Psychiatry & Psychotherapy Podcast - Munchausen Syndrome, Factitious Disorder, Malingering, and Munchausen Syndrome by Proxy

Episode Date: March 4, 2021

There are several disorders so branded with taboo, stigma, and legal consequences that they are almost never diagnosed and very little research has been done on them. These patients are literally seen by every specialty, often without knowing it, and without a good solution. I am hoping this podcast brings awareness to this important topic and gives providers insight into the power of empathy in helping these patients. Link to blog. Link to YouTube video.

Hello and welcome to the Psychiatry and Psychotherapy Podcast. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. One thing that created a lot of burnout and angst for me was trying to get continued medical education right at the last minute. So why not join the CME membership and do CMEE while listening to this podcast. Go to Psychiatrypodcast.com, sign up, sign in, take the test, and the certification is emailed to you in seconds. All right. Welcome to the podcast.

I am here with a special guest today who would like to remain anonymous, and we are going to talk about her journey through factitious disorder imposed on self, or also previously called Munchausen syndrome. She's a podcast called I Am Munchausen, and I think you're really going to enjoy this interview. Before I begin, I'm going to give you a little bit of background on some of the disorders that sort of are similar and different, and, you know, this may act as a good board review. We'll go through some of the DSM-5 criteria.

And hopefully this kind of glues in your mind, these diagnostic groups, and helps you see them. I have a particular interest in these disorders because I work as a medical director of a program in California. it's an IOP and partial program, which means we meet multiple times a week with our clients, the therapists do group therapy multiple times a week. And we treat people with medical and psychiatric issues. So of course we see people with cancer, you know, who have depression maybe, or we see people who have gone through big procedures and whose life have changed and some of the psychological ramifications of that. But we also see people inevitably who get referred for factitious disorder, which is they're basically trying to get their psychological needs met

through the medical system. Often these patients, we are converting them from medical patients to psychiatric patients, trying to move them from getting their needs met through the medical sphere to their needs met through the psychological sphere. Factitious disorder is different. than other somatic symptoms like fibromyalgia or irritable bowel or chronic fatigue because they know that they're inducing illness in themselves, they're consciously inducing illness. They're doing it to get psychological connection, to get some sort of secondary gain that is not financial. It's a psychological secondary game. So my role in this program is to, you know, do the basic mystery and physicals, see them once a week, get them off of medications which are harmful to them or unnecessary.

And so I have quite a bit of experience seeing these clients and seeing them improve, which is unusual as I read the literature again to prepare for this episode. So the first question is what is malingering? I think it's important to talk about some of these other diagnostic sort of categories that are similar to factitious disorder so that you can understand factitious disorder better. So what is malingering? Malingering is when someone lies about an illness to gain external benefits like compensation from an insurance company, money from a disability claim, avoid the military, avoid a criminal conviction, etc. To call someone malingering is to call them a liar. So as medical professionals, it is prudent to document exactly what happened,

the inconsistencies, and to record quotes, to basically have supporting data before you put this in the chart. I think most of us are very hesitant to put it in the chart. As I write this, multiple patients, come to mind. One wanted me to sign off on his inability to work because of his depression. And then a week later, he told me that he was working under the table for a friend, and he was doing all of these different things that were work-related. Interestingly, this particular situation, initially I wanted to write this for him.

I wanted to help him out. But then after these sort of red flags came up, like, hey, this guy's working. And oh, yeah, he wanted this for his lawyer. Okay. I kind of like thought to myself, hmm, I don't feel comfortable doing this. And I told him that, you know, hey, I'm not a forensic psychiatrist. I think in this case you need a forensic psychiatrist to make that assessment. In retrospect, he reported, you know, ten,

not attend depression, but it was completely not in his affect, meaning, like, I didn't sense any depression when I was talking to him. Another case was a woman suing her work for an injury, she claimed, that happened at work. But I've seen real injuries like this, and I know the constellation of symptoms, and she had none of them. She did have some flagrant narcissism, and burned a lot of bridges all around her. And yeah, enough on that one. Okay, the third one is I've seen countless cases of people wanting me to document how severe their illness is, only to tell me later that they wanted these notes to help them finish some court case. Interestingly, in the MEND program, they'll come in and they'll report to me every week, 10 out of 10 depression, 10 out of 10 anxiety.

but what they don't realize is that I talk to the therapist quite a bit and the therapist report they're laughing, engaging, you know, great conversations with people and they don't seem to be depressed or anxious in the group. And only are they depressed or anxious when they come to see me, but it's not like a normal depressed person. It's really hard to fake a depressed affect with me. And so I'll document both what they report, and what the therapist report in the note. And so when they ask me for the notes for their court case, sometimes I'll let them know, like, hey, I just want to let you know that I'm not sure this is going to help you with your court case. So one approach to malingering is to set boundaries until they move on or to move them on immediately. No benzos, no adderol, nothing addicting.

In one man's case, I followed him for years. and I did see some improvement in his anger. And I might add, I was a little bit more honest and put out to him kind of like, hey, this is what I'm seeing. I think you're lying about this. And he was someone who was very ill. I mean, he had committed suicide several times. So I kept following him because he had real psychological things going on.

But at the same time, you know, I had some very strong. rules like, hey, if you get benzos or opiates from anyone else and I see that in the pharmacy, I'm going to have to stop seeing you as a client. So, you know, nowadays we have in California, for the California patients I treat, we have cures which allows us to see which controlled substances they've been on. And it's actually a requirement for me to look that up from time to time. So I see things that they didn't report. And that lets me know, like, hey, this person's doctor shopping or this person's just trying to get multiple meds for multiple people to get what their drugs are, you know. So I also put in my introduction letter a little comment that I do not

give legal testimony for my clients and I require them to employ an independent forensic psychiatric service for this type of testimony. And I do this to sort of put, away potential people who might want me to sort of build a legal case for them. If I even see a hint of malingering, you know, like I'm not quite sure, but I'm kind of thinking that it might be there. I'll send them to do, you know, like let's say they come in for ADHD. They want amphetamines. I'll send them for a neuropsychie vow. And I'll send them specifically with someone that I know who can test for malingering. And I will also, if they want benzos, you know, benzodiazepines, Xanax, clonopin, I will check to see what they're actually getting from the pharmacy

records. And if they are not telling the truth, I will recommend detox and I will send them out with the detox center. And usually they never come back after that because they're not going to go detox. If they do go detox, then it's less likely they're malingering, and they really just got stuck, you know, somehow. But I will be not giving them addicting substances that have street value. Okay, so that's malingering. And I should probably do a full episode on malingering in the future. The next disorder, which is sort of in this constellation of disorders,

is factitious disorder imposed on another, also previously called Munchausen by proxy. And this is when someone consciously, a caregiver, consciously induces illness in their child or let's say in their maybe disabled adult that they're taking care of too, for some sort of gain. And usually their gains are not completely understood, right? But they're inducing these illness. It's a form of child abuse. And I would say nothing really angers me more than to see this right before my eyes,

like child abuse, right? This severe form of abuse and neglect. watching a person they should have loved harming them. The caregiver is usually fairly disturbed themselves, and of course this involves the police. So let me give you a few cases from the news rather than tell you about the cases that I've seen. A mother forced her daughter to use a wheelchair

and undergo unnecessary medical procedures, and the daughter ended up killing the mother. That's a current case going on. In my blog and in my resource library, I'll have links to all of these if you want to dig into them further. Here's another case. After poisoning her infant daughter, a mother was arrested for child abuse

after the baby was diagnosed and treated for nine different rare infections. So sometimes they're literally injecting contaminated material, which can either kill the child or cause severe sepsis. Here's another case. By age eight, a young boy had been hospitalized 323 times and undergone 13 major surgeries based on his mother's claims that he had cancer or a degenerative disorder affecting his oxygen supply. can you imagine them missing this 323 times like that's that's kind of scary so if you're a provider listening to this

and you get and you suspect that something fishy is going on really um consider investing some time to to elucidate this and i'm going to talk about some clues that we might be able to have Here's another case. Until age 17, a mother convinced her daughter that she had Lyme disease, which resulted in years of alternative treatments, homeopathy, laser treatments, electric bands, that made her weak to the point of requiring a wheelchair. I'm going to have to do a full episode on Lyme disease. It's one of my pet peeves, chronic Lyme, specifically, and the charlatans who try to make a lot of money off of people. Rogers 2020. This was another case. A mother starved her 13-year-old son until he weighed only

