You Make Me Sick Trivia Quiz

Answer: Telling outrageous stories

Unlike the eponymy of many psychological disorders, Münchhausen was neither a sufferer nor the discoverer of his namesake syndrome: After returning from the Russo-Turkish War (1735-1739 CE) Baron von Münchhausen reportedly told a number of very far-fetched stories about his adventures away from home.

The naming of the psychological disorder is credited to Dr. Richard Asher, who noted that "Like the famous Baron von Münchhausen, the persons affected have always travelled widely; and their stories, like those attributed to him, are both dramatic and untruthful." For this reason, Asher decided to name the syndrome after Münchhausen--a dubious honour, indeed!

Answer: Factitious disorder

Munchausen syndrome, or factitious disorder, is closely related to the range of mental health problems classified as somatoform disorders. The main difference between the two is that patients with Munchausen syndrome are intentionally deceptive while persons with somatoform disorders truly believe that their symptoms are real and will often become worried when doctors are unable to diagnose an aetiology.

However, since intention to deceive is very difficult to determine, there is a strong case for classifying Munchausen syndrome as a type of somatoform disorder.

Answer: False

The ailments could be fictitious, or they could be exaggerations of illnesses from which the victims already suffer. In her autobiography titled "Sickened: The Memoir of a Munchausen by Proxy Childhood", Julie Gregory describes how her mother would take a one-off ailment, like an ear ache, and describe it to the doctor as a chronic trouble. Further, Julie describes how she was coached to slump into a "sick pose" for the doctor, and how her mother would blame her if the doctor dismissed the case because she wasn't acting as sick as she did at home.

Answer: External incentives for the behaviour

While the majority of Munchausen syndrome by proxy perpetrators present their wards as having physical symptoms, the "DSM-IV-TR" also recognizes "Factitious Disorder with Predominantly Psychological Signs and Symptoms" and "Factitious Disorder with Combined Psychological and Physical Signs and Symptoms."

When external incentives for the behaviour are present--financial gain, avoidance of work, etc.--the patient is deemed to be malingering.

Answer: are women (generally mothers)

While patients with Munchausen Syndrome are split almost 50/50 between men and women (some studies note a slightly higher incidence rate in men), Munchausen syndrome by proxy has an astonishing 98% occurrence in women. The victims (usually the offspring) are also split 50/50 between boys and girls. The mortality rate among the victims is estimated to be 9-10%.

Answer: The physician

MSbP perpetrators have a fundamental need to gain sympathy and attention from the physician and other health care providers. When the perpetrator feels that the physician's attention is waning, the victim's symptoms will usually escalate as the perpetrator strives to win it back. Meanwhile the perpetrator dons the face of a doting care-giver, graciously giving up her/his time to take the victim on repeated hospital visits.

This duality, leading to a relationship with the physician based entirely upon lies, was dubbed "mother imposturing" by Drs. Schreier and Libow.

Answer: True

A common feature among Munchausen syndrome by proxy victims is that their symptoms will disappear once the suspected perpetrator is denied access to the victim. The abatement of symptoms in the absence of the care-giver is one of the primary indicators of Munchausen syndrome by proxy; however, the separation test may be fatally misapplied.

In more than one case a child has died because a physician has underestimated the seriousness of the child's condition while suspecting an innocent care-giver of MSbP.

Answer: Multiple wards of the person suffer from mysterious illnesses

Sadly, many cases of Munchausen syndrome by proxy go undiagnosed because no one wants to believe that a parent would deliberately hurt a child, or care-givers their wards. In an extreme case of Munchausen syndrome by proxy, nine children of a Duanesberg, New York mother died mysteriously before she was suspected of having murdered them. Doctors believed that there might be a genetic reason for the children's deaths until the death of two-year-old Michael, who was adopted. Michael was the eighth child to die in her care.

Answer: He gave misleading information in a court case

In 1999 British solicitor Sally Clark was (wrongfully) convicted of the murder of her two sons. Sir Roy gave expert testimony during the trial, stating that the chances of two infants in the same household dying of SIDS was extremely unlikely--about one in 73 million. According to the Royal Statistical Society, there was no statistical basis for this numerical value and, further, the figure was used in a misleading way to represent the likelihood that the defendant was innocent.

In 2003 Clark's conviction was overturned when evidence was brought forward that showed that at least one of the babies died from a staphylococcus infection (i.e. natural causes), and therefore was not a victim of Munchausen syndrome by proxy.

In 2005 Sir Roy Meadow was removed from the British Medical Record for professional misconduct, but was reinstated following an appeal in 2006. Sadly, Clark's ordeal led her to develop a drinking problem and she died in 2007, from alcohol poisoning, at the age of 42.

Answer: Physicians disagree over the diagnostic criteria

"Physicians are reluctant to acknowledge that they could be deceived in such a manner, although they concede that the syndrome exists--apparently suggesting that it happens, but only to other physicians" (Sheridan, 1994, as quoted in Parnell & Day, 1998). In other cases a physician may be suspicious that a child's malady may be caused by MSbP but is unable to gather sufficient evidence and as a result the case may never be officially investigated. Thirdly, MSbP may manifest itself along a continuum of severity, from mild to life-threatening, and many researchers tend to focus only on the most severe cases.

The criteria for a diagnosis of Munchausen syndrome by proxy (factitious disorder) are laid out in the "DSM-IV-TR".