DRHOOK- Faking it: Mysterious syndrome baffles physicians

"Fake it ‘til you make it!" I think we all fake certain things. We tell a happy mom her baby's cute, even if it looks like a larva. We fake not noticing something unfortunate hanging out of a person's nose. I won't mention the most obvious one– to you women.

Usually we fake things to avoid hurting someone's feelings or to avoid stirring up trouble. We call it being polite.

But what happens when someone fakes disease in order to stir up trouble?

Munchausen syndrome is the most extreme form of factitious disorder, which means faking illness. Now, people have been known to fake illness for personal gain, such as getting out of school, avoiding confrontation with the boss– or even worse, trying to get money through worker's compensation, disability insurance, suing after an accident. 

But Munchausen folks don't want anything except attention from the medical community. They voluntarily play the sick role because of some not-well-understood psychological need. 

Even more bizarre is Munchausen by proxy, in which a caretaker intentionally makes others sick, such as a child or elderly parent. (Remember Sixth Sense, a film where the mother poisons her daughter for attention?) 

A person with Munchausen feigns illness by complaining of psychological or physical symptoms. This should not be confused with people who have psychosomatic illness, because their symptoms are actually felt. Munchausen folks pretend to have problems because they love to confront physicians. 

Faking it is sometimes not enough. Munchausen people can go to extremes and actually make themselves ill by doing things such as taking insulin to drop their blood sugar, injecting stool into their veins to become septic, or making themselves bleed. 

So much for "An ounce of prevention is worth a pound of cure." It's more like "An ounce of sickness is worth a pound of attention from the doctor."

Many Munchausen folks will even undergo dangerous surgeries and procedures to prove they're sick; it's as though they enjoy enjoying baffling the doctors. 

To keep up the pretense of being a patient, they often create aliases so other medical communities won't discover they are Munchausen sufferers. To make their discovery even more difficult, victims of the disease often leave hospitals against medical advice when on the brink of discovery. They leave like fugitives, and in the process, create havoc. 

I have diagnosed only one person with Munchausen. All her tests were negative, every procedure resulted in nothing, and she was mysterious about everything: no family or friends to discuss things with. After she was discharged from the hospital, she went directly into the ER, not stopping to pass "Go" on her way!  

So, like Nancy Drew, I peeked around the corner to see how she was. She was practically belting out a song like Judy Garland at Carnegie Hall. As soon as I entered the room, however, she forced wheezing sounds. As soon as I confronted her, she gathered her things and stormed out.

We don't really know what causes people to have factitious disorder. Most people gain attention the healthy way: posing nude for Playboy– er, let me think of another example. Sickness imposters probably are sadomasochistic. They tend to feel hollow inside (maybe from all their removed internal organs?), yet feel rage, a need to control things, to turn people against each other (like Sherry Palmer in 24), and, because they tend to be loners, they absolutely hate rejection and abandonment. 

If you ask me, the best thing to fake is your clothes or handbag– like knock-off Prada or Gucci. Faking illness is no laughing matter.

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.

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