# How to deal with Munchausen Syndrome?



## furnacedock (Jun 21, 2011)

I chose the subject line because I couldn't think of a better one. I do actually know if my wife has this condition, but based on the description of it I see online, she exhibits many of its fundamental traits. Since meeting my wife 8 years ago, there have been many occurrences over the years where she has self-diagnosed a particular ailment (or believed it was likely), when there wasn't good reason to draw her conclusion. I remember the worst case was two years ago she insisted she had kidney stones (she explained she did have stones removed in the years before she met me), and wanted to be rushed to the ER. I felt sure she was just having gas pains, but I'm not a doctor, so to the hospital she went. Several hours later, a sonogram and several other tests and scans, and she was sent home with no evidence of anything- but the visit cost $6000 (our copay was $500). That was the most egregious case, but these occurrences happen often. 

Over this past weekend she complained of achy joints while we were on a two hour trip. The complaints got progressively worse so bad that at one point she was writhing in her seat, insisting that she be rushed to the ER. Her pattern of behavior didn't make sense to me, laughing and talking to our kids one moment, then 'agonizing pain', then laughing again, then the pain, etc. My thought was she was a little sore and stiff and stretching her legs would make her feel better. It was awful, because she was pleading with me to go to the ER, and crying (in front of our toddlers), which I know most likely would have resulted in a long evening in a waiting room a big bill. -but what if I was wrong? I'd be a monster for denying her. We ended up making it home, she lied down and seemed to be better again- but not before popping some strong prescription pain killers she somehow had obtained or saved.

This has become a difficult problem in our marriage, because in addition to the sudden 'serious' ailments, the complaints conveniently happen when it's time to take on a chore, or when we plan to get some exercise together. My biggest fear though is that (I believe) she is often crying wolf, and I won't take seriously the time when she does have a serious medical condition. This leads to a lot of frustration, because I have to choose between offering sympathy and respecting the ailment she says she has as real- or insulting her by not respecting it, making her upset with me. Despite my words of support she seems to be able to read my mind know it's the latter.

I love my wife dearly and genuinely care about her health but I don't know how to deal with this issue. Kind, carefully chosen words aren't doing it. If I try the tough love approach both she mother (and probably mine) will get a call promptly, painting me as a callous and uncaring jerk for not believing her.

Can anyone offer guidance?


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## LongWalk (Apr 4, 2013)

My SIL and her sister seem to have this. But hers is by proxy. She constantly submits her family to invasive examinations and testing. The worst was when she believed my nephew had a heart defect. She pushed so hard that she convinced the doctors to send a scope up his femoral artery to the heart. Not a risk free procedure. There was nothing wrong with him.

Every summer vacation for them includes testing for dyslexia or some other ailment. Money, time, torture for the children.

One time she was convinced the entire family had mercury poisoning from eating fish from the sea. They don't anymore fish than the average family. But they are underwent tests.

My brother lets her do this stuff. Makes me sick.

Looking at the furrows of worry on her face gives me the feeling that this illness is like a bad radio or TV program constantly in the background of her mind. She cannot turn off the fear channel.

She is not a bad person. Just a little nuts.


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## john117 (May 20, 2013)

Could it be attention seeking and a bit of NPD thrown in? Would she go for a neuro/psych evaluation?


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## Theseus (Feb 22, 2013)

How does she respond when you confront her with the fact that she was wrong about needing to go to the ER?


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## furnacedock (Jun 21, 2011)

The problem is that it's almost never so clear she was wrong that I can prove it in a confrontation. Kind of like the burden of trying to convict someone of a crime you know they committed, with very strong circumstantial evidence but no actual proof. 

For example, after this weekend's incident, she correctly sensed that I thought it was all in her head, and said she would see our PCP the day after to get checked up. She reported that they told her she didn't need emergency treatment or meds, but they did discover that she had 'alarmingly' high blood pressure. There's *always* something like that, anything that will validate her concern, require some type of treatment, and that I be sensitive to her. In this case, I tried to turn it around on her by suggesting that a very good way combat high blood pressure is with diet and rigorous exercise. As expected, that got me the cold "you just won't believe me, I just wish you would be sensitive" tone. Another day goes by and her tone gradually softens. At that point I just don't feel like confronting her, mainly because I get home late after working a long day and am too exhausted to bring up a topic that is well, exhausting to bring up, especially when she knows how I feel about it. That's the reason I'm looking for guidance. Specifically, when these occurrences happen, what's the correct, sensitive way to tell a loved one in front of other loved ones that they're *most likely* full of it when they think they have a dire need for medical attention?