51 pounds to convince the health care professionals to give him a feeding tube, central line, colostomy bag, and several pain medications. Tragic. 51 pounds. Can you imagine getting a 13-year-old down to 51 pounds? I think my five-year-old child is heavier than that. Here's another case. Following the death of her daughter, a mother was arrested for fraudulently portraying her as terminally ill and seeking donations to cover the medical care. And the daughter died. So there's dire ramifications if we don't do something as professionals.

Okay. Feldman 2004 made a list of things that we can look for. Episodes of illness begin when the mother is or has recently been alone with the child or the child has symptoms that only the mother has observed. This is where good history taking is so important, right? Illness abates when the child is separate from the mother. So if the child is separated from the mother for like three days, the illness abates. other children in the family have unexpected illnesses, and I would say unexpected and rare illnesses.

It's like, how rare is it for one illness and then take the statistical probability that multiple children have had super rare illnesses? At some point, it's a statistical anomaly. The mother has provided false information about the child, physiological or laboratory parameters, are consistent with induced illness. So, for example, they might put honey in the urine to make them look like they're diabetic, but then the blood tests show no diabetes, stuff like that.

Okay, the suspected disease or disease pattern is extremely rare. This is where it's really good to get the subspecialists involved and to discuss the case with them because what the parent who is doing this to the child doesn't realize is that we've seen thousands of cases and so there's a certain pattern of things that we witness and so when things sort of diverge from that pattern it's often something we can know

the child has been to numerous medical care purposes, providers without a cure or even a clear diagnosis. So that would be a good warning sign. The mother has medical or nursing training or access to illness models. So, you know, to successfully evade being caught, they need to have some intelligence about the system and how it works. The mother has a personal history of somatic symptom disorder. or disorders. So they've been through the medical sphere over and over again for their own issues. The mother is unresponsive to the child's need when unaware of being observed. So this is where

sometimes video camera in the room can be helpful to see how the mother is interacting differently when the care providers are there or not there. I could go on, but basically there's a brainwashing that occurs of the child to take on the sick role. Sometimes the child tries to please the mother by taking on the role as the child grows up. And the mother gains something from it, attention, power, financial benefit. The kid often believes it deeply for a long time causing horrific damage. at some point, you know, like in this one case where the daughter was in the wheelchair and ends up killing the mother because the daughter sort of came to this realization of the horrific abuse that she's actually in jail and there's a trial case, there's lots of details about this.

I'm not going to go into. Okay, so those are two issues, the first malingering, the second, factitious disorder imposed on another. Now we're going to talk about factitious disorder imposed on self, which is really the thrust of the interview that you're going to hear today. And, you know, last time in our last episode on The Hero's Journey, we talked about how, you know, the hero ventures into the unknown to face conflicts and adversity and then returns transformed. And I talked about how factitious disorder imposed on another. also known as Munchausen syndrome by proxy, the mother is keeping the child from launching into the quest. And alternatively, with fact justice disorder imposed on self, or Munchausen syndrome,

if the patient is considered the hero, then they are not following their own journey. Rather, they craft a false narrative of a hero's journey to engender guides to provide psychological empathy for underlying real psychological needs. Real psychological needs, which will not be met because the attunement is not for something that is real. It is something that is fabricated. So to get them back on the hero's journey, they need to start being 100% honest. And we will hear from our anonymous.

interviewee later, how she came to a place where she started being honest with what was going on. So factitious disorder imposed on self involves fabrication of illness, injury, or impairment to get psychological needs met. Oftentimes, a motivation to adopt the role of the patient is present. you know, there's something about being a patient, which is giving them some sort of benefit. And you'll hear how that sort of occurred in our, in our interviewing. So common underneath this is like what is driving them to desire to put themselves in this place. It's not sometimes fully known. you know, it's not like they fully understand why they're so drawn to this lifestyle of sorts, right?

And, you know, some articles have said that they desire to receive care and support. Maybe they desire to escape from the reality of a current situation, to experience the thrill of undergoing medical procedures, or maintain a sense of control by puzzling mental health professionals or health care professionals, right? Because you can have fictitious disorder in the mental health sphere as well, where you're faking symptoms. And I might add to this that of people with factitious disorder, in two different studies, they estimated the, or like when they looked at specifically people with borderline personality disorder, there was a link between borderline personality disorder and factitious disorder.

So something around like 15% of people with factious disorder have borderline personality disorder. And somewhere from 15 to 30% of people with borderline personality disorder have factitious disorder. So there is some overlap there. And so you can see how like instead of cutting themselves there, having someone else cut into them, there's some self-harm and some affect dysregulation that's going on and they're using the medical sphere to augment them or to stabilize them so people with factitious disorder are taking on the sick role to get their psychological needs met and do this consciously the part that's

conscious is the fabrication of the illnesses but they may not fully know what their psychological needs are, but they are consciously fabricating their illnesses. Unlike other somatic disorders, like somatic symptom disorder, conversion disorder, in which they are not consciously fabricating their illness. Something like psychogenic seizures in which the person is having these seizures, they're not consciously deciding to have the seizures. The seizures are not real. no epileptiform activity in their brain. The seizures can go on for hours sometimes, which, by the way,

real epileptiform seizures that go on for hours would cause brain damage that is huge. It's like a head injury. So, you know, the psychogenic seizures will go on for several hours a day, multiple days of the week, and are usually revolving around stress or some sort of high stress situation. we take care of those quite frequently. There are also people who fabricate seizures. They fake seizures, and they do that consciously. But those people are different than just the person that is unconsciously and does not know that they are having this psychological event that is looking like a physical event.

Okay. So hopefully that makes sense. So Munchausen syndrome is thought to be an extreme variant affectious disorder. In one article, they said it accounted for 10% of the cases affectitious disorder. And they said that this is like the severest of the cases where there's multiple hospitalizations, multiple locations going on for a long time. I think it's most useful to think about them as the same thing. because the DSM-5 calls it factitious disorder imposed by self. So a factitious disorder, Munchausen patient,

will frequent various hospitals, sometimes under different names. They provide a fake history as well as they simulate symptoms to gain attention, empathy, and comfort from the staff. They may consume contaminated food or self-induce a disease, by using, they may use like non-human blood in order to fake bleeding. Following admission, they undergo multiple diagnostic tests. Often the testing itself generates problems, right? Lines get infected, surgeries, exploratory abdominal surgeries lead to abdominal adhesions.

