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, an astounding number of other hospitals."
Munchausen syndrome by proxy (MSbP) was first named by the British physician Roy Meadow in 1977, who wrote "Here are described patients who, by falsification, caused their children innumerable harmful hospital procedures, a sort of Munchausen syndrome by proxy."
Key Features of the Syndrome
Repetitive Illness in the Victim (Need for an Illness) in his original report, Meadow described a 6-year-old girl with recurrent bouts of blood and pus in her urine. He wrote: "Bouts were recurring more often and everyone was mystified by the intermittent nature of her complaint and the way in which purulent, bloody urine specimens were followed by completely clear ones a few hours later”.
The victims can be newborns, teenagers, or adults. They typically undergo long hospitalizations and frequent outpatient and emergency department visits. In one report, a child spent 43% of his life in hospital. In addition, they spend an unusually long time with their mothers and remain out of school and away from social contacts.
Separation can be instituted in the hospital by one-to-one nursing and allowing only strictly supervised visits. In these situations, early family therapy is helpful. The...