The Prevalence of Munchausen Syndrome or Factitious Disorder in Medical Professionals

Munchausen Syndrome, sometimes known as Factitious Disorder, is a mental illness in which the sufferer acts as if s/he has a physical or mental disease when in fact the symptoms are self-inflicted (Cleveland Clinic). The ways in which those with Factitious Disorder fake illness include faking symptoms, making up medical histories, causing self-harm, and tampering with medical instruments and tests (Mayo Clinic).

More women than men suffer from Factitious Disorder, and there is research showing an increased representation of the disorder in medical professionals (Burnel). Because one of the main warning signs of Factitious Disorder is extensive knowledge of medical terminology, hospitals, etc., it may be more difficult to diagnose among healthcare workers who would already possess such knowledge.

In addition, medical workers have an understanding of and access to resources that they may use to further the fiction of their illness. For example, tampering with medical equipment and lab tests to skew the results of diagnostic procedures is very common. Healthcare workers with Factitious Disorder may contaminate their own urine samples with blood or other substances to alter results, or may heat up thermometers to fake a fever (Mayo Clinic).

Those in the medical field have direct access to a number of other resources that they may use to. One study found that a significant subgroup of those with Factitious Disorder is made up of female healthcare workers (Krahn et al). One theory that addresses this outsized phenomenon is that healthcare workers have the medical knowledge base and skills to fake a disorder or disease. In other words, their expertise allows them to easily convince those around them of a fictitious ailment.

An additional complicating factor for healthcare workers with Munchausen Syndrome is the connection they have to medical personnel, and their close relationships with other physicians, nurses, etc. It may be easier for the Munchausen patient to convince colleagues and other healthcare professionals of an illness because of a prior personal relationship.

Another study on Factitious Disorder found that most qualifying participants were female, and half were in ‘caring professions’, including those in the healthcare field. The majority of the participants had severe emotional problems, and had often experienced traumatic life events (Carney & Brown).

Savino and Fordtran, in the Baylor University Medical Center Proceedings Journal, detailed several relevant case studies on persons with Factitious Disorder. The first is that of a young mother who worked as a medical technologist. She came to the hospital complaining of chronic urinary tract infections and blistering skin condition. However, her lab results showed no immune disorders and a normal urinary tract. She had no abnormal medical history, and the only surgeries she had undergone were a C-section and a hysterectomy. Because her symptoms did not match any underlying cause, a doctor on her case became suspicious that her illness was self-induced. While the patient was gone from her room undergoing an x-ray, the doctor searched her purse and found needles, a syringe, a tourniquet, and a Petri dish with bacteria growing in it. When confronted with the evidence, the patient denied harming herself. She confessed only when a needle fell out of her purse after she turned it upside down, intending to prove she had no self-harm materials. However, her confession was only to using the bacteria to culture blisters on her skin and she continued to deny injecting the bacteria into her body, which was the likely cause of her symptoms.

This case illuminates the link between medical workers and Factitious Disorder in two ways. First, her medical knowledge allowed her to understand how to cultivate bacteria and use medical tools (syringes, needles, tourniquets) to induce her illness. Second, when confronted with evidence, the patient was still able to come up with a somewhat plausible explanation and deny the more intrusive aspects of her behavior. This is likely due to her background working in the medical field.

Savino and Fordtran describe a second case that exemplifies the representation of Factitious disorder among medical professionals. This patient, also a young mother, worked as a nurse in an assisted living facility. She came to the hospital at Baylor from out of state and claimed she had undergone treatment for an intestinal carcinoma. She described the finding of a large mass in her abdomen and her subsequent cancer diagnosis. When the oncologist at Baylor examined her, no abnormalities were found. The only symptoms noted were abdominal surgery scars and hair loss, attributed to recent chemotherapy she claimed to have undergone. The patient subsequently provided medical records, specifically a surgical report, from a hospital she had previously been treated at. The oncologist found the records to have strange terminology, misspelled words, and bizarre formatting that suggested possible alteration. In some parts of the report the physician and patient names looked to be copied and pasted on. The oncologist was suspicious, and the patient never returned to the hospital or provided any other medical records.

However, the oncologist received phone calls from other doctors seeing the same patient for years after the single visit to Baylor. It appeared that the patient had provided former physician information as she traveled from doctor to doctor, in an effort to legitimize her stories of previous treatment. Several years later, the patient came to another Texas hospital complaining of fever and abdominal pain. That physician attempted to contact an oncologist the patient claimed to have seen, only to find that the information she provided was of a nonexistent doctor. When confronted, the patient claimed marital problems had led her to admit herself to the hospital under the guise of illness. Still, she continued to travel from hospital to hospital, claiming to suffer from mysterious pain, ovarian cancer, and abdominal infections.

Factitious Disorder can be highly detrimental for anyone who suffers from it, but the damage it can have on the lives of medical professionals can be extraordinary. Possible complications that result from Factitious Disorder include injury or death from self-inflicted medical conditions, severe health problems from unnecessary procedures, and significant conflicts in daily work and relationships (Mayo Clinic). In addition, healthcare workers risk losing their licensure and jobs if they are found to be feigning sickness. The elaborate nature of the Factitious Disorder charade is time-consuming, dangerous, and often has grave consequences.

About the Author:

Kathrina Jeorgette Flores graduated doctor of medicine from Dona Remedios Trinidad Romualdez Medical Foundation, Tacloban City, Philippines, in May 2017. She is currently a Post Graduate Intern in Remedios Trinidad Romualdez Hospital. Alongside her medical studies, she is passionate about supporting causes related to children, education, health, and disaster/humanitarian relief.

Additional information about Kathrina can be found on her LinkedIn profile.

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