Crime Library: Criminal Minds and Methods

Beverley Allitt: Suffer the Children

Factitious Disorders

Beverley Allitt was thought to have suffered from both Munchausen Syndrome and Munchausen by Proxy syndrome. These conditions belong to the group known as factitious disorders, which are characterized by physical or psychological symptoms that are feigned, exaggerated, or self-induced. It's not common to find both in the same person, but the core motivation — getting attention through illness — is common to both. Let's first discuss Munchausen syndrome, a disorder in which people fake an illness to obtain medical care.

One of the worst cases on record is that of Wendy Scott, a British woman who was admitted to more than 600 hospitals in 12 years and underwent a shocking 42 unnecessary surgeries. Scott's illness, she believed, had developed from the attention of a kind nurse during childhood, an experience she'd never had before. When she started to work in a depressing job as an adult, it wasn't long before she realized that illness brought her the affection she sought from others. Thus began her odyssey as a "hospital hobo." Eventually she recovered and started a support group, but she had done more damage than she realized.

When she eventually experienced genuine problems, it was difficult to get help. London physicians knew her record of faking complaints and turned her away, so she tried elsewhere, but the multiple scars on her abdomen alerted caregivers to her disorder. Finally she got help in the U.S., but it turned out that she had inoperable intestinal cancer. Six months later, she died.

Book cover: Patient or Pretender
Book cover: Patient
or Pretender

Dr. Marc Feldman, a psychiatrist at the University of Alabama and co-author of Patient or Pretender: Inside the Strange World of Factitious Disorders, says that people who suffer from Munchausen syndrome generally present dramatic symptoms, including serious self-mutilation or injecting themselves with a toxin. Often, they return to a healthcare facility over and over. They mostly just seek attention and care, although a small percentage of them have a different motive: they want to baffle a physician so they can feel powerful. If the medical staff at one place suspects fakery, the patient moves on to another.

Most Munchausen patients are male, and they range in age from children to the elderly, although the illness often peaks in middle age. Females may stick to a set of symptoms and bond with one doctor, but both genders know how to lie in great detail and to disguise what they are doing. They usually know as much about their disorders as their doctors.

Dr. Marc Feldman
Dr. Marc Feldman

Of the percentage of patients faking a disorder, only 10 percent have Munchausen syndrome, although it is difficult to be accurate. "We can only count a case for statistical purposes," says Feldman, "when the deceptions have failed. If someone is very crafty, he or she will never be caught and so there will never be the opportunity to add the case to the list."

British physician Richard Asher published the first account of Munchausen syndrome in 1951. He described three people who went from doctor to doctor with fake illnesses. Since these imposters often tell whopping lies, Asher named the condition after Hieronymous Karl Friedrich von Munchausen, an eighteenth-century German baron who wowed his friends with endless tales of exotic adventures, all of which he fabricated.

Almost every disease has been mimicked by Munchausen patients, making diagnosis tricky. Even so, Munchausen syndrome is not hypochondria. These people know they are not ill and they tend not to improve. They don't wish to. It also differs from malingering, which involves faking for clear external gain. A criminal who mimics mental illness to avoid a trial is malingering. For Munchausen sufferers, the point is the treatment and they will do whatever it takes to get it. In his book, Lies! Lies!! Lies!!!: The Psychology of Deceit, Charles Ford describes a patient with the ability to mimic renal colic who more than once caused the emergency landing of a commercial airplane.

It appears that the childhood experience of many of these people includes a sadistic, neglectful, or rejecting parent. They may also have had some experience with a caregiver during a long illness that made them feel special, or they found that faking an illness got attention while being well did not. The motives are simple to understand, but the condition is nearly impossible to treat.

The most common signals to doctors include

  • A textbook case of symptom patterns
  • A long and varied history of medical work-ups
  • Numerous surgical scars
  • Inconsistent lab tests
  • Evidence of lying in other areas, such as a name, address, or previous physician.

For Munchausen patients, the prognosis is poor, because they tend to ignore psychiatric referrals. Instead, they move on to the next healthcare facility.

As dangerous as these people can be toward themselves, it's when the syndrome makes a substitution of others for self that it becomes truly depraved. That's what Beverley Allitt eventually did.

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