Munchausen’s Syndrome: Towards a Psychodynamic Understanding

INTRODUCTION The third edition of the Diagnostic and Statistical Manual of Mental Disorders cites two essential criteria for the diagnosis of chronic factitious disorder with physical symptoms, more poetically known as Munchauseri\u27s Syndrome: a) Plausible presentation of physical symptoms that are apparently under the individual\u27s voluntary control to such a degree that there are multiple hospitalizations; b) The individual\u27s goal is apparently to assume the patient role and is not otherwise understandable in light of the individual\u27s environmental circumstances(I). Additionally noted is the frequent occurrence of a true physical illness entailing extensive hospital treatment during the childhood or adolescence of these patients, as well as the horrific incapacitation of the disorder due to a chronic course of repeated hospitalizations. Munchausen\u27s Syndrome is apparently more common in males than females, but the prevalence is in question. Some authors claim it is ubiquitous, but rarely recognized . Others believe it to be rare because certain cases are continually overreported (1). This paper presents a summary of the hospital course of a Munchausen patient recently treated by a psychiatric consultant in a community general hospital. Major themes and an historical perspective of the thinking regarding the psychodynamics of this intriguing illness will follow