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Hello, I am canna and welcome back to diagnosing a killer

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What are you turning this off?

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Shit!

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So, we are back with another quick mental breakdown.

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This one is probably only 20 minutes, 25.

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It's not going to be super long, but it is really interesting.

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So I wanted to talk about it.

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We have talked about this in passing in certain cases,

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and we've kind of mentioned it just because we think it's super interesting.

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So we're going to talk actually in depth about it.

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So today we are going to be talking about Munchenhausen syndrome.

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Or is it Munchhausen?

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I must say Munchenhausen.

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Munchenhausen.

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So, if that sounds really German, it's because it is.

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So they have actually renamed this disorder.

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The actual name for it is called Faktisches Disorder.

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So it's called Faktisches Disorder, also known as Munchhausen.

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It was named after Baron von Munchhausen.

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That was actually pretty good.

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Baron.

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Baron.

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No, I think it's Baron von Munchhausen.

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Damn, that is a super German name.

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I love that.

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He was an 18th century German officer,

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and he was known for embellishing the stories of his life.

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That's what that faktisches comes from.

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He was a fucking liar.

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I love that.

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And Munchhausen syndrome involves the falsification of physical or psychological signs

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or symptoms with no obvious reward.

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Not to be confused with somatic symptom disorder,

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which is in the DSM-5, in that patients are aware that they're exaggerating,

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or a hypochondrasis, where sufferers of hypochondrasis

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actually believe that they have the disease.

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Faktisches disorder is when you falsified the disease,

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but you know that you don't have it.

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Whereas hypochondriacs think that they really have it.

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They do, okay.

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They're not falsifying on purpose.

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Now, the prevalence of faktisches disorder is unknown,

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since the disorder involves deception.

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And in hospital settings, it's estimated that up to 1% may meet criteria for faktisches disorder.

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It's more common in women and healthcare workers, which I thought was interesting.

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You said in a hospital?

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In hospital settings.

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It's estimated that up to 1% of patients in hospitals...

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Have it?

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It's estimated that they meet criteria.

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What?

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Wow.

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I mean, if you find yourself in a hospital bed for a long period of time,

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it's not out of the realm of possibilities to think that some people would kind of come to like that attention,

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and that constant comfort and care.

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Interesting.

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In fact, faktisches disorder imposed on another,

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aka, Munchhausen syndrome by proxy, which we'll also talk about,

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almost all perpetrators are female, and more than 95% of those are the mother of the victim.

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I know.

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It makes you like jeevs.

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So for the prognosis, faktisches disorder usually has first onset in early adulthood,

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and it often follows a hospitalization for medical or psychiatric reasons.

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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.

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Some people kind of realize, oh, like, this is a way to get attention.

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Individuals often have a history of multiple hospital admissions

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and are often willing to undergo invasive procedures.

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Like, okay, I had hip surgery in December of 2019, I think, or 2020,

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and it was terrifying for me, and I was terrified to go under the knife, so to speak.

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Like, these people kind of like welcome that.

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Well, it's like a drug, you would think, you know, that they have like a certain tolerance,

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and then you're like, wow, that amount of attention felt really good.

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What if I do something more extreme?

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The attention is going to be greater and the more rewarding it feels.

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And like, if I have open arms or a dream in the hospital for months,

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and they have to take care of me then, you know.

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The overall prognosis is generally poor when confronted.

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The majority of individuals will deny their behaviors and very few will seek treatment,

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which is odd because you'd think that you'd want the treatment,

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but they don't want to admit that they have a problem,

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they just want to be taken care of and believed that they have this disease or disorder.

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Now, for factitious disorder, impose on another, again, Munchausen by proxy.

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It usually begins after an initial hospitalization of the individual's child

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or other dependent for legitimate reasons.

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For the victims of Munchausen by proxy, for example, children,

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the mortality rate can be between 6 to 22%.

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And for the victims, poisoning and suffocation are the most common forms of harm.

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Oh, that's awful.

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Now, there's a couple of different criteria that you need to meet

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in order to be diagnosed with factitious disorder.

