Introduction: In 1994 a physician consulted psychiatrist Berney Goodman regarding the condition of a patient who seemingly had a rare bowel conditionthe patient vomited every time she ate. Together they diagnosed the patient with bowel paralysis. Goodman himself wanted to examine the patient. From the start, the patient refused to cooperate with Goodman. Goodman discovered that the patient had low blood pressure. This, though, did not correspond with the diagnosis of bowel paralysis.

Hypothesis: Goodman suspected that the patient suffered from Munchausens Syndrome. Those who suffer from the ailment have developed great sensitivity to emotional pain and will use any methods possible to avoid feeling it. These methods are quite extreme and often deadly. The sufferers often attempt to hospitalize themselves with self-defined or self-induced symptoms. Their ultimate goal is to have the physician take extraordinary measures to save their life.

Method: After further investigation, Goodman discovered that the patient was secretly taking diuretics to produce the symptoms associated with bowel paralysis. His suspicions had been correct. A Munchausens patient might complain of a variety of symptoms. A physician, though, has trouble finding these symptoms when examining the patient. Patients have added sugar to samples of urine, suggesting the presence of diabetes. They have visited dermatologists with rashes, sores, and lesions with no medical explanation but used sandpaper, chemical irritants, or excessive heat to make these symptoms appear. Munchausens patients have swallowed corrosive substances, eroding the lining of their stomachs and throats to produce vomiting. Munchausens patients are not limited to displaying physical symptomsthey also imitate psychiatric disorders. Overdosing on psychoactive drugs to induce delusions and hallucinations is common for them. Patients may use techniques of persuasion to try to influence the physician to perform thorough medical investigations.

Although Munchausens patients can puzzle and deceive physicians, they have a tendency to hide their methods poorly. Syringes are left lying around, they do not conceal pills neatly, and they allow themselves to be observed during their symptom-causing routines. These scenarios result in most diagnoses.

Results: Describing how Munchausens Syndrome sufferers behave is much easier than explaining why. Some leads suggest that either all-caring or all-rejecting parental relationships are experienced and then re-created by the patient. They seem to invite their physicians into an allnurturing relationship, and at other times they despise their physicians and create an all-rejecting relationship.

The difficulty in discovering and diagnosing Munchausens Syndrome led to the absence of a clear-cut definition in the DSM-IV. Because of this, it is extremely difficult to treat those who are affected.

Analyzing the Case Study

1. What is Munchausen's Syndrome?

2. What are some possible causes of Munchausen's Syndrome?

3. Critical Thinking Why might a physician or psychologist suspect that someone is suffering from Munchausens Syndrome? What is the danger in misdiagnosing this disorder?