Who is munchausen

Munchausen syndrome. Actions for this page Listen Print. Summary Read the full fact sheet. On this page. About Munchausen syndrome Symptoms of Munchausen syndrome Common presentations of Munchausen syndrome Common complications of Munchausen syndrome Risk factors for Munchausen syndrome Diagnosis of Munchausen syndrome Treatment of Munchausen syndrome Munchausen syndrome by proxy Where to get help.

About Munchausen syndrome Munchausen syndrome also known as factitious disorder is a rare type of mental disorder in which a person fakes illness.

Often people with Munchausen syndrome have experienced childhood trauma. Symptoms of Munchausen syndrome A person with Munchausen syndrome gains intense satisfaction from the attention associated with playing the ill patient.

Signs and symptoms that may suggest Munchausen syndrome include: a spectacular medical history that includes many tests, medical procedures and operations an odd collection of seemingly unrelated symptoms a lack of conclusive results despite intense medical investigations new symptoms that appear after medical tests prove negative extensive medical knowledge of many different illnesses frequently visiting many different doctors, sometimes in other states or territories frequent presentation at emergency departments, usually at different hospitals requests for invasive medical procedures or surgeries failure to improve despite medical treatment, including relapsing for unknown reasons.

Common presentations of Munchausen syndrome A person with Munchausen syndrome may convince doctors in many ways. Common complications of Munchausen syndrome A person with Munchausen syndrome is at risk of many complications including: side effects from prescription medicines, including overdose complications from poisoning or self-harm practices complications from medical procedures or surgeries death from self-harm or complications of medical intervention.

Risk factors for Munchausen syndrome Some people may have a higher risk of developing Munchausen syndrome than others. Risk factors may include: chronic illness during childhood — the person may have received a lot of attention because of their illness chronic illness of a significant family member when the person was a child self-esteem or identity problems relationship problems difficulty distinguishing reality from fantasy ability to lie and manipulate a history of mental problems such as depression , hallucinations or post-traumatic stress disorder PTSD the need to blame personal failures on external factors, such as illness.

Diagnosis of Munchausen syndrome Diagnosis is difficult because a range of legitimate physical and mental illnesses must be ruled out first. The person is unusually eager to undergo invasive medical procedures and operations.

Treatment of Munchausen syndrome Treatment aims to manage rather than cure the condition, but is rarely successful. Treatment options may include: Medications to treat associated mental health illnesses such as depression or anxiety. Unfortunately, a person with Munchausen syndrome may misuse prescription drugs to provoke symptoms for further medical intervention.

However, it is unlikely that someone with Munchausen syndrome would admit to falsifying symptoms, which can make progress difficult. Some people with Munchausen syndrome flatly refuse psychiatric help. Avoiding unnecessary tests and surgeries is important to reduce the risk of complications. This can be aided by encouraging the person to go to only one primary care doctor. However, a person with Munchausen syndrome is likely to move on to other doctors and start again.

Munchausen syndrome by proxy Munchausen syndrome by proxy MBP was the term previously used for a rare but serious form of abuse where a person either fakes or produces symptoms in someone else, usually their child. Munchausen's syndrome is complex and poorly understood.

Many people refuse psychiatric treatment or psychological profiling, and it's unclear why people with the syndrome behave the way they do.

Several factors have been identified as possible causes of Munchausen's syndrome. These include:. Munchausen's syndrome may be caused by parental neglect and abandonment, or other 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 because they:. There's also some evidence to suggest people who have had extensive medical procedures, or received prolonged medical attention during childhood or their teenage years, are more likely to develop Munchausen's syndrome when they're 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. It could be that the person has an unstable sense of their own identity and also has difficulty forming meaningful relationships with others.

Playing the "sick role" allows them to adopt an identity that brings support and acceptance from others with it. Admission to hospital also gives the person a clearly defined place in a social network. People with the syndrome are often very convincing and skilled at manipulating and exploiting doctors. If a healthcare professional suspects a person may have Munchausen's syndrome, they'll look at the person's health records to check for inconsistencies between their claimed and actual medical history.

Healthcare professionals can also run tests to check for evidence of self-inflicted illness or tampering with clinical tests.