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So, criterion A is falsification, deliberately feigning of physical or psychological signs or symptoms,

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or induction of injury or disease associated with identified deception.

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So, you're faking an illness, mental or physical,

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or you're inducing an injury on yourself or a sickness.

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Criterion B, the individual presents himself or herself to others as ill and paired or injured,

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so you're just pretending, you're telling people that you are ill,

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you're telling people that you are suffering from cancer when you're not.

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Criterion C, the deceptive behavior is evident even in the absence of obvious external rewards.

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So, you're not gaining anything, not anything like physical.

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You're not gaining any physical gifts or rewards or even more attention,

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but you're still doing it, you're still trying to get that.

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And then criterion D, the behavior is not better explained by another mental disorder,

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such as delusional disorder or another psychotic disorder.

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Early stage medical conditions is one of those differential diagnoses.

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Clinicians suspecting factitious disorder should always rule out early stage medical conditions

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because they want to make sure that you're not actually suffering from something

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before they just say, yeah, you're faking it.

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Sematic symptom disorder, like I said earlier, there may be excessive attention and treatment seeking

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for perceived medical concerns, but there's no evidence that the individual is providing false information

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or behaving deceptively.

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So, they want the attention for the medical condition, but they think that they actually might have it.

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They're not trying to fake it to get the attention, but they like the attention from thinking.

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And especially when you realize how rare it actually is,

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and of course you don't want to really want to walk into a situation and be like,

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clearly this is a fictitious disorder.

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Now, malingering is another one.

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It's differentiated from factitious disorder by the intentional reporting of symptoms for personal gain,

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an example of money or time off of work.

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So, in contrast, the diagnosis of fictitious disorder requires the absence of obvious rewards.

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So, primary gain would be...

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I get what you're saying.

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So, primary gain would be symptoms developed in order to assume the sick role to get medical attention and sympathy,

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and the secondary gain would be symptoms developed for obvious external gain, like time off work or compensation for missing out.

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I just can't come in today.

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And lastly, a conversion disorder is a functional neurological symptom disorder.

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It's characterized by neurological symptoms that are inconsistent with neurological pathophysiology.

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Fictitious disorder with neurological symptoms is distinguished from conversion disorder by evidence of deception and falsification of symptoms.

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So, it's just a little bit different.

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And borderline personality disorder is also one of them.

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So, I talked about Munchausen syndrome and Munchausen by proxy,

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but we're going to go into by proxy just a little bit more,

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because I feel like Munchausen is kind of cut and dry.

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I gave you the criterion for that.

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So, when someone has Munchausen by proxy or fictitious disorder imposed on another is what they call it,

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they might act as though their child or dependent has a medical condition that needs attention.

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If anybody has seen the show, The Act, Gypsy Rose, it's based on a true story.

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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.

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In this case, however, the child or dependent person isn't sick.

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So, people with, I'm just going to call it FDIA because it's easier,

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people with FDIA lie about an illness and another person.

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This other person is usually someone in their care, often a child under the age of six,

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but in some cases the dependent person can be another adult, disabled person, or an elderly person.

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So, I thought this was interesting.

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What is the motivation behind fictitious disorder imposed on another?

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So, there may be different reasons, of course, why someone with this disorder might seek unnecessary medical treatment for a child or dependent,

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but often people with this disorder have an inner need for their child or other dependent person to be seen as ill or injured.

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It isn't done to achieve a concrete benefit like financial gain,

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but it is often done in order to gain the sympathy and special attention given to people who are truly ill and their families,

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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.

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You're saying that they do want that to happen?

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They see the...

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It's the attention they get.

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...rewards or the attention, of course, as someone that actually suffers from that get.

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But not necessarily financial.

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It's more of the reward of the attention.

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It says, yeah, I misspoke.

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It's not done to achieve financial gain.

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They want the big check in front of a live audience.

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They want the make-a-wish.

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Yeah, exactly.

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So, there are certain characteristics that are common in a person with Munchausenbhai proxy,

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including being a parent, usually a mother,

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but the person can also be the adult child of an elderly parent, spouse, or caretaker.