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## Anon Pink (Jan 17, 2013)

furnacedock said:


> Specifically, when these occurrences happen, what's the correct, sensitive way to tell a loved one in front of other loved ones that they're *most likely* full of it when they think they have a dire need for medical attention?


You say, "Gee honey, I'm terribly concerned that you're in pain. I want you to phone your doctor as soon as possible and let the doc know what is going on."

No more trips to the ER unless she can't breath, without a call to her primary care doc first.

Like John said, she needs a psych eval.


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## LongWalk (Apr 4, 2013)

You don't have children, right?

Imagine if this anxiety came into play along with her maternal instincts?


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## furnacedock (Jun 21, 2011)

> You don't have children, right?
> 
> Imagine if this anxiety came into play along with her maternal instincts?


We do, a 3 yr old girl and 16 month old boy. -and that is definitely one of my concerns. I'm already worried that our daughter is being negatively influenced by this behavior.

As it turns out I did sit down and have a long talk with my wife last night. I never directly refer referred to the 'medical needs' issue, but instead pointed out that she seems to have a lot of anxiety lately, and suggested she might be helped by a psy evaluation. I pointed out specific things that have been a problem lately, like yelling ,arguing and emoting in front of our kids, being overly defensive, and some responsibilities around the house not being met. I went out of my way not to take an accusatory tone, and pledged to do whatever it takes to help her. Despite being very tired myself, I felt like I articulated things well (I usually have a hard time with that). I think the talk was productive, but it's hard to know for sure. She expressed some guilt about some of the things we talked about. I tried to assure her that she need not feel guilty but that we needed to work together improve things. The irrational medical needs behavior was way to sensitive a topic to bring up directly during this conversation. I just wanted it to be about explaining that I understand she has anxieties, and we've had a rougher than usual past few months, and I wanted to support her, but that our life responsibilities must be met along the way. I guess we'll see what happens going forward.


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## PieceOfSky (Apr 7, 2013)

This, or perhaps an earlier book by the same author, was a good read for me a few years ago. Might be worth a look.



http://www.amazon.com/gp/aw/d/0415949343/ref=mp_s_a_1_1?qid=1399559549&sr=8-1&pi=SL75



I might choose a Psychologist to do the evaluation over a Psychiatrist. Ymmv.



Psychologytoday.com has a good search tool for finding professionals to help.


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## MSP (Feb 9, 2012)

There are some medical issues that defy standard diagnoses. You could try taking her to a naturopath or holistic medical doctor. 

Or maybe just move to a country with free health care.


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## Uptown (Mar 27, 2010)

furnacedock said:


> How to deal with Munchausen Syndrome?


Furnace, Munchausen Syndrome is known as a "*factitious disorder*" because the patient deliberately fabricates her alleged "illnesses." Yet, if the patient genuinely believes the multiple "illnesses" are real, what you are describing sounds like a warning sign for *somatization disorder* -- a mental disorder characterized by multiple physical complaints that do not have a medical explanation.

Significantly, if your W actually does have factitious disorder (i.e., is fabricating it all) or has somatization disorder (i.e., sincerely believes it all), there is a small-but-significant chance she may also suffer from BPD (Borderline Personality Disorder). I say this because a number of studies have demonstrated a significant association between BPD and both factitious disorder and somatization disorder.

With respect to *factitious disorder*, a Professor of Psychiatry at Wright State University described its association with BPD as follows:
Several studies have examined the relationship between factitious disorders and BPD. In a review of the literature, Sutherland and Rodin found that factitious disorders were associated with BPD, among other psychiatric disorders. Several authors have associated pseudoseizures or psychogenic seizures with BPD.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012616/#B59 Finally, BPD has been reported in factitious vomiting,http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012616/#B60 iron deficiency anemia actually caused by intentional blood-letting, psychogenic purpura, and *Munchausen's syndrome* alone or by proxy.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012616/#B63 Indeed, factitious illness may be a variant of BPD in some individuals. See Sansone 2004 Article.​With respect to *somatization disorder*, that same psychiatrist concluded:
The prevalence rate of somatization disorder in the entire sample of 75 BPD patients was 36 percent. In our studies of patients in an outpatient internal medicine clinic, we also found relationships between BPD and somatic preoccupation. Specifically, in one study of 120 participants, we found that BPD demonstrated high correlations with somatic preoccupation. See Sansone 2004 Article.​


> Can anyone offer guidance?