For example, the person's blood can be checked for traces of medicine they should not be taking but which could explain their symptoms. Doctors will also want to rule out other possible motivations for their behaviour, such as faking illness for financial gain or because they want access to strong painkillers. Treating Munchausen's syndrome can be difficult because most people with it refuse to admit they have a problem and refuse to co-operate with treatment plans.

Some experts recommend that healthcare professionals should adopt a gentle non-confrontational approach, suggesting the person may benefit from a referral to a psychiatrist. Others argue that a person with Munchausen's syndrome should be confronted directly and asked why they've lied and whether they have stress and anxiety. People who have Munchausen's are genuinely mentally ill, but will often only admit to having a physical illness.

Prior to discussing the specific legal issues for FIIC that have arisen as a result of recent court cases, there is some legal background knowledge that child protection practitioners should be aware of before taking cases involving Fabricated or Induced Illness by Carers to court. It is important to distinguish between criminal trials and child protection hearings.

The focus of a criminal trial is the hearing of criminal charge or charges against a person who is alleged to have committed a crime or crimes. In such a trial, the onus is on the prosecution to prove that the accused person committed certain acts, and committed those acts with criminal intent. The proving of criminal intent is essential to the criminal trial. In child protection hearings, the focus of the hearing is whether or not a child is in need of protection.

In such a hearing, the onus is on the child protection authority to prove that a parent or carer has done or failed to do certain acts and as a consequence, a child has suffered or is likely to suffer some form of harm. Unlike the focus on intention in the criminal trial, the intention of the carer or parent is often not particularly relevant. Different legal proceedings, not only have different aims but different rules of evidence, and different standards of proof.

The rules of evidence in criminal trials are far stricter than those applied in child protection hearings. To prove a criminal case, the prosecution must produce evidence that establishes the guilt of the accused on the standard of proof known as 'beyond reasonable doubt'.

In child protection cases , the standard of proof applied to the evidence is the lesser standard, that is 'on the balance of probabilities'. Thus, evidence about Fabricated or Induced Illness by Carers is likely to be treated vastly differently in the two types of courts because of their differing aims and standards of proof. Australian Children's Courts applying the lower standard of proof in care and protection proceedings may take into account relevant findings from previous criminal proceedings if presented to them in the court hearing.

Statements on the law however, made in the course of a criminal trial where MSbP or FIIC was raised as an issue, may not be relevant in the very different arena of child protection proceedings. Evidence usually fall into three broad categories: 1 direct evidence , that is, what has been seen or heard or acquired or experienced through the senses by the witness; 2 real or physical evidence , which may constitute objects such as documents, photographs, videos, diaries, reports, or x rays; and 3 opinion evidence , that is evidence which contains the opinion of the witness in circumstances where it is established that there is a recognised body of relevant learning, outside the experience of ordinary men and women in which the proposed witness holds relevant qualifications.

In each Australian state or territory, legislation outlines the grounds on which care and protection proceedings are usually brought before the court.

Although the legislation differs slightly between jurisdictions, there are broad similarities. The statutory child protection authorities are mandated to respond where a carer's act of omission or commission has caused the child to be harmed: physically, emotionally, or psychologically.

This includes acts of physical abuse, sexual abuse, psychological abuse, and neglect Bromfield and Higgins Cases in which it is alleged that a carer has put a child at risk by fabricating or inducing an illness in their child may be brought before the court supported by direct evidence of acts which back up such assertions.

It would usually be essential that such cases would be supported by the opinion of a suitably qualified expert both as to the interpretation of the asserted acts and the consequent risk or risks to the child.

Care and protection proceedings in which it is alleged a child is at risk of harm because a carer has fabricated or induced an illness in their child may be brought before the court using the grounds for intervention set out in each state or territory's legislation. The actual grounds used must relate to the individual facts in the case and the risks those facts pose for the child who is the subject of the application.

There are a small number of recent criminal cases that have led people to question the likelihood that any courts will hear cases in which it is alleged that a parent has fabricated or induced an illness in their child, in particular where this case is made on the basis of expert testimony rather than direct evidence. Cases heard in the UK Criminal Appeals Court in relation to testimony by Roy Meadow on the basis of 'Meadow's Law' also appear to have contributed towards confusion over the use of expert witnesses.

