The name of the syndrome — Munchausen syndrome-was proposed in 1951 by Richard Asher, who described several clinical cases where patients invented, or even intentionally caused themselves painful symptoms. No, similar cases have been described before. So, a nomadic patient was described, the “hospital flea” syndrome, the syndrome of a hospital frequenter. But you know, the memory is stored with what is associated with more associations and emotions.

Nevertheless, all these syndromes, along with baronsky, took their place on the shelf of the international classification of diseases. In its 10th revision-under the code F68. 1 That is, it is “intentionally causing or simulating symptoms or disabilities of a physical or psychological nature (fake violation)”. But note that the simulation itself is encrypted as Z76.5 in the same classification. Why is this? And most importantly-what symptoms are invented or demonstrated?

Yes, a lot of different things. Abdominal pain? As many as you want, and whatever you want. Bleeding? Any, up to the real ones (like, for example, a swallowed razor blade on a thread that you can pull, so that somewhere there, in the bowels, it is cut and bled?). And suffocation, heart pain, fainting and seizures, paralysis and headaches, unsteadiness of gait and numbness of the limbs. Someone even, for example, manages to borrow a porphyria patient’s urine to pass it off as their own for analysis. I’m not even talking about the comrades who mow down our psychiatric patients. These, however, are not very many — still not resort conditions in the hospital — but they are also found. Just to get to the hospital, for examination, for treatment, and even for surgery. Well, now a few words about why Munchausen syndrome is considered separately from the banal simulation. And why the Barony is not hung on a whole cohort of hysterics and hypochondriacs.

To begin with, it is different from a simulation with external motivations. What is the difference? Yes, just in the absence of these most external motivations. That is, there is no need for a person to mow down from the army or hide in a hospital from prison, there is no intention to get additional coins or square meters of living space on benefits, there is no need for narcotic analgesics like tramal or something roof-bearing like cyclodol. All exclusively … well, not that out of love for art, but for some internal reasons. So far, there is a lot of speculation and discussion about these internal motives, but no final and unified opinion has been reached. It is assumed that in this way patients are looking for care, psychological support, escape from everyday life and the need to do something independently and decide — the list can be supplemented, but so far it remains tentative.

In addition, Munchausen syndrome should not be confused with distantly similar, but nevertheless related to other operas, experiences and symptoms in hypochondriacs and hysterics. Yes, the very personality of a patient with this syndrome may have a number of hysterical features, and something hypochondriacal may be present in it — but nothing more. The main difference is in the awareness of causing symptoms of the disease. And if a patient with Munchausen syndrome does this just consciously, then the hysteric or hypochondriac is not. For them, all the work is willingly performed (I’m not afraid of this word, it will be appropriate here) by their unconscious.

As you can imagine, recognizing such friends is quite a quest. And as for the treatment… Psychotherapy is often ineffective, because, as one electrocuted but overly corpulent client used to say when the judge asked him angrily why he hadn’t lost weight by the time the court ordered, ” I don’t have the proper motivation, your honor…

Delegated Munchausen syndrome

If, speaking or reading about Munchausen syndrome, an ordinary person, shaking his head, can say-they say, go on, how the people are over themselves izgalyaetsya, and voluntarily! — that description of delegated Munchausen syndrome will probably make many people clench their teeth and fists. And it will cause an irresistible desire to cause irreparable benefit to the delegator. Well, or at least weigh correction pills quantum satis.

Encrypted in the international classification of diseases of the tenth revision, this syndrome is no longer in the psychiatric section-T74. 8. Or as “other cases of ill-treatment”. With whom? Someone who will be delegated the symptoms of a disease that doesn’t actually exist. That is, it would be fine if the person himself portrayed or caused signs of the disease: well, he is not well, well, others are deluded, but at least the radius of the lesion is limited. But when the victim of such a friend becomes a child or a person being taken care of by a sick person (most often-a disabled person)…

And that’s exactly what happens. After all, it is not difficult: add a drop of blood to the urine collected for analysis, give another medicine (or what was prescribed, but based on the average horse), cause diarrhea or vomiting, bleeding or fever, starve. Poison a little. Strangle, in the end — no, not quite to death, but so that you can pump it out: after all, with a baby or with a weakened person (or with someone who trusts you infinitely), it’s so easy! “Oh, my God, why?!” — you will ask.

The benefit (if this is really delegated Munchausen syndrome) is not material, but psychological. This is what the opportunity, slightly polynov utrechka halo, walk and Shine in his eyes and a distant light! What a Martyr’s halo you can carefully wrap yourself in-lo, see what and in what quantities I have to endure (no, I don’t mean a duck, but in a global sense), looking after this unfortunate! This is such a geyser of someone else’s admiration-they say, there are such selfless people! And most importantly-not at your own expense. The victim is the victim. Even if it’s your own. And who appreciated when she was given birth (raised, raised, supported-underline)?

“What kind of monster is this?» — you may ask. Often a pretty cute monster, I must say. Technically not crazy. It has become a part of the mask of a benefactor, a Martyr who patiently bears his heavy cross, his burden of care and responsibility for a seriously ill person. Should I draw a psychological profile? Here, rather, a sketch will turn out. Smears. Abstractedly. Like a Checkered portrait, but there will be recognition. So, check it out.

A person with a stunningly developed self-centeredness. There is he, and there are other means to achieve his own goal-of course, he will never tell you about this. Psychologically immature. In some places. No, it will look and behave outwardly as accomplished and responsible, but if you dig — there will be too little “can’t” and too much “want”, with a completely sluggish, almost agonizing struggle of motives. Emotionally cold — Yes, but only internally. For show, there is just a flood of feelings, but to be warm and loving is only in relation to the precious self. Hysterical features? Yes, perhaps. Not at all and not always, but often. The oppression of certain past and present external circumstances? May be present, though not always: the authoritarian parent “you should/should not dare to” not really existing marriage, when it is necessary to do a good mine at bad game (and not anti-personnel and not on the football field), an underlying but permanent feeling of inferiority or neozelandese and the deficit either desires, or possibilities to turn the tide in their favor something constructive.

What adds dark notes to the situation is that it is extremely rare to detect such a syndrome and press the carrier against a warm wall in a dark corner. This is all within the family, as a rule, happens. A little push, doubt — and then you will not wash away from the counter-accusations. How! This is distrust! This is a vile slander! What kind of doctor/social worker/investigator are you after that? Again, go on to prove it, even if something was discovered: was it really done intentionally or out of thoughtlessness? You know how we are doing with the health literacy of the population, doctor… And even if everything is revealed and proven — how to treat? Psychotherapy that a person is sure to refuse? Or undertake to radically change the foundations of personality? Well, this (and thank God) is generally from the field of science fiction. And if the carrier of such a syndrome is also a doctor himself — then you can safely make a horror movie.

In short, this is a problem-fortunately, not too widespread.