The Munchausen Spectrum: Borderline Character Features

In this paper the author presents a continuum of disease simulation that ranges from hysteria to malingering, with a range of relative unawareness to awareness of producing such deception. Focus is on the particular group of patients who consciously and repeatedly simulate disease. The frequency and form of such disease mimicry vary within such a group. A continuum in terms of frequency ranges from occasional adventures to the simulation of disease as the center of a person's life. Two groups of patients designated as exhibiting Munchausen Syndrome are defined within this continuum: (a) those who work (mostly as nurses or in other medical professions) and (b) those called "hospital hobos" --the more prototypical Munchausen patient. The author takes a somewhat different approach to Munchausen Syndrome in that it is viewed as a subgroup of the borderline character. Further, the often found exhortation for psychiatric treatment of Munchausen patients is reexamined, and caution regarding such zeal and its potential negative effects is registered.