Munchausen Syndrome, Autism, and Self-Diagnosis

Munchausen syndrome is a mental illness classified as a factitious disorder (note: factitious meaning artificially created or developed). It was named after Baron Freiherr von Munchausen, an 18th century German officer known for outrageous tall-tales about his military career. In this discussion, the term applies to an individual who deliberately acts as having behaviors that typify an autism spectrum disorder (ASD).  The reason(s) for what could account for such behavior can be disputed; however, rather than a financial gain, my own opinion is that there appears to be a need to be seen as ill or disabled.  In this regard, stereotyped behaviors may cue those with whom they interact as to a diagnosis, influencing others to behave differently, decreasing expectations, and making their own shortcomings more acceptable. Another possibility, is the satisfaction in deceiving individuals whom they consider more important and powerful than themselves.  In the cases where I have suspected this condition, it came from a parent of a newly diagnosed ASD child. In those cases, it could be that the parent identifies with the child or that the behaviors harmonize their self-interests with those of the child.

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I should clarify that I am not making reference to Munchausen by proxy where some mothers have been accused of imagining or causing the medical problems of their children.  This accusation has led to the unfortunate legal accusation of child abuse.  Dr. Bill Long has written an essay espousing a cautionary stance on Munchausen by proxy in autism, and has provided a review paper on the subject for laymen, lawyers and judges.

Munchausen syndrome is classified as a mental disorder; however, a clear demarcation to other psychiatric entities is difficult due to the concomitant presence of emotional problems and/or personality disorders.  I have written about personality disorders in a previous blog entitled, “Autism Self-Diagnosis: The Seinfeld Syndrome”. The difference to somatoform disorders (another type of factitious condition) is that with the latter an individual does not fake symptoms or mislead others on purpose

I have noticed the possibility of a Munchausen syndrome in individuals who have taken their diagnosis as a way of validating authoritarian credentials and voicing in a peremptory manner their opinions as to ASD.  These are adults who upon their child receiving a diagnosis of ASD they soon “realize” that they share the same symptoms. In that instance, and based on their newly found diagnosis, they have a clear explanation, or excuse, as to any life misgivings.  In truth, some of these people may have poor coping skills and problems forming healthy relationships. They are easily embarrassed, frustrated, offended, and are quick to respond emotionally.  Although some of these behaviors may bridge into ASD, they lack the severity of the latter and, moreover, the symptoms may be inconsistent by appearing or being exaggerated only when they are with others or being observed.

Although a broader spectrum of symptoms is undeniable and tends to run in families, in those with Munchausen syndrome their behaviors are taken to an extreme. These are individuals who, for example, use tinted glasses as props to support their self-diagnosis.  This is the “Superman Syndrome” where literally, by using or not using glasses, they transform themselves from Clark Kent into the world’s greatest superhero and viceversa. These individuals often have a dramatic or inconsistent medical history and rail against the medical establishment by proffering the credos of the anti-psychiatry movement. They believe in self-diagnosis and are reluctant to allow health care professionals to meet with them or have them contact previous doctors. Unsurprisingly, they are not reassured when told by health professionals the “good news” that they have no symptoms nor are they reassured by friends when told that they do not appear to display symptoms. Rather, the person may go to extremes to prove the presence of his/her illness. Self-diagnosis is their credential for voicing personal knowledge from a soapbox and hustling their opinion ahead of everyone else’s.

As previously stated, some individuals fulfilling our description of Munchausen syndrome may have a child or a close relative with ASD. There may have been a history of frequent illnesses in their relative that required hospitalization and multiple visits to medical professionals.  This has led them to acquire extensive knowledge of textbook descriptions of the condition and medical terminology.  Because they appear to be so concerned with their loved one no wrongdoing is suspected.

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I would not like to be viewed as an acerbic critic with no compassion towards these individuals. In the end, it may be that they would like to receive the same love and attention that they have provided to their child.  However, the above discussion pinpoints a major problem in ASD, namely that the same is a diagnosis based on behaviors whose value or importance differs in a substantive manner among observers.  It is true that there is a broader spectrum of symptomatology, but when will the elastic band of diagnostic inclusion break? We need better and more objective criteria for defining autism and many other mental disorders.  Until then, a tentative diagnosis made by a person based either on interospection or  their online reading experience should remain suspect.

References

Munchausen Myth Debunked. Autism Research Institute. https://www.autism.com/understanding_byproxy

 

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