Factitious disorder - Symptoms of Munchausen's syndrome

Symptoms and signs of Munchausen's syndrome may include pretending to be ill or self-harming to aggravate or induce illness.

There are four main ways people with Munchausen's syndrome fake or induce illnesses, including:

• lying about symptoms – for example, choosing symptoms that are difficult to disprove, such as having a severe headache or pretending to have a seizure (fit) or to pass out
• tampering with test results – for example, heating a thermometer to suggest a fever or adding blood to a urine sample
• self-infliction – for example, cutting or burning themselves, poisoning themselves with drugs, or eating food contaminated with bacteria
• aggravating pre-existing conditions – for example, rubbing faeces into wounds to cause an infection, or reopening previously healed wounds

Other signs

Some clues that a person may have Munchausen's syndrome include:

• making frequent visits to hospitals in different areas
• claiming to have a history of complex and serious medical conditions with little documentary evidence to support this – people often claim they have spent a long time out of the country
• having symptoms that do not correspond to test results
• having symptoms that get worse for no apparent reason
• having very good medical knowledge
• receiving few or no hospital visitors – many people with Munchausen's syndrome adopt a solitary lifestyle and have little contact with friends or family
• being willing to undergo often painful or dangerous tests and procedures
• reporting symptoms that are vague and inconsistent, or reporting a pattern of symptoms that are "textbook examples" of certain conditions
• telling highly unbelievable and often very elaborate stories about their past – such as claiming to be a decorated war hero or that their parents are fantastically rich and powerful

Munchausen's by internet

A relatively new condition has been labelled Munchausen's by internet. This is where a person joins an internet support group for people with a serious health condition, such as cystic fibrosis or leukaemia, and then claims to have the illness themselves.

While these actions may only be confined to the internet, they can have an incredibly destructive effect on support groups and online communities. People with genuine health conditions have reported feelings of betrayal and anger upon discovering they have been lied to.

One expert on Munchausen's by internet has compiled a list of warning signs that indicate someone may be affected by the condition, including:

• posts and messages that contain large chunks of information and appear to have been directly copied from health websites, such as NHS Choices
• reports of experiencing symptoms that appear to be much more severe than most people would experience
• making claims of near-fatal bouts of illness followed by a miraculous recovery
• making fantastic claims that they later contradict or others disprove at a later date – for example, they may claim to be attending a certain hospital that does not actually exist
• claiming to have continual dramatic events in their life, such as loved ones dying or being the victim of a violent crime, particularly when other group members have become a focus of attention
• feigning an attitude of unconcern when they talk about serious problems, probably to attract attention and sympathy
• other "people" claiming to post on their behalf, such as a parent or partner, but they use exactly the same pattern of writing