I join the other respondents in recommending that your W see a professional, ideally a psychiatrist or psychologist. If you cannot persuade her to do that, I suggest you see a good psychologist -- for a visit or two all by yourself -- to obtain a candid professional opinion on what it is that you and your two kids are dealing with. 

I also suggest that, while you're waiting for an appointment, you read my description of BPD red flags at 18 BPD Warning Signs. If most of those signs sound very familiar, I would suggest you read my more detailed description of them in Maybe's Thread. If that description rings many bells, I would be glad to discuss them with you. 

Importantly, I am NOT suggesting that your W likely has BPD. On the contrary, I believe it is unlikely that she does. Rather, I am only saying that, because there is a significant association between BPD and these other two disorders, it may be worth your while to spend 15 minutes reading about BPD warning signs to see if most of them sound familiar. Take care, Furnace.


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## furnacedock (Jun 21, 2011)

Thanks for all your responses.



> I also suggest that, while you're waiting for an appointment, you read my description of BPD red flags at 18 BPD Warning Signs. If most of those signs sound very familiar, I would suggest you read my more detailed description of them in Maybe's Thread. If that description rings many bells, I would be glad to discuss them with you.


I appreciate this Uptown. I did read through the warning signs. My wife only exhibits one or two of them notably- so it would seem unlikely that she is a strong candidate for BPD based on that set of criteria. However, your pointing out that Münchausen is a factitious is very relevant. I'm never 100% sure, but in most of the cases (like the episode last weekend), she seems to genuinely believe her ailment is real, and really experiences the symptoms (which I think are manifested out of pronounced anxiety).

But on the other hand, after she sees a doctor and inevitably chooses some part of the prognosis as 'validation', it is used every time to avoid the activities she doesn't prefer, and/or evoke sympathy from me. Case in point, for the current episode her higher blood pressure (which has reduced over the past few days) justifies activities which are fun and stressless, like seeing her girlfriends for tapas last night at a winery. -but activities that would best contribute to reducing blood pressure, like very vigorous exercise (we both need to train for a running race next month) are off the table and I can't even bring them up without seeming insensitive, getting the "you think I'm fat" narrative. I happen to know that her doctor in this case did strongly recommend exercise. This pattern has been typical of all the other episodes over the years. 



> somatization disorder -- a mental disorder characterized by multiple physical complaints that do not have a medical explanation.


That description does seem to fit a little better.

I appreciate your suggestion about getting an evaluation (even if for myself if I can't get her to). I've thought about doing that for a while, it's extremely difficult for me to do so as on a work day I leave at 6am and get home at 7:30pm, with a 90 min commute separating home and work. This is one of the reasons I appreciate getting some insight here


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## furnacedock (Jun 21, 2011)

sorry- I meant NOT a strong candidate for BPD.


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## DCMarriageCounselor (Aug 30, 2007)

This is old thread but I'm very interested in it since I used to work in community mental health and currently run a mental health practice that specializes in working with emotional trauma and couples. When the term "psychosomatic" gets used it makes a lot of people go crazy because it seems to imply that a person is either deliberately inventing the symptoms or has conscious control over them. In my community work with serious, off the charts, mental illness and substance abuse (often combined) I learned that the way, way, way, upstream cause of the downstream physical or psychological symptoms is always some sort of chronic or acute disconnection from others. To give you an obvious example of a "psychosomatic" response everyone knows about: In the 1940s when hospitals started becoming obsessed with sanitation they took parents completely away from newborns. Everyone knows what happened. In the cleanest wards mortality shot up to 90%. This was a psychosomatic response. Our bodies, even as adults, are meant to have secure and meaningful connection to others for the immune system to function properly. Those of us who've had a disruption of this human connection, especially when younger, get a body that doesn't process pain and pleasure the same way as others. I really love the work of Dr. John Sarno and Dr. Herbert Benson (Harvard/Mass General) and many others that have finally legitimized the role of emotions and connection to others in the cause and the treatment of serious medical issues only previously viewed as the wheelhouse of surgeons and big pharma.


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## DCMarriageCounselor (Aug 30, 2007)

I thought of something I have to add to the comment above....Norman Doidge has an amazing book called The Brain that Changes Itself about the plasticity of our brain as adults. Even if we've inherited "bad" genes or "bad" attachment patterns from our parents we can absolutely make new connections in the context of safety, love, and the right amount of stress/challenge.


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