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Sometimes being a healthcare professional or having medical knowledge,

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it kind of sounds like Kristen Gilbert.

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Kind of. She had a different diagnosis, but it was almost similar to this.

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Well, then she burned that child too, remember?

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She scalded that child with hot water.

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Being very friendly and cooperative with the healthcare providers, of course,

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appearing to be quite concerned.

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Some might even seem overly concerned about the child or designated patient,

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and possibly also suffering from a fictitious disorder imposed on self.

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This is Munchausen syndrome.

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Like if they were to harm themselves.

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Yeah.

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So, usually, I think what they're trying to say is that,

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usually it starts out maybe as self-harm of Munchausen,

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and then it can transfer into a by proxy.

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I think what they're saying is that Munchausen by proxy,

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you're likely to have Munchausen as well,

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but it doesn't go the other way.

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Like if you have just a Munchausen, you don't necessarily have a by proxy.

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Like maybe you had Munchausen and then you had a baby,

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and then it transfers.

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Which I've heard cases of that as well.

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And then the prevalence of Munchausen by proxy,

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there's actually no reliable statistics, like I said with the other one,

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and it is difficult to assess how common the disorder is,

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because many cases go undetected.

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However, estimates suggest that about 1,000 of the 2.5 million cases

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of child abuse reported annually are related to it.

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Wow.

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Yeah.

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I always think about that too.

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I mean, you know, not to talk too much about it,

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because you know, I have a big thing about talking about harming children

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and things like that.

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It's not something that I typically want to talk about.

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And if it is in one of my cases, I usually just brush by it,

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not out of being disrespectful to the victim,

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but it's just, it's really hard content for me to talk about.

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Yeah.

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But yeah, I think we see that a lot,

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is that, you know, a lot of these cases,

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and I've seen quite a few of them, especially because of COVID

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and people are having to raise their own children.

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You know, instead of them being in school.

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But with that, you know, we've had a lot of cases locally

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that it seems that there has been abuse in the family,

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maybe a Munchausen, by proxy type situation,

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that it's just gone too far.

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And you know, then they end up harming the child

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and either permanently or they kill the child

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and it's just really sad.

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Yeah.

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So what causes Munchausen syndrome?

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I thought was interesting as well.

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Several factors have been identified as possible causes.

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These include emotional trauma or illness during childhood,

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is often resulting in extensive medical attention.

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As a result of the trauma,

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a person may have unresolved issues with their parents

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that cause them to fake illness.

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They may do this because they have a compulsion

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to punish themselves by making themselves ill

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because they feel unworthy.

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They need to feel important and be the center of attention,

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or they need to pass responsibility for their well-being

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and care onto other people.

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So that's one.

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Another one is personality disorder.

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So of course a mental health condition

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that causes patterns of abnormal behavior and thinking.

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Some of the different personality disorders

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thought to be linked is antisocial personality disorder,

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borderline and narcissistic personality disorder.

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And then also, I thought this was interesting,

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something else that can cause it is a grudge

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against authority figures or healthcare professionals.

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So...

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I wonder why.

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I know, but I think it's probably like,

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you know, I don't...

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I don't know, the grudge thing kind of makes me think

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that they're like,

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well, you can take care of me.

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You know what I mean?

248
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Like, I don't like you.

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So like, here's your punishment, I guess.

250
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Yeah, you're forced to take care of me.

251
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Yeah, exactly.

252
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Now, treating Munchas and Sanjum can be difficult

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because most people with it refuse to admit

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that they have a problem

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and they refuse to cooperate with treatment plans.

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Some experts recommend that healthcare professionals

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should adopt a gentle, non-confrontational approach

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and suggest that the person may benefit

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from a referral to a psychiatrist.

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Others argue that a person with Munchas and Sanjum

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are confronted directly and asked why they've lied

262
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and whether they have stress and anxiety,

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which is like, I feel like that's kind of aggressive.

264
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Yeah, I do feel like this is...

265
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What's wrong with you?

266
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Yeah.

