BLOG No. FORTY SIX

Welcome back to my blog on anxiety and depression. Today, I would like to discuss Munchausen’s Syndrome. Munchausen’s is a disorder named for Baron von Munchausen, a German cavalry soldier who greatly exaggerated his battlefield courage and exploits for attention. Munchausen patients embellish their symptoms and even make up symptoms to get the attention of medical personnel. Where the vast majority of my patients beg me not to admit them to a hospital, Munchausen patients see it as an exciting event, where they are at the center of attention of medical students, nurses, doctors, and other medical professionals. So why would anyone do that? And what neurochemistry could be at the center of this bizarre behavior?

Munchausen patients insist that all attention must be placed on them. They usually get a diagnosis of borderline personality disorder prior to getting diagnosed with Munchausen’s. That tells us something, as we know from previous blogs that borderline personality disorder is a BS diagnosis that only describes the behavior of patients with high levels of D2 dopamine, usually Bipolar I or II.

(Mental Health Care hotline) “Welcome to our mental health hotline. If you have been diagnosed with OCD disorder, please press “1” numerous times. If you are co-dependent and need help, please have someone else press “2”. If you have multiple personality disorder, please press “4”, “5”,”6”, and “7”. If you suffer from paranoia, please stay on the line, we know who you are and are coming for you”.

What other disorders have we seen that demonstrate a patient’s need to be at the center of attention? Yeah, good job! Narcissistic Disorder, which, again, just like Borderline Personality Disorder, is just a snapshot of what behaviors patients with high D2 dopamine display.

So do Munchausen patients suffer from high D2 dopamine? Of course they do! It is D2 that drives their need for attention. And when the world does not give them the attentiveness that they crave, they exaggerate their symptoms and their complaints to get it. And when that attention comes from medical personnel, people usually highly thought of in the workplace, they even feel more important.

Patients have been known to cut themselves and drink their own blood, just to vomit the blood back up in an Emergency Room to get immediate attention. And some parents even injure their children (give them insulin to crash their sugar) to gain attention from medical staff (Munchausen by proxy). And I have been involved with patients who swallow items such as spoons and fishing hooks, just to get the attention of GI doctors—the docs that have to go fish them back out.

Drugs that lower D2 dopamine allow the patients freedom from needing all that attention as their narcissism fades, and helps them break free from the compulsion of feigning medical illness.

Well, I am landing in Kansas City on a business trip and there was no Chardonnay to be had due to Covid. But my buddy snuck on a few tiny bottles of gin and we were able to procure some ice. By the way, what do you call a large room with wood floors where you can go and drink spirits all day? Yep, a Gin-nasium! Until next time, this is Dr. G saying so long, and keep the faith!