
So of course a mental health condition
that causes patterns of abnormal behavior and thinking.
Some of the different personality disorders
thought to be linked is antisocial personality disorder,
borderline and narcissistic personality disorder.
And then also, I thought this was interesting,
something else that can cause it is a grudge
against authority figures or healthcare professionals.
So...
I wonder why.
I know, but I think it's probably like,
you know, I don't...
I don't know, the grudge thing kind of makes me think
that they're like,
well, you can take care of me.
You know what I mean?
Like, I don't like you.
So like, here's your punishment, I guess.
Yeah, you're forced to take care of me.
Yeah, exactly.
Now, treating Munchas and Sanjum can be difficult
because most people with it refuse to admit
that they have a problem
and they refuse to cooperate with treatment plans.
Some experts recommend that healthcare professionals
should adopt a gentle, non-confrontational approach
and suggest that the person may benefit
from a referral to a psychiatrist.
Others argue that a person with Munchas and Sanjum
are confronted directly and asked why they've lied
and whether they have stress and anxiety,
which is like, I feel like that's kind of aggressive.
Yeah, I do feel like this is...
What's wrong with you?
Yeah.
People who have Munchasans are genuinely mentally ill
but will often admit to having a physical illness.
They'll only admit to having a physical illness
instead of a mental illness.
That's really interesting to me
because I feel like people that suffer
from factitious disorder, I would think,
would want the assistance or the focus on...
Yes, I know what you're saying.
You know what I mean?
Yes, but I also think that they think that
once they get this treatment,
they'll no longer need the assistance
so they don't want to treat it.
Because that's what they want.
They want the help and the care.
Okay.
If a person does admit to their behavior,
they can be referred to a psychiatrist
for further treatment.
If they do not admit to lying,
most experts agree that the doctor in charge of their care
should minimize medical contact with them.
This is based on the doctor-patient relationship, of course,
because it's based on trust.
And if there's evidence the patient
can no longer be trusted, the doctor is...
The doctor is unable to continue treating them.
It may be possible to help control the symptoms
of factitious disorder if the person admits
that they have a problem and cooperates with treatment.
And there's no standard treatment for the syndrome,
but a combination of psychoanalysis and CBT,
cognitive behavioral therapy, has shown some success.
Psychoanalysis is a type of psychotherapy
that attempts to uncover and resolve
unconscious beliefs and motivations.
By the way, I got all of this off of a website.
And another thing, family therapy might be beneficial
if you get everyone in the same room
and kind of talk about it.
So lastly, there's not really any celebrities
that suffer from fictitious disorder,
but there is famous cases of it.
So I'm just going to touch on those.
One of the most famous cases of Munchausen by proxy
is actually Eminem, the rapper.
A social worker accused his mother Debbie Mathers,
who Eminem has rapped about in the past,
about wanting to kill, of having the disease in 1996
during juvenile court proceedings for Eminem's younger brother.
Apparently in 2002,
when Eminem released the song Cleaning Up My Closet,
he describes himself as a victim of Munchausen by proxy.
With the quote,
quote,
witnessing your mama pop and prescription pills in the kitchen,
someone's always going through her purse and stuff's missing.
In the quote, it says,
going through public housing systems,
victim of Munchausen syndrome.
My whole life, I was made to believe I was sick when I wasn't,
till I grew up, now I blew up, it makes you sick to your stomach.
I didn't know that that line was actually in that song
because I've heard that song so many times, but yeah.
Isn't that?
Yeah, that's like, I mean, I didn't think that that was,
I'd never heard about that before, and I'm just,
I used to be a huge fan of Eminem.
Lacey Spears is another one that's a really well-known case.
So to her online supporters, she was a blogger,
she was a loving mother caring for her sixth son named Garnet.
Is she the one that poisoned him with salt?
Yes, so Garnet was nine weeks old,
and he had to have stomach surgery to prevent him from throwing up.
Spears said that he had suffered severe ear infections
and projected vomiting, but doctors couldn't figure out
why he couldn't keep down food.
His sodium level was found to be dangerously high as an infant,
and I'm not going to go too much into it,
but he ended up passing from the...
Then she abused.
And lastly, we just talked about it, Gypsy Rose.
Her mom, Dee Dee Blanchard, was very,
I were covering this case because it's so interesting,
but she had been lying about...
This is Munchausen by Proxy again,
but lying about her daughter Gypsy Rose's ailments
since she was a baby, she subjected her to unnecessary surgery,
medication, she told her that she couldn't walk
and that Gypsy Rose...
Told her that she was blind and all this stuff.
...was bleeding, wheelchair.
She also told and convinced Gypsy Rose that she had suffered
from leukemia, muscular dystrophy,
mental retardation amongst other ailments, and that's a quote.
And then in a shocking turn of events,
if you haven't seen the show, a spoiler alert,
Dee Dee Blanchard was found murdered in her home in 2015.
Gypsy... again, we'll go into the case,
but Gypsy found out that this is what was happening.
That she was being manipulated.
Yes.
And we'll get... I don't want to spoil anything.
So we'll get to that case.
But yeah, I just wanted to quickly touch on that.
Again, we talked about that.
I think that's such an interesting disorder,
but I feel like... I mean, it's not as uncommon
as you think. I feel like we can maybe dig into our memory bank
and maybe think of a time that, oh, wow,
maybe someone was, you know, in fact, suffering from either one of those disorders.
But yeah, I think that...
That was the first time that I had heard that fictitious disorder
is actually the correct term for that.
I didn't know that.
I think it's really interesting the difference
between fictitious disorder and hypochondria disorders.
That was really interesting to me.
Only because I feel like I know a person or two
that says something like that and you're like,
is this person making themselves that way?
Or is it that they are overanalyzing themselves?
Or they truly believe that they have it.
Or if they truly... Yeah, exactly.
So yeah, fictitious is...
You know that you don't have it, but you're going to pretend that you do.
But you make it.
Hypochondria...
Or you make it happen.
And hypochondria is if you truly believe that you have it.
Believe that you have it.
But it's not a scary thing.
When you have fictitious disorder, it's not a scary thing that you have it.
It's an attention thing.
Hypochondria is, oh my god, I might have this.
Yeah, exactly.
Interesting.
But yeah, that was my little mental breakdown.
It was kind of a mini, but there was a lot of good information.
And yeah, we're going to continue to put these out.
Hopefully.
You guys are liking these honestly.
I know, right?
We're not going to make any more promises about it.
Yeah, no more promises.
I am a little excited just to see that notification pop up on my phone though.
That it came out?
Yeah.
It's like, oh, diagnosing a killer is updated.
I know, it's exciting.
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