These patients often discharge themselves when discovery might be imminent and when their deception is found out, when you report that nothing was found on diagnostic tests, they often get angry. And that anger sometimes can lead to you wanting to get more subspecialists involved. And ultimately, I think that they're going to get psychological needs met, but they have these physical consequences from unnecessary medical procedures as well as the costs of repeated hospital admissions and sort of the some of that can be traumatic in and of itself you know near death experiences so it's very challenging for medical providers to make this diagnosis and we can feel

incredibly frustrated and or guilty from being deceived and cheated of our time, energy, and resources. Okay, further, the setting of factitious disorder and munchausen syndrome is often not fully lived out in the medical hospital. So it could be in any, you know, psychiatry hospital. It could be in a psychiatry clinic. It could be in psychotherapy. but also it could be any place where they're able to engender kindness, empathy, and attachment needs, such as a religious center or school. You can imagine how this played out with people who don't know very much about medicine may actually be more convincing, such as a school or a church.

telling fake stories of rape, cancer, and death in the family, and heroic events are often part of these stories. So imagine the psychological turmoil this might cause to an empathic priest or caring teacher. I've actually had a patient who had a girlfriend who had been going through these turmoils, which were, of course, fabricated. and the psychological sequela on him was profound. With malingering, the person is motivated by financial reward, whereas factitious disorder, Munchausen, they're motivated by psychological needs. So here's some key facts about factitious disorder from a nice article where they looked back at a bunch of cases, and they found that.

that 66% of them were women, 34% were men, 57% of patients report an occupation related to healthcare or laboratory science. The most common profession described was nursing. Common disorders identified with factitious disorder included. So these were people with factitious disorder also reported. Depression, 41% of the time, personality disorder. or 16.5% of the time. Substance abuse, 15.3% of the time. And I will also insert here that it is very common that someone with factitious disorder

also gets benefit from opiates. And if they're more skilled, they'll get even like a port placed where they can get their dilauded, injected multiple times a day. So substance abuse is reported in these people, but it's also part of what I see as sort of what happens in practice, right? anxiety 14.7 percent functional neurological symptoms 5.3 percent eating disorder of 4 percent current suicidal

ideation or history of suicide attempts 14 percent in absence of comorbid psychopathology 17 so there are some people with no psychological comorbidities that they'll report so let's talk a little bit about the DSM 5 criteria so there's four things. Number one, falsification of physical or psychological signs or symptoms or induction of injury or disease associated with identified deception. So that's the first thing. The second thing is the individual presents himself or herself to others as ill, impaired, or injured. Number three, is this deceptive behavior is evident even in the absence of obvious external rewards.

Number four is the behavior is not better explained by another mental disorder such as delusional disorder or another psychotic disorder. So the question is, how do they present? Which specialty to they present to? And in the article, I go through every single subspecialty that they present with and essentially they can present with all sorts of different things. Allergic emergency, immune deficiency, hypertension,

synchable episodes, chest pain, mycardial infarction, generalized lesions, lesions of the face, arm, legs, genitals, pyodermo, gangriosum, recurrent hypoglycemia, Cushing's syndrome, thyroid issues, thyroid toxicosis,

they could be taking thyroid medication, diabetic ketoacidosis, they could push themselves, if they have diabetes, into, you know, harm's way, right, by eating a lot of junk and not taking their insulin. So sometimes what I'm saying is that they have a real illness and then they have fictitious sort of on top of a real illness. They can have facial swelling, airway distress, bleeding from the nose, mouth, ears, eyes. they could have diarrhea, hematemesis, epigastric pain, anemia, perpura, history of HIV, history of AIDS, when they may or may not have that, right?

Sepsis, septic arthritis, necrotizing fasciitis. They could have chronic pain, paralysis or weakness, unconsciousness, seizures, vaginal discharge, vaginal bleeding, menorrhagia, breast cancer, ovarian cancer, uterine cancer. They could have different eye issues, corneal damage. The list goes on, right? They could have oral or maxo-facial issues, including swelling of the mandibular region, abrasion of oral mucosa. They could present with orthopedic trauma, joint dislocation. They could present to plastics with skin ulcers, deep muscular abscesses, wound deterioration following surgery so they can like make their wounds not heal following a

surgery by putting maybe feces on it or something. They can have pulmonary and respiratory symptoms including asthmatic episodes, acute airway distress, coughing of blood, rheumatologic issues including, you know, fabricated lupus. They could have heurologic issues including UTIs, hematuria, proteinuria, protein in their urine, blood in their urine. They can also present with mental health complaints, and this is estimated to be in about 40% of the total factitious complaints that come out. These could include alcohol abuse, hallucinations, suicidal, homicidal ideation, PTSD, essentially made-up traumas, like They can lie about what happened to them.

I've had one patient that had these military traumas that they reported, but then in their record, they were never deployed. When you asked them about it, they said, oh, I was covert ops. And they actually said what branch they were in, which hadn't been formed yet. So sometimes it just doesn't make sense, right? They get up bereavement, so the loss of friends or family, they can make up stories about that. Child sexual abuse, you know, sexual assaults, they may insert foreign bodies to

fabricate evidence, pain disorders, Stockholm syndrome, dissociative identity disorder, and they may even fabricate stories of cult brainwashing. All of these are reported in case studies. And you can imagine the empathy that certain traumas, child sexual abuse, bereavement creates in people, right? Stories create empathy. Another person enters into your experience. I remember one time this person told the story of domestic violence. It was a horrific story. And I'm not saying it was true or not true, but on this person who was telling me this story's face, as I was suffering, there was a tinge of joy every time she felt me suffering.

And after a while, it was like, huh, where is the actual dissociation? You know, any one of these parts of the story would lead to a fairly strong dissociative reaction. factitious symptoms are stronger around physicians and hospital staff than when they are alone. So the symptoms may fade when they are, you know, alone. And so this is where you might pick up some discrepancies. I often have a therapist tell me that patients with factitious disorder display a bright affect in group, that they're laughing, having a good time with their peers, only to come into session with me with 10 out of 10 depression, 10 out of 10 anxiety,

and no emotional blunting. It's actually a lot harder to fake, you know, true changes in the affect, right? Like when someone's truly depressed and suicidal, you can feel that, you know, if you have an attuned brain. So these patients like psychiatric hospitalizations, partial programs, high level of treatment. They like the connection that they give from there. And they often try to one up other patients in the programs with stories that are similar, but even more graphic or horrible. So there can be like this competition where they try to one up each other with the most

horrific stories of trauma, right? And so they use these stories of trauma to try to stir up empathy. But often while they're telling these stories, they're not expressing dissociation, changes in body language, which would be consistent, sometimes even with a one-half smile of contempt on their face. And you can feel their joy. So at times, a more clever factitious disorder patients muddy the water by using substances to change their affect. stimulates produce real restlessness and insomnia. LSD makes people look altered. Opiates produces euphoria.

Benzos and barbiturates produce lethargy. And this can be a little bit more difficult to ascertain. I would say in the IOP, you know, we notice, right? One day they feel very lethargic, almost sleeping. The other day they're more awake. and we look at their medications. What are they taking? We had one person who would self-dose themselves

like four times the amount of sleeping meds during the day at times, mostly to escape reality, not to necessarily engender, empathy, or whatnot, but just as a way of coping. So it can be hard to disentangle what's really going on. Their altered state may mislead you, but it's very hard to be consistent about this, especially if they're admitted into a psychiatric

hospital. As someone who has studied micro-expression, small flashes of emotion that guide you to someone's true inner experience, I have found that the micro-expressions do not match some of the times where you feel like they should have emotion and other things show more micro-expression. So I tend to follow the emotion and what I actually see. I empathize with what I actually see, not just the words that are said. And we have this, one of the unique things about the IOP is that we do not give energy to things that are not congruent. So, you know, we're trained to kind of know when someone's congruently having an emotional experience. And if they're not congruent, we don't give it energy.