267
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People who have Munchasans are genuinely mentally ill

268
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but will often admit to having a physical illness.

269
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They'll only admit to having a physical illness

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instead of a mental illness.

271
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That's really interesting to me

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because I feel like people that suffer

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from factitious disorder, I would think,

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would want the assistance or the focus on...

275
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Yes, I know what you're saying.

276
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You know what I mean?

277
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Yes, but I also think that they think that

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once they get this treatment,

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they'll no longer need the assistance

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so they don't want to treat it.

281
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Because that's what they want.

282
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Because that's what they want.

283
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They want the help and the care.

284
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Okay.

285
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If a person does admit to their behavior,

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they can be referred to a psychiatrist

287
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for further treatment.

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If they do not admit to lying,

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most experts agree that the doctor in charge of their care

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should minimize medical contact with them.

291
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This is based on the doctor-patient relationship, of course,

292
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because it's based on trust.

293
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And if there's evidence the patient

294
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can no longer be trusted, the doctor is...

295
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The doctor is unable to continue treating them.

296
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It may be possible to help control the symptoms

297
00:14:52,000 --> 00:14:54,000
of factitious disorder if the person admits

298
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that they have a problem and cooperates with treatment.

299
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And there's no standard treatment for the syndrome,

300
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but a combination of psychoanalysis and CBT,

301
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cognitive behavioral therapy, has shown some success.

302
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Psychoanalysis is a type of psychotherapy

303
00:15:05,000 --> 00:15:07,000
that attempts to uncover and resolve

304
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unconscious beliefs and motivations.

305
00:15:09,000 --> 00:15:12,000
By the way, I got all of this off of a website.

306
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And another thing, family therapy might be beneficial

307
00:15:14,000 --> 00:15:16,000
if you get everyone in the same room

308
00:15:16,000 --> 00:15:18,000
and kind of talk about it.

309
00:15:18,000 --> 00:15:21,000
So lastly, there's not really any celebrities

310
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that suffer from fictitious disorder,

311
00:15:24,000 --> 00:15:26,000
but there is famous cases of it.

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So I'm just going to touch on those.

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00:15:28,000 --> 00:15:30,000
One of the most famous cases of Munchausen by proxy

314
00:15:30,000 --> 00:15:33,000
is actually Eminem, the rapper.

315
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A social worker accused his mother Debbie Mathers,

316
00:15:35,000 --> 00:15:38,000
who Eminem has rapped about in the past,

317
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about wanting to kill, of having the disease in 1996

318
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during juvenile court proceedings for Eminem's younger brother.

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Apparently in 2002,

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00:15:47,000 --> 00:15:50,000
when Eminem released the song Cleaning Up My Closet,

321
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he describes himself as a victim of Munchausen by proxy.

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With the quote,

323
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quote,

324
00:15:56,000 --> 00:15:59,000
witnessing your mama pop and prescription pills in the kitchen,

325
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someone's always going through her purse and stuff's missing.

326
00:16:02,000 --> 00:16:03,000
In the quote, it says,

327
00:16:03,000 --> 00:16:05,000
going through public housing systems,

328
00:16:05,000 --> 00:16:06,000
victim of Munchausen syndrome.

329
00:16:06,000 --> 00:16:09,000
My whole life, I was made to believe I was sick when I wasn't,

330
00:16:09,000 --> 00:16:12,000
till I grew up, now I blew up, it makes you sick to your stomach.

331
00:16:12,000 --> 00:16:15,000
I didn't know that that line was actually in that song

332
00:16:15,000 --> 00:16:17,000
because I've heard that song so many times, but yeah.

333
00:16:17,000 --> 00:16:18,000
Isn't that?

334
00:16:18,000 --> 00:16:21,000
Yeah, that's like, I mean, I didn't think that that was,

335
00:16:21,000 --> 00:16:23,000
I'd never heard about that before, and I'm just,

336
00:16:23,000 --> 00:16:25,000
I used to be a huge fan of Eminem.

337
00:16:25,000 --> 00:16:29,000
Lacey Spears is another one that's a really well-known case.

