'Reparenting' Used to Treat Woman with Munchausen's Syndrome

March 5, 2014— -- Andrea Avigal hit rock bottom in 2005, lying in a hospital intensive care unit dying of sepsis. The former nurse and mother of two young daughters had intentionally injected herself with bacteria, subconsciously seeking attention.

Avigal, not her real name, had since childhood suffered from Munchausen's syndrome, a psychiatric disorder that is rarely curable, drinking poison, starving herself and taking excessive laxatives -- once 90 of them.

"At 5, I went into the bathroom and cut my finger with glass and showed my parents," she told ABCNews.com. "I thought it would stop the arguing and it didn't work, but I got the attention I wanted. Around 12 or 13, I faked having an asthma attack and went to the emergency room and tried to break a bone by hitting my wrist with a hammer, hard."

Avigal, now 53, says she has had a remarkable recovery with the help of New Palz, N.Y., psychologist Tom G. Hall, who used unconventional methods to teach her healthier ways of coping.

Together, they wrote about her struggle in the book, "Secrets Unraveled: Overcoming Munchausen Syndrome."

Today, the pair is committed to educating others about an unconventional treatment they call "reparenting" to bring hope to those who suffer one of the cruelest, and least curable, of psychiatric disorders.

Hall allowed Avigal to contact him by email and telephone at any time outside scheduled therapy sessions, becoming a surrogate parent. Hall is a pseudonym, because he is still treating other patients for whom he cannot offer counseling around the clock. However he revealed his real last name to ABCNews.com

"I saw that her healing depended more on our relationship itself than any insight I offered, and I felt compelled to expand my role beyond the bounds of conventional therapy," he writes in the book's introduction. "This choice stretched me as a psychologist and a person, pushing me well outside of my emotional comfort zone. In the end, it proved instrumental to Andrea's recovery."

Patients with Munchausen's syndrome have a subconscious need for attention and pretend to be sick or injure themselves on purpose. They invent symptoms, beg for risky operations and even rig lab tests to win sympathy and concern, according to the Mayo Clinic.

Many have worked in the medical field, where they may have access to syringes and medications.

"It's often found in people with a history of severe child abuse, which was the case with Andrea," Hall said. "It becomes an alternative way of getting attention in terrible situations and carries into adulthood almost like a pattern of addiction. Often people go for many years, from hospital to hospital, emergency room to emergency room, with medical professionals not aware they are creating their own illnesses."

Munchausen's syndrome differs from Munchausen by proxy, a form of child abuse in which a parent induces illness in a child. The syndrome falls under the category of factitious -- Latin for "artificial" or "contrived" -- disorders, which incur hospital costs in the tens of millions of dollars each year.

The American Psychiatric Association's new DMS-V estimates that 1 percent of all hospital visits are by patients with Munchausen's syndrome, according to Dr. Marc D. Feldman, a leading expert in factitious disorders and a clinical professor of psychiatry at the University of Alabama.

"That statistic may be overstated, on the other hand, this is a disorder that is bathed in deceit and I think doctors miss most cases," said Feldman, who endorsed Hall and Avigal's book. "The patient presents symptoms that appear credible and the doctor doesn't have the time to review old records or collateral sources. It's easier to write a prescription or do a procedure than tell if the patient is telling the truth."

Feldman, the author of the 2004 book, "Playing Sick," said Munchausen's is "viewed largely as untreatable. ... The wording of the prognosis is guarded or grim."

There have been breakthrough cases, he said. One woman who was hospitalized 650 times and had 42 abdominal operations stopped her behavior after 12 years after adopting a cat and learning to get outside herself.

Feldman also said he successfully treated another patient who had injected herself with feces and water, going into septic shock, and even drank boiled lead to give herself lead poisoning.

But those are anomalies, said Feldman. He said that Hall was successful, in part, with Avigal because he had created for her, "sort of an ideal family." He does, however, acknowledge the methodology is impractical for most therapists.

Avigal said she grew up in a dysfunctional home in New York City, the daughter of a Holocaust survivor who suffered from bipolar disorder.

"He viscously beat me and stabbed my mother," she said. "In one of the worst situations, he held the whole family hostage at gunpoint for 24 to 36 hours. He started to sexually abuse me at the age of 5. … I lived my life in constant fear that me or others would be killed."

When she was 14, Avigal's parents had her institutionalized for psychiatric problems and she would stay for four years, never attending high school.

"They blamed all their problems on me," she said. "I was identified as the patient.

"In the 1970s, there were no patients' rights," she said. "They were very abusive toward young people like me -- it was like being imprisoned, horrible and awful."

When Avigal was 16, her father committed suicide after she confronted him about the sexual abuse.

"I was guilt-ridden for years," she said.

After getting her GED in the psychiatric hospital, Avigal got a nursing degree at a community college. She met her husband, a lab analyst, and had three children.

She said she felt "happy and safe" for the first time and focused on being a mother, keeping the Munchausen's, for a time, at bay. But in 1999, her 13-year-old son, who had been diagnosed with brain cancer as a toddler, died.

"My illness spiraled out of control," Avigal said. "It returned with a vengeance.

"My husband knew I was sick all the time and in the hospital, but he didn't know why," she said. "There was no end in sight and he had to constantly take time off from work."

She said for her, the illnesses became "an escape from the responsibility of having to function and the emotional pain. ... I wondered how far can I go without dying."

By 2002, Avigal was in treatment with Hall over the crushing death of her son, but even he was in the dark. Until two and a half years later, when she ended up on death's door, in the ICU.

"I knew it was no longer an option or I was going to die," she said.

Now, eight years later, Avigal credits her recovery to Hall.

"It was based on the trust he built in therapy," she said. "He went above and beyond conventional methods not typically used."

In between scheduled therapy sessions, Hall made himself completely available to Avigal.

"I couldn't do this with any other patients, but it seemed to be necessary in this case," Hall said. "I would stretch the boundaries and in doing so, talking between sessions, I could see it was helping."

Avigal said it was her idea to write the book because between patient and therapist they had "huge stacks" of emails and progress notes that chronicled her slow, but steady recovery.

"It was a story worth telling," she said.

The exchanges from September 2003 on the anniversary of her son's death bring their unconventional relationship to life.

Avigal writes: "Here I am again Tom, feeling helpless and out of control. I'm sorry for failing to help myself, failing everyone around me. I simply don't know how to live anymore without Eric."

Hall responds: "I can't begin to imagine how sad you must feel ... four years isn't a long time. I can see how easily you can touch that pain and why you'd want nothing more than a chance to see him again. When we meet tomorrow I want to hear about all of your feelings, but I also want to try to help you get back to a better place with your life."

Avigal said there were times he "seemed so frustrated and irritated" with her behavior, but she "never felt harshly judged" by Hall.

"I was a difficult patient, but I told him he couldn't give up on me," she said.

Hall said his mission is to advocate for those like Avigal who hopeless.

"I want to get the universal message out that even with a severe disorder like this, it can be treated with the right kind of help," he said.

Now, eight years later, Avigal said she is proud of her 30-year intact marriage and two successful daughters, aged 20 and 23. She said Hall even inspired her to go back to college where she earned her master's in social work.

"Despite being the same age, he was the good father I never had," she said.