Three recent cases that have been associated with MSbP or Meadow's Law are highlighted in Box 1 and the pertinent findings described. Of note, some courts are now taking a more cautious approach to expert testimony in criminal cases where FIIC is the issue and in some criminal appeals cases particularly those in the UK concerning Meadow's Law courts have criticised experts who have given dogmatic evidence. In Australia, the Supreme Court of Queensland, Court of Criminal Appeal found that Munchausen Syndrome by Proxy was not a diagnosis of a recognised medical condition, disorder or syndrome, and therefore there was no value in presenting an expert witness in a criminal trial simply to give evidence on what MSbP is, or an opinion that a person suffers from it.

It should be noted that this decision may have limited application to child protection matters. An edited excerpt from this interview is presented in Box 2. Judge Coate: What evidence is before the Court is a matter for each of the parties to the hearing. In an adversarial system like ours, the court does not make decisions about what evidence is to be produced. The Court's role is to make decisions about whether or not the party bearing the onus of proof has proved its case on the evidence, and if so, what order should then be made.

In child protection cases, the person or party bringing the application must provide evidence to support their claim. Evidence coming before a children's court, like any other court, can be in the form of direct evidence, real or physical evidence or expert evidence. The most common kind of evidence is direct evidence.

So in a Munchausen's case, the sort of direct evidence one would anticipate may be produced, may be things such as nurses' observations, doctors' observations, maybe an eye witness account of a carer doing or saying something it is alleged supports If physical evidence such as a video which contains relevant footage for example of the interaction between the child and carer were available one would expect that to be produced into evidence.

Expert witnesses have to fit some criteria first before they are able to do what no other witness is able to do - that is to give an opinion that falls into the category of opinion evidence. The use of an expert, or expert evidence has conditions attached.

First the party seeking to call the expert witness must establish that the witness is going to give an opinion based on a recognised body of learning outside the ordinary experience of people. Next, it must be established that this particular witness holds appropriate qualifications in the recognised field. Judge Coate: What the 'best grounds' are will be a matter for legal advice after an assessment of what the facts are in the case and how the facts fit the law.

There is no simple formula. It needs to be brought on the basis of the relevant grounds for intervention listed in that jurisdiction's child protection legislation in Victoria, the grounds for intervention are defined in Section 63 of the Children and Young Persons Act In cases such as these one would expect that the application would usually be based on one or more of the following grounds: physical, emotional or psychological abuse.

Judge Coate: As a judicial decision making body, the child protection arm of a children's court does not commence its judicial decision making task with any view as to the existence of a condition such as FIIC. The court must bring an impartial mind to its role. How that is done, as I said, is a matter for the party bringing the action. I venture that it would be impossible to prove to a court that a child was in need of protection from a parent on the basis that the parent suffered from FIIC without producing the evidence of an expert to that effect.

The expert would have to establish that there is a recognised body of learning in this area, which has been accepted authoritatively for example by some College or Institute or group of recognised experts. One would anticipate that the expert would be cross examined as to the different views held inside this recognised body of learning. The standard of proof and the onus of proof in these cases and the rules of expert evidence are the same in these cases as they are in other cases.

Judge Coate: They need to understand that this is a complex area in which many experts have differing views. Indeed, the very question of relevant expertise is a vexed question in this area. So, the first question that they should ask themselves is, 'Is this a useful way to conduct the application or may there be another way to approach it consistent with the capacity of the applicable child protection law to provide grounds for such an application?

This may well be done perfectly successfully without having to go down the path of producing an expert witness. The information provided by Judge Coate relates to general principles of law. Caution should be taken in applying these principles in different jurisdictions without first confirming their accuracy with an appropriate legal advisor. Courts will always approach a new case based upon the facts presented for that case, but general principles for good practice in bringing cases of alleged Fabricated or Induced Illness by Carers to courts may be drawn from the findings for recent court cases and the general principles for bringing care and protection proceedings before the court presented.

Priddis proposed the following as principles for good practice when presenting a fabricated or induced illness or unexplained death case before the court on the basis of expert testimony:.