We may even have a blank face. and so it teaches people to over time be more congruent with what they're really going on with because people want connection. People don't want a blank face. That is probably one of the highest levels of psychotherapy. I don't recommend trying that without some training because we don't want to still face our clients, right? In general, though, you know, getting microexpression training can be helpful. If you haven't listened to episode one, two, and three of my microexpression series, I recommend you go back and do that. There's an app emotion connection for iOS devices. Interestingly, some of the complaints I've gotten from it is that, you know, like, oh,

how can you learn emotion from actors? These are not actors. These are real people watching videos of emotion. Another complaint is, it seems hard or it's, you know, you can't quite understand why are some are some emotions. And that's because this is really hard to learn. You know, I'm also going to create a full training program. And that will be released in the next couple months. They'll be online with like 300 videos and some tutorial videos and stuff going over it. So stay tuned for that if you're part of my email list or I'll probably announce in the podcast as well when it's out. So this leads us now. into the interview. I hope that this introduction has been helpful for you in understanding this

disease and we'll leave it there. So it's nice to meet you. Yeah, you too. So you reached out to me by email and initially you just asked if you could if I could like promote your podcast on my Instagram or social media and you were you're doing a podcast called I am Munchausen. and I had the pleasure to listen to the episodes. I felt like it was very interesting and also up kind of my alley of what I really am passionate about. Actually, I don't know if you knew this, but I run a program for people with factitious disorder and with medical and psychiatric issues. So I see a lot of conversion disorder, a lot of somatization disorder and also factitious disorder. and real medical issues and psychiatric issues.

So I see where all those sort of intermix. Oh, that's really interesting. I actually didn't know that you ran that. But I actually participated in one of those programming in an outpatient intensive program. So it might be similar to what I did. Wow, that's interesting. So I think it would be good to start with kind of like

when your symptoms, were at its, maybe its fullest, and then kind of go back to when it started or before it started. So tell me a little bit about, like, when you were, you know, in the medical sphere or manifesting, you know, medical issues that were fabricated, so to speak, like, what was, did, were you aware that they were fabricated or were you aware that you were doing that? what was that like and what kind of illnesses were you manifesting? Yeah, so I guess it actually started around, I guess when it's the thick of it, it's probably around the age of 19 and really onset. And I actually started to have a tremor, which was probably just an essential tremor.

But I ended up going to my primary care doctor, a pediatrician at the time, and I was starting to have tremor my left hand. So I ended up going to her, and then she sent me to a neurologist, and this neurologist ended up doing quite a lot of invasive procedures. He ended up having a spinal tap done, and that kind of just led to this whole entry into the hospital because he was ordering all these different tests, an MRI, a PET scan as well. And then I ended up having to start a lot of different medications because he was wanting to test it. And that really led to this access to all these different doctors because all of a sudden I was seeing all these different specialists. And then that kind of took off because when that sort of ended, his official diagnosis

was some sort of infectious disease. So after a pretty intense course of antibiotics, that ended. And the tremors sort of went away. You know, it kind of still persists. to an extent when I'm anxious, it gets worse. But that ended, but all of a sudden, you know, I had all of this attention and was seeing all these specialists. And at that time, I was still an undergraduate. And, you know, what ended up happening is that I was getting all of this attention and I didn't want that to end. So then I started messing with the blood test. And at that point, you know, I was still seeing him to some extent and getting blood work done. So the next time I went in to get blood work done, I brought honey and I put it into the urine test. So then it came back that I had really high glucose in my urine. And I'd read about that online. And I ended up getting admitted to the hospital. And the doctors were so puzzled because, you know, clearly it's, you know, it's. And I read about that online. And I ended up getting admitted to the hospital. And the hospital and the doctors were so puzzled because, you know, you know, clearly it doesn't make any sense that my urine would show a huge amount of glucose and then

when they did the blood tests, you know, was completely normal. So then I think that kind of started this whole thing about the doctors being really puzzled and, you know, having a really high complexity case kind of fed that cycle because all of a sudden all these doctors are really interested in it. And that kind of fed the cycle that if you could keep, you know, confusing the doctors, they would end up spending more and more time trying to figure it out because they couldn't figure it out. And then from there, you know, I had a good friend with type 1 diabetes, and he always had a bunch of extra, you know, insulin and stuff. And he would often just, you know, not use it. And then I would just ask, you know, if I could have it just because I was curious.

and I would use that to induce seizures from using, you know, an excess of insulin. And that kind of led to this thing where the doctors for a long time thought I had some sort of, you know, tumor in my pancreas that was causing excess release of insulin. So that was really, I guess, the thick of it was using insulin to induce these seizures. And so you were hospitalized for that multiple times? How many times do you feel like you were hospitalized? So one of the times, I guess when I really realized the seriousness of this illness of Munchausen's was I had done that and actually ended up to an extent where I ended up needing ICU level of care. And that was really when it hit me the seriousness of what was going on. And at that point I was like, I need to get some sort of help or, you know, I'm going to end up accidentally killing myself.

So I think that was the last of a total, I think, of four ER visits and or hospitalizations. At that point, you know, I was like, this needs to be addressed or I'm going to end up killing myself. Wow. So there was something really scary about being in the ICU. Mm-hmm. About the seriousness of this. You know, I think the extent of the fact that that was really a time where it went too far, and I think I recognized that it had gone too far. And at that point, you know, it was really terrifying because I didn't think that I could actually get myself to stop fabricating these illnesses, but I also didn't want to. So I think at that point, it was this really scary realization that I felt completely out of control with my illness. And I also, you know, So I didn't think that I would be able to stop. Okay.

So something about this was just, it's kind of like an addiction of sorts, where there was something very pleasurable about it and or something that you were getting from being in this role, being in the sick role. In your podcast, you talk about when you got your IUD, how old were you when that happened? I just turned 16.

Okay. So tell me, tell me about that experience. You were going in to get your IUD and then you had this sort of encounter with this nursing team that seemed really different than anything you had ever experienced. Yeah, so pretty much up until this point, you know, I'd never really had any medical care. You know, I'd gone to see my pediatrician, you know, once a year and all those visits had had. know, I've ever been anything more than, you know, 15 minutes in and out. And then when I turned 16, I went to, you know, the local Planned Parenthood to get my IED placed. And, you know, I had a pretty extreme reaction. So, you know, I don't think this should cause hesitancy of somebody hearing this that they're considering getting an IED. But I had my IED place. And then, you know, immediately had this reaction where I was vomiting and having diarrhea. And, this nurse practitioner and then a nurse, another nurse stepped in, I think just how kind they were

and the fact that they were, you know, not judging me for what was happening really was reinforcing. And that was the first time I'd ever had this, I think, experience of being taken care of. And I don't know if I even had realized at that point that I was missing that in my life. But when that happened, you know, it kind of became this obsessive. session, I started having all these fantasies about needing to be taken care of, and I kept replaying exactly what happened over and over in my head. So I think this really set off this very obsessive thought in my head of needing to be taking care of and entering that sick rule. Yeah. When I heard that, I feel like I've met a lot of people like you, but this was like a very

perceptive sort of moment where you realize like, wow, these people are so kind and so tender to me. And there's something in me that just yearns for that. Yeah, I think it was this like deep sense of, you know, I think at that point I felt very lost and there was a lot of chaos in my life. And, you know, at that point, it was this moment of, feeling okay. And I don't think at the time I recognize, you know, all the underlying things that went into how reinforcing that moment was, but it was really reinforcing. And then it became, how can I keep getting that feeling? Yeah. What a powerful feeling that is. I mean, here you are

throwing up. And yet there's people who are just being so kind to you in the midst of that. I can see why that would be very meaningful. And then you describe in your podcast how your mom kind of reacted differently to you when you got hurt or when you know, like at the, I guess at the school, you did something to get a teacher to notice or, you know, you did some self-harm type of thing. And your mother reacted so different than the reaction you were getting. Can you tell me a little bit about that? Yeah, so pretty much, you know, after this interaction with this nurse practitioner and nurse, then it became very obsessive. This idea of needing to be, you know, taking care of. And it was something, you know, I would think about all the time.