338
00:16:29,000 --> 00:16:32,000
So to her online supporters, she was a blogger,

339
00:16:32,000 --> 00:16:35,000
she was a loving mother caring for her sixth son named Garnet.

340
00:16:35,000 --> 00:16:37,000
Is she the one that poisoned him with salt?

341
00:16:37,000 --> 00:16:40,000
Yes, so Garnet was nine weeks old,

342
00:16:40,000 --> 00:16:43,000
and he had to have stomach surgery to prevent him from throwing up.

343
00:16:43,000 --> 00:16:46,000
Spears said that he had suffered severe ear infections

344
00:16:46,000 --> 00:16:48,000
and projected vomiting, but doctors couldn't figure out

345
00:16:48,000 --> 00:16:50,000
why he couldn't keep down food.

346
00:16:50,000 --> 00:16:54,000
His sodium level was found to be dangerously high as an infant,

347
00:16:54,000 --> 00:16:56,000
and I'm not going to go too much into it,

348
00:16:56,000 --> 00:16:58,000
but he ended up passing from the...

349
00:16:58,000 --> 00:17:00,000
Then she abused.

350
00:17:00,000 --> 00:17:02,000
And lastly, we just talked about it, Gypsy Rose.

351
00:17:02,000 --> 00:17:05,000
Her mom, Dee Dee Blanchard, was very,

352
00:17:05,000 --> 00:17:08,000
I were covering this case because it's so interesting,

353
00:17:08,000 --> 00:17:10,000
but she had been lying about...

354
00:17:10,000 --> 00:17:12,000
This is Munchausen by Proxy again,

355
00:17:12,000 --> 00:17:15,000
but lying about her daughter Gypsy Rose's ailments

356
00:17:15,000 --> 00:17:18,000
since she was a baby, she subjected her to unnecessary surgery,

357
00:17:18,000 --> 00:17:21,000
medication, she told her that she couldn't walk

358
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and that Gypsy Rose...

359
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Told her that she was blind and all this stuff.

360
00:17:24,000 --> 00:17:25,000
...was bleeding, wheelchair.

361
00:17:25,000 --> 00:17:27,000
She also told and convinced Gypsy Rose that she had suffered

362
00:17:27,000 --> 00:17:29,000
from leukemia, muscular dystrophy,

363
00:17:29,000 --> 00:17:32,000
mental retardation amongst other ailments, and that's a quote.

364
00:17:32,000 --> 00:17:35,000
And then in a shocking turn of events,

365
00:17:35,000 --> 00:17:38,000
if you haven't seen the show, a spoiler alert,

366
00:17:38,000 --> 00:17:41,000
Dee Dee Blanchard was found murdered in her home in 2015.

367
00:17:41,000 --> 00:17:44,000
Gypsy... again, we'll go into the case,

368
00:17:44,000 --> 00:17:48,000
but Gypsy found out that this is what was happening.

369
00:17:48,000 --> 00:17:50,000
That she was being manipulated.

370
00:17:50,000 --> 00:17:51,000
Yes.

371
00:17:51,000 --> 00:17:53,000
And we'll get... I don't want to spoil anything.

372
00:17:53,000 --> 00:17:55,000
So we'll get to that case.

373
00:17:55,000 --> 00:17:57,000
But yeah, I just wanted to quickly touch on that.

374
00:17:57,000 --> 00:17:58,000
Again, we talked about that.

375
00:17:58,000 --> 00:18:00,000
I think that's such an interesting disorder,

376
00:18:00,000 --> 00:18:03,000
but I feel like... I mean, it's not as uncommon

377
00:18:03,000 --> 00:18:07,000
as you think. I feel like we can maybe dig into our memory bank

378
00:18:07,000 --> 00:18:09,000
and maybe think of a time that, oh, wow,

379
00:18:09,000 --> 00:18:14,000
maybe someone was, you know, in fact, suffering from either one of those disorders.

380
00:18:14,000 --> 00:18:15,000
But yeah, I think that...

