Cerebral dysfunction in the Munchausen syndrome.

Brain dysfunction has been noted Munchausen syndrome patients but rarely explored. We describe five Munchausen syndrome patients who all appeared intellectually intact because of their excellent verbal skills. However, formal neuropsychological assessment testing revealed deficits in conceptual organization, management of complex information, and judgement. We suggest that subtle but important neuropsychological impairment may contribute significantly to the aberrant behavior of Munchausen syndrome patients. Typical Munchausen behaviors such as irascibility, the desperate search for care, and pseudologia fantastica, may be understood as solutions to problems created by brain damage.