And, you know, I would think about it at night. And it would become just this very big fantasy. And all of a sudden I was, you know, doing all this research online, you know, what would happen if you fainted in class? And I think I kept coming to these answers of people really caring. And, you know, the teachers would care and you would get this attention. And then, you know, I think that the first time I really acted out on those thoughts, it wasn't actually anything I'd planned out. It ended up being a pretty compulsive, not well thought out moment where I was walking to the bathroom.

And I saw this, you know, old nail on the ground of the high school. and I just had this thought of, what if I started bleeding from that? So I went to the bathroom and I cut myself with that nail. And then I walked back into my classroom and just went up to the teacher and said, I'd accidentally bumped into something and it was bleeding. And in that moment, you know, it was that really nurturing moment with the teacher where all of a sudden they really were concerned. And I ended up going to the nurse.

And then she actually called my mother. And I think, you know, that car ride to the emergency room with my mother only made it that much worse because, you know, here I'd had all these people who were showing me a lot of, you know, care and attention. And then in the car ride, you know, my mother was saying things like, why are you interrupting my day? This is so annoying. And all these things where she was making it all about her. and then we got to the ER and, you know, she didn't even come inside with me. And I think it was just there was this very big, you know, she went up and made sure that, you know, it was in network with our insurance company.

And then she just left. And then, you know, I think that propelled this need to want to be taking care of. And, you know, that really set off this thing where it was this huge contrast between what my mother was like versus what all these other different adults were like. And I think a lot of, I think something's really important to realize that none of my fantasies or thoughts were about my parents ever taking care of me. It was about other adults and caretakers. Yeah. So you had this, just this yearning, this desire for connection. And, you know, in these moments where you were in pain, where you were hurting, it was pleasurable to feel

another human being who actually cared. And the contrast seems so stark between what you got from your mother. And I'm sure this is just like one of a 10,000 episodes, right? Of her kind of, you know putting her preference of care and her own sort of self first, right? You tell this story also about how

you took on this sort of maternal role towards your mother growing up. Your mom was not showering. You were picking dandruff from her hair. Tell me about that role that you had. And was that just a physical, like doing physical things to help clean her, or were you actually maybe also listening to her in a way that she wanted to be listened to?

Yeah, so I think, you know, with my mother, there is very much this disconnect of, you know, the body and the fact that, you know, we inhabit these bodies. And I think that, you know, she both passed that on to me in the sense that we never had any conversations about, you know, your body and it changing. So I think in that sense, I never really had this sense of like I have a body and I get to choose what happens to it. And, you know, my mother growing up, she, you know, had five young children. You know, she'd had five children within six years. So obviously a lot of chaos in her house. And, you know, she herself didn't practice a lot of, you know, the hygiene that you might expect from other people. And, you know, I share this story of my mother, you know, often wouldn't shower for months at a time.

So she had, you know, a lot of danger filled up in her hair. And I became very aware of that in a sense that I thought that all the other people at school, you know, were always judging me for that. So it became this sense where my, I think my first really connection to the body was this thing of shame that my mother, you know, presented a certain way. So then I, you know, couldn't convince her to ever shower. So I would sit and, you know, pick all the dandruff out of her hair. And, you know, I do think that, you know, there probably were some genetics, maybe tendencies for OCD. But I think that was kind of the first compulsion I had where I'd just spend hours picking dandruff out of her hair. And then, you know, it was both because I felt this deep shame related to,

how my mother came to school and what she looked like. But then it became this thing where, you know, I would always be thinking about the need to pick out all the dandruff, and I would be so hyper-focused about it. And I wouldn't be able to sleep before I spent, you know, those hours doing that. So it definitely became a compulsive thought that I needed to act out. And your mom kind of just let you do that for hours every day? Mm-hmm, yeah. So I think my mom, you know, for her, it was something where she really liked that attention on her, where she really loved having me do that. And she also kind of fueled it because she would always ask when I was going to do it or tell me to speed up my homework because she wanted me to do that.

Did you ever like listen to her going rants or anything like that where you just kind of like provided maybe emotional? support. Yeah, definitely. I mean, I think that she very much had a, you know, troubled childhood herself. And, you know, she, I think, really struggled with a sense of lack of identity for herself. So oftentimes, you know, she would tell me a lot about the struggles with her marriage with my father. And, you know, he was anyways a pretty distant actor in my life. And I think that she very much wanted the center of all of her children's worlds to be herself. And I think that very much made it so that I very much felt that I needed to protect her because I felt that, you know, my father never listened to her. And then I very much felt this deep sense of needing to protect her.

And I think, you know, that's something that carried into all of my life where I felt like I needed to protect her from the other parents at school who might judge her. And, you know, I felt like I needed to protect her from my father and from my siblings. So it very much became this thing where I always felt the need to be hyper aware of her rather than myself in order to protect her. Hmm. Okay. Wow. And that's kind of heavy.

That's like a burden. And it's kind of a role reversal of. sorts, you know? It sounds like she kind of told you too much, maybe too early about her own traumas and her own struggles. Yeah, and I think the biggest thing, you know, was that the body very much became this thing of shame where, you know, she shared a lot of her struggles with intimacy with my father. And, you know, it all very much added to this sense of shame where I felt a lot of shame about the way that her body looked while at school. And I never really had this opportunity to, you know, talk about my own body. And, you know, when puberty started hitting, you know, we never had any

conversations about it. So I felt this deep sense of shame that, you know, my body was changing. And when I actually got my period for the first time, you know, I didn't tell her for about eight months. And I very much felt this need to hide it from her because I was so worried that she was going to be mad about it. So that was definitely this deep sense of shame from an early age when it came to my body. Yeah. So that even magnifies this moment with this nurse practitioner when the nurse practitioner was kind of teaching you about your body. Yeah, for sure. And that was the first time I'd ever, you know, had a conversation with anyone about, you know, consent or anything. And I think a big thing that was going on in my life at that time was kind of being taken advantage of in a relationship

because, you know, I'd never had that conversation that, you know, it wasn't okay for people to just touch your body and that you, you know, had a right to say that you didn't want that, you know, especially with my own mother and her relationship, you know, she would often get into these big fights with my father, and then she would, you know, come upstairs and just get into bed with you and hug you and you'd just be kind of in this position where you were taught that, you know, when she thought she needed to use your body as a sense of comfort. And I think that when, you know, it did get into this puberty,

age, middle school age, I just never knew that I was allowed to say no to anyone, you know, doing anything to me. And when I met with that nurse practitioner, that was really the first time that anyone told me that, you know, your body was for yourself and that you could say no and that you needed to want what was going to happen to your body. So I think that it was kind of this first time that anyone even told me that I had agency over my body. Wow. I think that that is such an amazing transcendent moment that you had with that nurse practitioner when she was teaching you, listening to you, right, and empathizing with you in the midst of this journey you were having with your body and like, okay, you know, hey, let's have some, you can have boundaries. You can say what you do or don't want in your body, right? Yeah. Was it like an epiphany moment in regards to that, or do you feel like it took time for you to get in touch with boundaries, limits, having a voice?

