Possible Munchausen Syndrome

Munchausen’s Syndrome, called Factitious Disorder in the DSM, is a condition where people induce an injury or illness (by taking action to harm themselves) and then bask in the attention of doctors and nurses and the general sick patient role. A variation, Munchausen’s by proxy, occurs when a person induces illness or injury in another person, often someone dependent upon them like a child, and then basks in the medical attention and caregiver role. We should say this much up front, so that people who aren’t familiar with the term will understand what you’re talking about.

I really have no idea how someone would induce ovarian cysts; a medical doctor would need to be consulted on that question. It does seem unlikely that someone could cause such things to occur. This condition seems to specialized to be the result of self-poisoning or such stuff. And ovarian cysts do spontaneously occur in the normal condition of things. Be open to the possibility that some of this stuff is naturally occurring illness, and some of it is abnormal behavior. The two can co-exist. Also be open to the possibility that your niece may have a Somatoform Disorder such as Hypochondrias (e.g., where she is convinced that every little twitch inside her is a symptom of dangerous illness that requires immediate treatment). Hypochondrias is not at all like Factitious Disorder, being based more on obsessionality and fear rather than lies and manipulation.

It is difficult to diagnose Factitious Disorder, as people who have it are often good liars (of the compulsive lying sort) and not motivated to tell the truth about what might actually be occurring. Often, the condition only comes to the attention of a physician when that physician starts seeing patterns that don’t fit a normal patient well (such as being seen too often, or presenting for conditions that appear to be self-induced). Diagnosing the disorder is never done quickly, but rather requires a clinical history. To the extent that the same doctor (or same group of doctors communicating with one another about their patients) sees the patient each time, this sort of pattern can become more readily apparent. On the other hand, if multiple, non-communicating doctors are seen, it becomes much harder for doctors to catch on. Even when doctors do catch on, the condition is difficult to treat, because the patient often simply refuses the psychiatric treatment that might prove helpful and/or moves on to a new set of doctor-victims.

Factitious disorder occupies its own little chapter in the DSM, but conceptually, it is very likely related to what are called “Cluster B” personality disorders (including anti-social, borderline, narcissistic and histrionic personality disorders; the so-called dramatic-erratic cluster). It takes a rather rigid (fixed, inflexible) and primitive (child-like) coping style to gain attention through inducing physical harm on yourself. It takes a special kind of lonely to feel so desperate for the sort of attention you get when ill to actually harm yourself to obtain it. It takes a special kind of rigidity to require this and only this sort of attention, and not be able to substitute other forms of attention that most people are content with (e.g., romantic partners, friends, family, club members, etc.) or to learn how to obtain more reasonable forms of attention. And then there is the lying and the willingness to manipulate and deceive in order to gain this attention. This is primitive and rigid behavior, make no mistake, of the sort that is often seen with dramatic personality disorders. Once identified, the condition is probably best treated with some form of psychotherapy aimed at helping people to become more accountable and straightforward, to self-sooth and self-calm better, and to help train social skills needed to help the patient gain more acceptable forms of attention. A reasonable therapy might be a modified form of Dialectical Behavior Therapy or DBT, which is often used for treating people with borderline personality disorder.