Munchausen and Munchausen by Proxy Syndromes: Forms of Pathological Narcissism?

By Sam Vaknin
Author of “Malignant Self-love: Narcissism Revisited

Patients afflicted with the Factitious Disorder colloquially known as “Munchausen Syndrome” seek to attract the attention of medical personnel by feigning or by self-inflicting serious illness or injury. “Munchausen by Proxy Syndrome” (Factitious Illness or Disorder by Proxy, or Imposed by Another, or FII – Fabricated or Induced Illness by Carers) involves the patient inducing illness in or causing injury to a dependent (child, old parent) in order to gain, in her capacity as a caretaker, the attention, praise, and sympathy of medical care providers. Both syndromes are forms of shared psychosis (folie a deux or a plusieurs) and “crazy-making” with hospital staff as unwilling and unwitting participants in the drama.

Superficially, this overwhelming need for consideration by figures of authority and role models (doctors, nurses, clergy, social workers) resembles the narcissist’s relentless and compulsive pursuit of narcissistic supply (which consists of attention, adulation, admiration, being feared or noted, etc.) But, there are some important differences.

To start with, the narcissist – especially the somatic variety – worships his body and cherishes his health. If anything, narcissists tend to be hypochondriacs. They are loath to self-harm and self-mutilate, let alone fake laboratory tests and consume potentially deleterious substances and medications. They are also unlikely to seriously “damage” their sources of supply (e.g., children) as long as they are compliant and adulating.

As opposed to narcissists, people with both Munchausen Syndromes desire acceptance, love, caring, relationships, and nurturing, not merely attention: theirs is an emotional need that amounts to more than the mere regulation of their sense of self-worth. They have no full-fledged False Self, only a clinging, insecure, traumatized, deceitful, and needy True Self. Munchausen Syndrome may be comorbid (can be diagnosed with) personality disorders, though and the patients are pathological liars, schizoid, paranoid, hypervigilant, and aggressive (especially when confronted.)

While narcissists are indiscriminate and “promiscuous” when it comes to their sources of narcissistic supply – anyone would do – patients with the Munchausen Syndromes derive emotional nurturance and sustenance mainly from healthcare practitioners.

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