Factitious disorder - Causes of Munchausen's syndrome

There is little available evidence about the possible causes of Munchausen's syndrome because many people with the condition refuse to co-operate with psychiatric treatment or psychological profiling.

Based on the available research and case studies, there are several factors identified as possible causes of Munchausen's syndrome. These include:

• emotional trauma or illness during childhood – this often resulted in extensive medical attention
• a personality disorder – a mental health condition that causes patterns of abnormal thinking and behaviour
• a grudge against authority figures or health professionals

Childhood trauma

Some experts have suggested many cases of Munchausen's syndrome may be the result of parental neglect and abandonment, resulting in feelings of childhood trauma.

As a result of this trauma, a person may have unresolved issues with their parents that cause them to fake illness. They may do this for a number of reasons. For example, this may be because they have:

• a compulsion to punish themselves (masochism) by making themselves ill because they feel unworthy
• a need to feel important and be the centre of attention
• a need to pass responsibility for their wellbeing and care on to other people

There is also some evidence to suggest people who have had extensive medical procedures, or received prolonged medical attention during childhood or adolescence, are more likely to develop Munchausen's syndrome when they are older.

This may be because they associate their childhood memories with a sense of being cared for. As they get older, they try to obtain the same feelings of reassurance by pretending to be ill.

Personality disorders

There is some evidence many people with Munchausen's syndrome have a personality disorder.

Personality disorders are a type of mental health condition where an individual has a distorted pattern of thoughts and beliefs about themselves and others. This leads them to behave in ways most people would regard as disturbed and abnormal.

Some examples of the different personality disorders thought to be linked with Munchausen's syndrome include:

• antisocial personality disorder – a person may take pleasure in manipulating and deceiving doctors, giving them a sense of power and control
• borderline personality disorder – where a person struggles to regulate their feelings and often swings between positive and negative views of others
• narcissistic personality disorder – where a person often swings between seeing themselves as special and fearing they are worthless

It could be that the person has an unstable sense of their own identity and also has difficulties establishing meaningful relationships with others.

Playing the "sick role" allows them to adopt an identity that brings unconditional support and acceptance from others with it. Admission to hospital also gives that person a clearly defined place in a social network.