I think it took time. I mean, in that sense, you know, now I can look back on it and really reflect on all of these things, you know, in a sense where I've been able to have that reflection in my own, you know, therapy now. But I think back then, you know, what it went from was the sense of having no body to all of a sudden learning that my body was a way to get some sort of, you know, thing that I didn't even know how to describe at that time. So I think it went from this flip-flop of feeling this deep sense of shame around my body to all of a sudden realizing that my body could be a way to meet these unmet emotional needs. So, you know, in terms of consent, I think then the problem was that, you know, I learned, okay, I get to choose what happens to my own body, but I still didn't have that aspect of you need to respect your own body. And I definitely learned that, you know, I got to choose what happened in terms of other people. But I don't think that led into a conversation about, you know, why self-harm might not be the best option to take.

Hmm. So you kind of went from, okay, I can use my body to get my psychological needs met, my needs for intimacy, my needs to be mothered. And for a while it worked, right? For a while you got those needs met. And it sounds like it was meeting these needs so powerfully that it became like an addiction. And then how did you move from getting your needs met in the medical? sphere to getting them met outside the medical sphere. Like medical as in like, you know, you're injecting yourself with insulin. You have nurses, doctors very concerned about you. Yeah. So, you know, I think that, you know, I ended up, you know, in this ICU room and kind of had this moment of, you know, this. Because up until that point, I don't think I was really ready to admit that I had, you know, munch houses. I think up until that moment. I was so deep in, you know, just the fueling of that need to have that met that I couldn't really step back and accept what was actually wrong. But I think in that moment, just, you know,

the harsh reality of being, you know, in an ICU, you know, realizing this isn't sustainable. But then, you know, at that time, I still didn't know how to get out of the situation. I knew I didn't want to be in this situation, but I didn't know how to escape it. And, you know, I then got discharged and ended up, you know, going online. And everything I was reading was just pretty daunting, that, you know, I kind of then became deeply, deeply depressed because I thought there was no hope of it getting better. And, you know, I just felt this deep shame about having this illness because everything that's kind of written about it online just presents people who have this illness as monsters, and there's really no discussion online about the fact that you can move forward

from it. So at that point, you know, I ended up getting so depressed. I decided to take my own life, and then what ended up happening is I ended up surviving that, and then, you know, I ended up going to a psychiatric hospital, and then, you know, I think what really transformed at that point was actually telling my full story to a nurse there. To a nurse there? Yeah. And finally, just letting, you know, it all out. Because I think, you know, even at the hospital, the medical hospital, right after the

suicide attempt, I still just felt so much shame and so much despair that I didn't even feel like it was worthwhile telling any of the staff there what was really going on and at that point they all just thought you know i'd pretty severe depression which i definitely did um but it felt like when i got transferred to the psychiatric hospital that you know they were having all these conversations about it does get better and you know you'll recover from your depression but it felt like this you know voice screaming in my head but you don't know what's actually going on so that i think at some point you know i had the thoughts in my head of, yeah, like, that works if your problem's just depression, but my problem

isn't depression, so I should, I should die. And then, you know, I ended up just having this breakdown to this nurse and telling her everything. And, you know, the thing she said to me at the end was, okay, we can go from here. And I think just the fact that she didn't tell me that it was hopeless and the fact that she sent the message that yes you've told me everything and you're still not unhelpable you can still get help and I think that was really transformational where at that point I felt like I could actually speak about what was going on and that kind of opened it up to a sense where I felt like okay the medical professionals can handle the truth because at that point up until that point with a nurse i didn't feel like anyone could handle the truth because i felt

like i was too broken past the point of what doctors or nurses could even do for someone yeah it's what a what an amazing moment um i have a lot of nurses that listen to my podcast and a lot of people in psychiatric hospitals who are not necessarily the physician you know they're not the you know kind of the person prescribing, but it's just such a testament to how the system can really help someone. Listening to your story, listening to everything that you felt so much shame, so much shame, to the point of suicide, you know, I'm going to kill myself because there's nothing that anyone can do to help me. And to be met with, you know, hey, you're here. We care for you. we're going to do things that we can to make life better for you.

And we're not overwhelmed by this story that you felt very overwhelmed by, you know? Yeah. And when I listen to your story, that's why I was like, oh, man, I need to get her on my podcast. Because it's like, it's a story of hope, you know? It's a story of that you could move from someone getting their needs met in the medical sphere to maybe getting their needs met by therapists, by psychiatrists, by the mental health sphere. Is that kind of the shift that you saw happen at that point? Yeah. And I think what was really important is recognizing, okay, this is an oneness.

You know, I think that it's so demonized in what you read online that it feels very much like something, you know, you're choosing. And in a sense, yes, you do choose to act out in those compulsions. But I do think that, you know, behind, you know, how annoying and frustrating, it definitely is, you know, for a nurse and doctor to have these people use the medical system. And that way, I think underneath that is, you know, this very sick person, even if they might be sick in a way that they aren't even willing to admit. And I think recognizing, okay, I have this illness. And it definitely took a while to reach that point. And, you know, throughout my whole illness, I definitely had these moments of, you know, wow, I'm really sick. But it definitely was in this place where I was willing to accept it.

But then being in that psychosper, I definitely reached this point of acceptance, you know, where I was willing to admit that I had this problem. And, you know, then explore all the reasons that I might have gotten to this point. And I think that's something that became really important is, you know, getting discharged and doing psychotherapy three times a week and really exploring what areas of my, you know, development, you know, might not have been there and then learning ways to kind of meet those needs by myself. And, you know, looking back, I definitely have a lot of gratitude for that hospitalization because I'm not sure if I hadn't had that. experience that I would have been able to be at the point I'm at today. And, you know, then moving from that to a place of, okay, how do I actually get to the next point? And I know the next point I want to be at is not needing to act out these thoughts that I have. And that was really important to enter, you know, pretty intensive psychoanalytic psychotherapy, where I was meeting

with a psychotherapist three times a week and really getting to explore what was going on and what parts of my unconscious were causing me to act out these needs. And a lot of these things were things I wasn't even aware of. And it really allowed me to explore, you know, how my early childhood might have led me to feel the need to act out these thoughts I had in my head and how, you know, I was so desperate just for any sort of attention. I was even willing to use my body and self-harm in order to meet that need. And then, you know, I think through then participating in this outpatient program, I was able to learn other ways to meet those needs and really learn to accept the things in

my life that were wrong and kind of accept them for what they were. And just, I think just bringing light to that made me. me aware enough of it so that when I did start having those thoughts, I would be able to stop the thought and then coming up with a different way to kind of get that nurturance. And, you know, it's not to say that, you know, I don't have some of those thoughts today, but I think that I'm in a place where I can stop those thoughts pretty easily. And I think that's what you don't really hear in, you know, the media or anything is the fact that, you know, Munchausen's I don't think anybody with Munchausens will never not have those thoughts,

but I think you can get to a point where you don't act out any of those thoughts ever. Wow. Okay. So, yeah, break down for me what was helpful that helped you be able to sort of see those thoughts? Those thoughts are there, but not act upon them. Yeah, so I think, you know, in the psychoanalytic therapy, I did, you know, we took a deep dive into just the relationships I had in my early life and how, you know, I probably never had anyone who showed me that unconditional love.

