Munchhausen by Proxy and Its Effects on Children

Munchhausen by Proxy and Its Effects on Children

Munchausen syndrome by proxy (MSbP), or factitious illness by proxy, is the form of child abuse in which a parent (most often the mother) deliberately produces an illness in the child. The perpetrator, by definition, suffers from a serious emotional disorder that impairs judgment. The emotional disorder is not diagnosable; its pathology is culturally invisible and masked by social adaptation (e.g., overreacting to the child's illness and emotional hunger). The offending parent usually has significant medical knowledge, while being naive about human relationships. She or he seeks psychological gain (love, attention, or sanity) through provoking medical illnesses and conflicts. This entity is common and carries substantial morbidity and mortality reported mortality rates range from 10% to 30%.6,7

Recently, concerns have been raised about the appropriateness of the Munchausen syndrome by proxy diagnosis. The purpose of this report is to emphasize its unique features and discuss its management. Pediatricians need to be familiar with this entity in order to prevent the abuse and provide the appropriate supportive care (Table 1).

Munchausen syndrome was named by the British physician Richard Asher in 1951, who wrote "Like the famous Von Munchausen, the persons affected have always travelled widely; and their stories, like those attributed to him, are both dramatic and untruthful. Accordingly the syndrome is respectfully dedicated to the Baron, and named after him. The patient showing the syndrome is admitted to hospital with apparent acute illness supported by plausible and dramatic history. Usually his history is largely made up of falsehoods; he is found to have attended, and deceived,...

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... a confession was made, the mother expressed feelings of hatred, violence, and a wish to kill.

References

McClure RJ, Davis PM, Meadow SR, Sibert JR. Epidemiology of Munchausen syndrome by proxy, nonaccidental poisoning and nonaccidental suffocation. Arch Dis Child. 1996;75:5761.

McGuire Tl., Feldman KW. Psychologic morbidity of children subjected to Munchausen syndrome by proxy. Pediatrics. 1989;83:289-292. 5. Waller DA. Obstacles to the treatment of Munchausen syndrome by proxy. JAm Acad Child Psychiatry. 1983;22:8085.

Meadow R. Munchausen syndrome by proxy: The hinterland of child abuse. The Lancet. 1977;2:343-345. 2. Morris M. Munchausen syndrome by proxy and factitious illness. Curr Opin Psychiatry. 1991;4:225-230. 3. Sigal M, Gelkopf M, Meadow RS. Munchausen by proxy syndrome: the triad of abuse, self-abuse, and deception. Compr Psychiatry. 1989;30:527533.