Probing the dynamics of Münchausen's syndrome. Detailed analysis of a case.

During a 10-week period we made in-depth observations of a patient with Münchausen's syndrome who had chronic myelogenous leukemia. Probably because he perceived that his life expectancy was brief, he disclosed his wanderings and regularly used methods of deception. These methods were usually based on his knowledge of pathophysiology. He exploited the desire of medical personnel to be helpful. Through interviews with the patient, family members, and previous physicians and review of 14 kg of medical records, we attempted to reconstruct his life to gain insight into his conscious and unconscious motivations. Most features of Münchausen's syndrome appear to be explainable by the patient's attempts to have control over his immediate environment.