And we really explored what that probably meant in terms of my attachments. Because, you know, I had a lot of issues with attachments. And I think that we were really able to explore kind of how my mind worked and how I, I felt that the only way to get any sort of attention was through harming myself. And then, you know, something alongside, you know, having this psychoanalytic therapy and really learning about myself was, you know, doing this group where I was learning other ways to kind of meet those needs. So I was learning a lot about journaling, and I was learning a lot about, you know,

even just taking walks and being outdoors and kind of ways to minimize that anxiety and that deep need to act out compulsions that I felt. So I think those two alongside was both, you know, learning what my unconscious might be going on and then learning ways to replace that. And, you know, something I will say is also medications definitely played a big influence and kind of really helping me figure out, you know, the brain chemistry aspect of it too, because I, as I talk about in my podcast, you know, I do have quite a lot of genetic underpinnings of mental illness. So I think also finding the right medications was really important for me as well. Wow. Yeah. How wonderful that you were able to see this therapist three times a week. How did you, I mean, I'm imagining some of the people listening to you.

this are like, how do I find a therapist like that who would be willing to see me three times a week, you know? It's hard enough to find a good therapist once a week. Was it something local, like some program, an analytic institute? Like what was, what allowed you to do that? Yeah. I mean, I think that, you know, it was actually the, so I think what I was really lucky is that when I was leaving, you know, the psychiatric hospital, you met with a social worker who kind of came up with a plan for you. But I think that the best way to actually, you know, find that would be just to look at your local psychoanalytic institutes. And they usually have, you know, a find a therapist feature. And then, you know, I think something to always think about is that when you do reach out to a mental health professional, you can always be very upfront about what your needs are.

And if they aren't going to be able to meet that, you know, then you find someone else. Like there's always other people. I recently moved. kind of had to go through the process of finding care again. And it definitely is a obstacle where, you know, it's this very kind of awkward thing where you're kind of sending these emails or calling these people and, you know, not wanting to disclose too much, but also wanting to make sure that they can handle it. I think that why I've just learned is the most important. It's just being up front. And if they can't handle it, then find someone else. Yeah. That's good. That's good. So I like,

I like how proactive you are and you're seeking and sort of advocating for yourself. That's really good. Yeah, the other thing is like I get a lot of people who reach out to me. I don't have very many patients per se, but I think the fact that you had your own podcast and that it seemed like you had done your own work already, once in a while I'll get someone who sends me a long message who hasn't really done much therapy. They really don't understand. and then you don't want to get into this sort of complicated relationship where you are a provider

who's listening to them, then they don't have access to care or whatnot, you know? Yeah, I think a big thing for me too was in, you know, in healing. And, you know, I did therapy three times a week for two years and did an intense about patient program, I think, for about six months. And, you know, at that point was seeing a psychiatrist, I think about every three weeks. And I think, you know, at that point, it was very much, you know, healing. And I think I've now kind of reached a point where I have a career I really love. But I still think about that moment in the ICU after that insulin overdose where I felt so hopeless.

And I think that in making a podcast, it's kind of hoping to send a message that, you know, no matter how severe you may think your mental illness is that there's still a way to get better, not that that means that everything's going to be perfect, but it definitely can get better. And I think that's a message that I didn't see out there, and that definitely led to a lot of despair. But I think if you're really willing to admit, you know, what's actually going on and really tell a medical professional

and, you know, really share that because it's so isolating to just have all this pain in your head and feel like you can't tell anyone. Yeah. Yeah, it's very lonely. It's very isolating. And I think that's part of the, that's part of what drives people to often do things that are fictitious. Fictitious disorder, just for those who are listening, who might not be too aware of it, is a fabrication of physical symptoms or psychiatric symptoms with no apparent motivation other than to adopt the role of being a patient. And malingering is a little bit differently, is a little different. Malingering is when someone fabricates something consciously, fully consciously, to gain benefits such as like

compensation, financial compensation to avoid conviction, avoid the military service, gain disability benefits. Somatization is a little bit different. Somatization conversion. These are symptoms that are unexplained, but not deliberately produced. So often, you know, there was an acute stress that led to someone having some sort of conversion issue. You know, they develop like psychogenic seizures or whatnot. And Munchhausen syndrome by proxy is when the parent induces illness in the child. Often the parent has a personality disorder and often themselves having a history of fictitious disorder. But getting to fictitious disorder and what we know about it, it's not incredibly well known compared to like a lot of the other disorders. Often I think because,

you know, we have a lot of case studies of it, but not necessarily like this is this is the effective treatment for it because there just aren't a lot of programs that treat it. We do know that 66% of people with infectious disorder are women. The mean age is 34 years old when they're diagnosed. So often they've had it for years. Most frequently working in health care, you know, so a lot of the people who end up having infectious disorders are nurses or someone who's in health care or had a family history of health care. There's a 41% history of or current episode of depression and there's a 16% history or current episode of personality disorder and then within factitious disorder is munchhausen syndrome not by proxy but just

munchausen which i think one article put it the best it's like the 10% worst cases of factitious disorder and uh there's another article i read i kind of am leaning away from how they described it, but they're probably describing more of like a malingering munchausen where you're, where there's the, the wandering from place to place to get the medical benefits that doesn't seem related to like attachment needs or whatnot. So I think how you're describing your munchausen was, it's kind of a severe form of factitious disorder with a desire for connection, a desire for someone to, to hear you, to have empathy towards you. Would you agree with that?

Yeah, definitely. And, you know, something I do think that, you know, makes it complicated is, you know, the fact that often people with Munchausen don't just have, you know, a factitious disorder, they have a whole lot going on for them. And I think that's something important to realize in that is that oftentimes the treatment isn't just the treatment of this one disorder, but it's kind of treating that whole person and everything that's going on for them. And, you know, when I talk about, you know, having, I call myself in remission for Mun Chausen's,

because I haven't, you know, acted out any of those thoughts that I may have in over four years. But I think that there's still a lot of other things going on for me. And those are the things that I'm still actively in treatment for. So I think something that's really important to recognize too in treating it. is that oftentimes it's not just treating one thing, but it's kind of treating a whole person and addressing various other illnesses that they may have. And that makes it really tricky, too, is that, you know, when I was doing all this research online, I read about all these different disorders I may have. And then I kind of got to this point, too, of feeling like, okay, well,

I have not just one, but, you know, five mental illnesses. I must be. so messed up beyond, you know, what anybody can handle. And I think that was definitely something that led to this deep depression is feeling that I had too many things going on. And I felt that, okay, if I just had one thing, I could tell a psychiatrist and they could handle it, but I have too many things for mental health professional to address. And I think that, you know, now that I've also gotten, you know, a hold of my other illnesses, that the Munchausen's was definitely part of that. And healing isn't just healing one of those things,

but it's kind of addressing it all at once and moving forward from all of those different illnesses I had. Yeah. Yeah. I think that feeling of feeling overwhelmed is so, or just like hopeless in that overwhelm of like, no one's going to be able to take care of me, no one's going to be able to help me in the midst of everything that I'm going through. it's a very isolating feeling and it's a very alone place to be and I'm so glad that you were able

to break through that and get help and find resources and you know you're on your journey I'm sure there's still stuff that's there that you need help with and and people to listen to and whatnot but I think you've come so far and it's it's really a testament to your your willingness to reach out and seek care and seek help, you know? Yeah, and I think being willing to seek help for, you know, what's actually going on, no matter how bad you may think it is. And I think something that was really important, you know, learning at the, you know, psychiatric hospital was one of the, you know, social workers told me,

okay, even if you go to a psychiatrist and they get, you know, get completely overwhelmed by you, they still can't tell anyone. And I think that was what was really important is kind of realizing that, okay, I don't have to be alone with this. I can reach out to someone. And then, you know, even if they can't help me, they still aren't going to tell anyone. And I think that was a really important part of being willing to open up is kind of learning that, you know, I can go to someone. And as, you know, I can go to someone. And as, you know, messed up as they may think I am, if they think of a monster, they still can't tell anyone. And I think that was what was really important for me. Because I think with, you know,

Munchausen's and, you know, the other diagnosis I have is where I had was borderline personality disorder. And I think there's so much stigma associated with it that you feel that if you tell someone, all of a sudden the whole world is going to know. And all of a sudden, you're just never going to be able to have any friends or have a relationship. But in reality, you know, just telling one person as huge as that may feel to you, it's just what it is. It's just telling one person. And, you know, that doesn't mean you need to tell anyone else, but just telling one person is the place to start. And, you know, it's not going to go beyond just that one person if you don't want it to. Yeah.

