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What is Munchausen syndrome by proxy?
Munchausen syndrome by proxy (MSP), a type of factitious disorder, is a
mental illness in which a person acts as if an individual he or she is caring
for has a physical or mental illness when the person is not really sick. People
with MSP assume the role of a sick person indirectly by producing or lying about
illness in another person under their care, usually a child under 6 years of age. However, cases have been reported of adult victims of MSP. (The term
"by proxy" means "through a substitute.")
People with MSP have an inner need for the other
person (often his or her child) to be seen as ill or injured. It is not done to achieve a
concrete benefit, such as financial gain. People with MSP are even willing to have
the child or other patient undergo painful or risky tests and operations in
order to get the sympathy and special attention given to people who are truly
ill and their families. Factitious disorders are considered mental illnesses
because they are associated with severe emotional difficulties.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition (DSM-IV), which is the standard reference book for recognized mental
illnesses in the United States, organizes factitious disorders into four main
types: those with mainly psychological symptoms, those with mainly physical
symptoms, those with both physical and psychological symptoms, and those that do
not match the conditions for the other three types. MSP falls into the fourth
category.
MSP most often occurs with mothers—although it can occur with fathers—who
intentionally harm or describe non-existent symptoms in their children to get the attention given to
the family of someone
who is sick. A person with MSP uses the many hospitalizations as
a way to earn praise from others for her devotion to the child’s care, often
using
the sick child as a means for developing a relationship with the doctor or other
health care provider.
People with MSP might create or exaggerate the child’s symptoms in several
ways. They might simply lie about symptoms, alter diagnostic tests (such as
contaminating a urine sample), falsify medical records, or induce symptoms
through various means, such as poisoning, suffocating, starving, and causing
infection.
What are the symptoms of Munchausen syndrome by proxy?
Certain characteristics are common in a person with MSP:
- Often is a parent, usually a mother, but can be the adult child of an
elderly patient
- Might be a health care professional
- Is very friendly and cooperative with the health care providers
- Appears quite concerned (some might seem overly concerned) about the
child or designated patient
- Might also suffer from Munchausen syndrome (This is a related disorder in which the
caregiver repeatedly acts as if he or she has a physical or mental illness when he
or she has caused the symptoms.)
Other possible warning signs of MSP in children include the following:
- The child has a history of many hospitalizations, often with a
strange set of symptoms.
- Worsening of the child’s symptoms generally is reported by the
mother and is not witnessed by the hospital staff.
- The child’s reported condition and symptoms do not agree with the
results of diagnostic tests.
- There might be more than one unusual illness or death of children in
the family.
- The child’s condition improves in the hospital, but symptoms
recur when the child returns home.
- Blood in lab samples might not match the blood of the child.
- There might be signs of chemicals in the child’s blood, stool, or
urine.
What causes Munchausen syndrome by proxy?
The exact cause of MSP is not known, but researchers believe both biological and psychological factors
play a role in the development of this disorder.
Some theories suggest that a history of abuse or neglect as a child or the
early loss of a parent might be factors in its development. Some evidence suggests
that major stress, such as marital problems, can trigger an MSP episode.
How common is Munchausen syndrome by proxy?
There are no reliable statistics regarding the number of people in the United
States who suffer from MSP, and it is difficult to assess how common the
disorder is because many cases go undetected. However, estimates suggest that
about 1,000 of the 2.5 million cases of child abuse reported annually are
related to MSP.
In general, MSP occurs more often in women than in men.
How is Munchausen syndrome by proxy diagnosed?
Diagnosing MSP is very difficult because of the dishonesty that is involved.
Doctors must rule out any possible physical illness as the cause of
the child’s symptoms, and often use a variety of diagnostic tests and
procedures before considering a diagnosis of MSP.
If a physical cause of the symptoms is not found, a thorough review of the
child’s medical history, as well as a review of the family history and the
mother’s medical history (many have Munchausen syndrome themselves) might
provide clues to suggest MSP. Remember, it is the adult, not the child, who is
diagnosed with MSP. Indeed, the most important or helpful part of the work-up is
likely to be the review of all old records that can be obtained. Too often, this
time-consuming, but critical, task is forgotten and the diagnosis is missed.
How is Munchausen syndrome by proxy treated?
The first concern in cases of MSP is to ensure the safety and protection of
any real or potential victims. This might require that the child be placed in the
care of another. In fact, managing a case involving MSP often requires a team
that includes social workers, foster care organizations, and law enforcement, as
well as the health care providers.
Successful treatment of people with MSP is difficult because those with the
disorder often deny there is a problem. In addition, treatment success is
dependent on the person telling the truth, and people with MSP tend to be such
accomplished liars that they begin to have trouble telling fact from fiction.
Psychotherapy (a type of counseling) generally focuses on changing the
thinking and behavior of the individual with the disorder (cognitive-behavioral
therapy). The goal of therapy for MSP is to help the person identify the
thoughts and feelings that are contributing to the behavior, and to learn to
form relationships that are not associated with being ill.
What are the complications of Munchausen syndrome?
This disorder can lead to serious short- and long-term complications,
including continued abuse, multiple hospitalizations, and the death of the
victim. (Research suggests that the death rate for victims of MSP is about 10
percent.) In some cases, a child victim of MSP learns to associate getting
attention to being sick and develops Munchausen syndrome him or herself. MSP is considered a form of child abuse, which is a criminal offense.
What is the prognosis (outlook) for people with Munchausen syndrome?
In generally, MSP is a very difficult disorder to treat and often requires
years of therapy and support.
Can Munchausen syndrome be prevented?
There is no known way to prevent this disorder. However, it might be helpful to
begin treatment in people as soon as they begin to have symptoms. Removing the
child or other victim from the care of the person with MSP can prevent further
harm to the victim.
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