The Munchausen Syndrome: A Report of Four New Cases and a Review of Psychodynamic Considerations

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Abstract
Four new cases of Munchausen syndrome are described and compared to prior reports in the literature. Remarkable is the high frequency of childhood histories which include rejecting or sadistic parents, exposure to death or chronic illness and institutional placement. It is proposed that the symptoms comprising the syndrome are a defense against psychosis or infantile anxiety and are precipitated by either real or threatened separations from ambivalently regarded object relations. Hospitalization allows gratification of dependency wishes while the pseudologia and malingering serve to deny the feelings of impotence.

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