Yeah, it's wonderful to have a place where you can feel heard, hopefully you've heard. But if not heard, at least not that they're going to, like, they're not going to gossip about it. Like, legally were prohibited from talking to other people, talking to our spouses, you know, talking to our friends about these, you know, cases we see every day. you know, when I talk about cases on my podcast, I usually change some variables enough so that the person may not even be able to understand who's being spoken about. Or maybe a bunch of my patients will think I'm talking about them because I'm talking in more generic terms. But yeah, I think it's good to have someone willing to put out their case anonymously like you're doing to give hope. And interestingly, with borderline per size, or a lot of the articles, long-term articles,

and I'll send you one if you want, show that people who get effective treatment, you know, when they're followed up for the five-year period after the treatment's done, let's say it was like a two-year intensive treatment, they're on much less meds, like a fraction of the meds, of the people who didn't get the effective treatment,

and their hospitalizations are almost completely gone. and, you know, two-thirds of them no longer meet criteria for borderline per size disorder. So although it is considered a personality disorder, I consider it as something that you can completely be in remission or, you know, it's no longer there, right? It should no longer be in your chart. And the same for factitious disorder. And I think you mentioned that in one of your episodes, kind of like how you feel like some of these diagnosis can kind of linger, you know? And in my program, we spend a lot of time looking at our identity outside of diagnosis because we want people when they introduce themselves to introduce themselves in terms of what their passions are,

what their gifts are, what their talents are, you know, what they're into. We don't want them to say the first thing, I'm so-and-so and I have blah, blah, blah, blah, mental illnesses and blah, blah, blah, blah, blah, blah, physical illnesses, you know? And often what can happen is people start to put an identity as like, I am, you know, this illness. And so I was hearing you talk about this in your episode, how you kind of like are in this sort of camp that you don't want these things to be permanently, permanent labels, but then at the same time, the title of your podcast is I am Munchausen. So tell me a little bit about that, where your thoughts are on that. And if you can kind of see what I'm talking about,

and if that's applied to you at all. Yeah, I mean, I think it goes back to this idea of, you know, living beyond the diagnosis. You know, I think it's so easy, as you were saying, when you get a diagnosis, to think that that's all that you are, you know, and I think I was at one point diagnosed with, you know, factitious disorder, borderline, OCD, depression, anxiety, and it's so easy to just think that your whole life are these three or four letter acronyms and think that that's all it's ever going to be. But, you know, I think you can get a lot of treatment. And in that treatment, you both learn to accept those illnesses as part of who you are, but also kind of learn to see them as both having good aspects with them, but on that same side of the coin, having gratitude

for the things that, you know, you have learned from them. And I think, I think you reach a point in your healing where you kind of get to this point where you're not sure if you would take back all the experiences you had, but you're not sure if you actually would choose to have them again because, you know, you are the person you are today because of those experiences. You know, today I have a master's degree in social work and do a lot of really meaningful work. And I think that what has led me to, you know, have this career where I wake up. genuinely really excited about going to work. And I feel a deep sense of peace in my life is having been at that, you know, rock bottom. I think now, you know, kind of being in this really stable position,

it feels that much better. And something, you know, I like to tell a lot of people is if you just think about, you know, starting from ground level and going to the top of a mountain, you know, that feels really high. But if you start from, you know, the bottom of the, ocean and go to the top of the mountain, it's that much better. And I think that joy works that way as well. You know, I think that because I've had these moments where I felt that I didn't even want to live, now that I do want to live, it feels that much better. You know, I think I have a lot of gratitude even just for very basic things. You know, I can really appreciate things. And I think that when you do have these diagnosis, it's really easy to think that that's all that life is ever going to be.

And, you know, there's more life than that. And maybe it's even possible that because in that moment, that was all that your life was that when your life does become more than that, you will have a lot of gratitude for all the things that are beyond that diagnosis. So I think it's really important to both accept your diagnoses and accept that that's what you're dealing with and then realize that, you know, everyone has challenges and that's your set of challenges. And now you have to figure out, you know, how to live beyond that diagnosis. So at this point, I'm not afraid to say that, you know, I survived Munchausen's, but also, you know, that's not what defines me, even though that's a really important part of who I am today,

it's not the only thing of who I am at this moment. Wonderful. Wonderful. Very eloquently put, I can tell that you both have a passion for your work as a social worker. It gives you intense meaning. And I love that image of climbing this mountain, but also climbing it from a very, very far down place. I think this was a good,

conversation, giving hope to maybe people who are listening to this. Maybe family members will stumble upon it, who have kids who are struggling. And I think it will hopefully give them a place of like, okay, there are some things that we can do, some steps we can take. You know, we don't have to just give in to the conspiracy that like it's hopeless, right? I met with a couple this morning had kind of a hopeless situation in their mind and hopeless for a lot of people. But for me, it's like, okay, there's a challenge there. That sounds really like a very, very, very, you know, bottom of the cave place.

But I think with the proper treatment, I think there can be hope. So I'm glad that you're giving hope today and through your podcast. I'll put a link in the show notes to your podcast. It's just called I Am Munchausen, if you guys want to check it out. And, you know, you're working somewhere.

You're probably not accepting patients yet who are listening to this. But I don't know, you want to stay anonymous at this point. That's correct, right? Yeah, I do. And it's not so much because I, you know, it's not because I'm embarrassed by my diagnoses, but it's because, you know, it's not all that I am, you know, and I think it can be really easy to associate hope with just one specific person.

But I think that hope is more than just one person, you know. And yes, I am one person who has gotten better, but there are a lot more stories in that. I think that when you hear about one specific person who's gotten better, it's easier. It's easy to imagine, you know, they might have gotten better because this is how they look, or it's easy to make explanations of why they might have gotten better. And I think I'm not knowing, you know, where I live or what my life looks like, I think it's easier to have this understanding that hopefully. is more broad than just one person in one place.

And it kind of transcends all of those constructs that we might have. Yep. Yep. Wonderful. Wonderful. Well, thank you so much for coming on. And I will leave it there for today. And thank you so much.

Thank you so much for listening to this story and listening to this episode. I hope it helps you understand that these people really do need connection and that we can of connection through psychotherapy, helping them be congruent with their emotions, helping them find ways of connecting with other people outside of illness, outside of fabricated stories. And also sometimes it's necessary for them to overcome addictions, right, because they get addicted to painkillers in the hospital and stuff like that. So in the blog, I will leave the information to the partial program that I run, the daytrimand program.

We have a nurse Anne Morris who's there right now who can be reached at 909-6-5-1-4-9-9-054. Once again, 909, 651-44. On the blog, I'll also put a link to our website for the MEN program. If you know anyone in California or who would be willing to travel to California to get treatment, this is an option, and I think it's a good option. So, not that there's other programs out there that aren't good, but this is one good program where we treat people with complex medical and psychiatric issues. All right, we'll leave it there for today.