Munchausen Syndrome by Proxy as a Cause of Child Abuse

Munchausen syndrome by proxy (MSBP) is a rare form of mental disorder and is known as a particular type of child abuse. MSBP has been described since 1977 as a severe form of abuse with illness falsification or the intentional harming by guardians, mostly mothers. The perpetrator of MSBP may inflict damage to the child directly or indirectly through medical procedures. The perpetrator’s alleged motive is to satisfy her psychological needs, and she has a history of mental illness, mostly, factitious disorder, personality disorder, and somatic disorder. The pathology is not well known; as such, it is difficult for medical personnel to detect it early. In addition, it is hard to be handled effectively by the police and child welfare agencies because of the scarcity of evidence. Therefore, the authors attempt to examine the essential information from early detection and child abuse prevention by analyzing its clinical characteristics and the perpetrator’s characteristics, including alerting signs of MSBP. For this purpose, we focus on the role of nursing staff to detect this unusual cause of child abuse.

MUNCHAUSEN BY PROXY SYNDROME

In this study, the main aim is to shed light onto the Munchausen by Proxy Syndrome news case articles from Turkey and the USA as well as to increase awareness related to the topic. Munchausen Syndrome by Proxy is a form of child abuse and as the perpetrator of the abuse mostly a parent of the victim, it is not easy to prove the abuse by the medical staff. Most of the time, the perpetrator is ‘mother’ of the child, who fabricates a story about the child’s sickness and seeks for medical attention for the child.

Particularities of Münchausen Syndrome by Proxy

This article contributes to a wider understanding of the Münchausen syndrome by proxy, which is a form of child abuse, very complex and destructive, difficult to diagnose and individualized. The abuser, most often the mother induce the symptom to the child, for which he addresses and requires the intervention of a specialist. Thus, the victim is subject to medical treatments, often invasive and very painful but unnecessary. The complexity of this type of abuse also consist in the difficulty of an early diagnosis as well as in the anticipated perception of the risk of Münchausen victimization. The paper aims to inform those who are directly or indirectly in contact with problems related to this syndrome.

First Report of “Munchausen Syndrome by Proxy Variant” in an Injection Drug User with 12 New Organisms in Blood Cultures 17 Days after Admission to the Hospital

The term Munchausen syndrome is used to describe a situation where a person inflicts an illness or injury on self. Munchausen syndrome by proxy is when a person fabricates an illness on behalf of another. We report the case of an injection drug user admitted to the hospital for a spinal epidural abscess which was drained, treated with antibiotics and doing well, suddenly becoming very sick and febrile on day 17. The blood cultures grew a total of 12 organisms including 2 fungi. Someone who visited the patient in the hospital around this time was suspected to have injected a solution of drugs brought from home directly into the patient’s intravenous line used to administer antibiotics resulting in a polymicrobial bacteremia/fungemia. Presence of Lactobacilli in one blood culture raised the suspicion that the girl friend who was also a drug user, may have been responsible as Lactobacilli are more frequently found in hands of females. We caution physicians and nurses to be vigilant when handling injection drug users and other drug abusers admitted to hospital. Materials brought to the patient’s room from outside must be screened. New onset of unexpected symptoms should alert caregivers of the possibility of such abuse.

Munchausen syndrome by proxy (MSBP): a review regarding perpetrators of factitious disorder imposed on another (FDIA)

Munchausen syndrome by proxy (MSBP) is well-known to clinicians, but its usage is discouraged now in favor of other terms placing emphasis on the victim. This study aims to determine the most common characteristics of perpetrators but only in case reports labeled as MSBP, published in PubMed literature in the past 15 years. MSBP has been described as a rare form of abuse due to illness falsification, where the perpetrator usually receives the diagnosis of factitious disorder imposed on another (FDIA). We extracted data from 108 articles, including 81 case reports. Almost all perpetrators were female (91% female, 1% female and male, 7% unreported). Twenty-three cases (28%) had a perpetrator with psychiatric diagnosis: factitious disorder imposed on self (10%), depression (9%), and personality disorders (7%). In more than one-third (36%) there was familial conflict or abuse. Fourteen cases (17%) had perpetrators working in healthcare. The most common type of falsification was induction (74%); however, 15% of cases had more than one type of falsification. The most common outcomes were: separation (37%); no follow-up (22%); imprisonment (14%); death of victim (12%); treatment of the perpetrator (10%); continued living together (4%); and suicide of perpetrator (1%). Recurrence was present in more than three quarters of cases. Our results reiterate that awareness of the most common findings in MSBP allows physicians to identify them in a clinical context.