381
00:18:15,000 --> 00:18:18,000
That was the first time that I had heard that fictitious disorder

382
00:18:18,000 --> 00:18:20,000
is actually the correct term for that.

383
00:18:20,000 --> 00:18:21,000
I didn't know that.

384
00:18:21,000 --> 00:18:24,000
I think it's really interesting the difference

385
00:18:24,000 --> 00:18:28,000
between fictitious disorder and hypochondria disorders.

386
00:18:28,000 --> 00:18:30,000
That was really interesting to me.

387
00:18:30,000 --> 00:18:35,000
Only because I feel like I know a person or two

388
00:18:35,000 --> 00:18:37,000
that says something like that and you're like,

389
00:18:37,000 --> 00:18:41,000
is this person making themselves that way?

390
00:18:41,000 --> 00:18:45,000
Or is it that they are overanalyzing themselves?

391
00:18:45,000 --> 00:18:47,000
Or they truly believe that they have it.

392
00:18:47,000 --> 00:18:48,000
Or if they truly... Yeah, exactly.

393
00:18:48,000 --> 00:18:50,000
So yeah, fictitious is...

394
00:18:50,000 --> 00:18:52,000
You know that you don't have it, but you're going to pretend that you do.

395
00:18:52,000 --> 00:18:53,000
But you make it.

396
00:18:53,000 --> 00:18:54,000
Hypochondria...

397
00:18:54,000 --> 00:18:55,000
Or you make it happen.

398
00:18:55,000 --> 00:18:57,000
And hypochondria is if you truly believe that you have it.

399
00:18:57,000 --> 00:18:58,000
Believe that you have it.

400
00:18:58,000 --> 00:19:00,000
But it's not a scary thing.

401
00:19:00,000 --> 00:19:03,000
When you have fictitious disorder, it's not a scary thing that you have it.

402
00:19:03,000 --> 00:19:04,000
It's an attention thing.

403
00:19:04,000 --> 00:19:06,000
Hypochondria is, oh my god, I might have this.

404
00:19:06,000 --> 00:19:07,000
Yeah, exactly.

405
00:19:07,000 --> 00:19:08,000
Interesting.

406
00:19:08,000 --> 00:19:09,000
But yeah, that was my little mental breakdown.

407
00:19:09,000 --> 00:19:13,000
It was kind of a mini, but there was a lot of good information.

408
00:19:13,000 --> 00:19:15,000
And yeah, we're going to continue to put these out.

409
00:19:15,000 --> 00:19:16,000
Hopefully.

410
00:19:16,000 --> 00:19:17,000
You guys are liking these honestly.

411
00:19:17,000 --> 00:19:18,000
I know, right?

412
00:19:18,000 --> 00:19:19,000
We're not going to make any more promises about it.

413
00:19:19,000 --> 00:19:21,000
Yeah, no more promises.

414
00:19:21,000 --> 00:19:24,000
I am a little excited just to see that notification pop up on my phone though.

415
00:19:24,000 --> 00:19:25,000
That it came out?

416
00:19:25,000 --> 00:19:26,000
Yeah.

417
00:19:26,000 --> 00:19:27,000
It's like, oh, diagnosing a killer is updated.

418
00:19:27,000 --> 00:19:28,000
I know, it's exciting.

419
00:19:28,000 --> 00:19:33,000
In the meantime, while you're waiting for a new episode, you guys can follow us on

420
00:19:33,000 --> 00:19:34,000
Instagram at Diagnosing a Killer.

421
00:19:34,000 --> 00:19:40,000
We have Twitter at Killerdiagnosis, patreon.com, slash diagnosing a killer if you feel so inclined

422
00:19:40,000 --> 00:19:41,000
to donate to the Patreon.

423
00:19:41,000 --> 00:19:44,000
And Gmail, diagnosing a killer at gmail.com.

424
00:19:44,000 --> 00:19:45,000
Anyways, we love you guys.

425
00:19:45,000 --> 00:19:46,000
Love you guys.

426
00:19:46,000 --> 00:19:47,000
Bye.

427
00:19:47,000 --> 00:19:57,000
Bye.