DEAR DR. ROACH: Could you address Munchausen syndrome and how to treat a person who might have it? What causes the constant talk about real or imagined illnesses, and is there a treatment for it?

Anonymous

ANSWER: Factitious disorder, sometimes called Munchausen syndrome after the 18th century German nobleman Baron Karl Friedrich Hieronymus von Munchhausen, who was famous for exaggerated stories that were published in English in 1785 and defied belief. The term “Munchausen syndrome” was coined in 1951 to describe people who intentionally fake or induce medical symptoms. There are no clear data on how prevalent this condition is.

The underlying cause is unknown, but psychological traumas, including neglect, abandonment and abuse, are more common than expected in people with this condition. Factitious disorder may also be imposed on another person (a child, spouse or parent); this condition used to be called “Munchausen by proxy” and is a horrific type of abuse.

Nearly every resident physician recalls patients with factitious disorder, and I recall several of mine very clearly. One person injected foreign material into their intravenous line, causing severe sepsis. The infectious disease doctor recognized the pattern of microorganisms and was able to deduce the likely cause of the infection.

Another patient introduced bladder stones that they had purchased from a medical specimen supplier into their own bladder, then feigned terrible pain. The nephrologist, who suspected the diagnosis, had the stones analyzed by an electron microscopy, which confirmed the true nature of the stones.

While these stories may be fascinating, it’s important to realize that this is a serious disorder with a poor prognosis. People who suffer from this condition can make themselves seriously sick, and physicians who don’t realize the underlying problem can — in good faith — order tests or procedures that can have serious complications.

It’s common for a person with factitious disorder to leave the hospital when they’re confronted with evidence of this type of behavior. Most of the time, the person continues to deny the diagnosis, which can make treatment very difficult.

Considering and confirming the diagnosis is a real challenge. I was fortunate in my training to have expert diagnosticians who had seen previous cases. Even when the diagnosis is made, treatment is challenging. If a person has treatable psychiatric conditions (such as depression and anxiety), the prognosis is better. If a person has less-treatable psychiatric diagnoses (such as personality disorders), the prognosis is worse.

ToYourGoodHealth@med.cornell.edu.