Munchausen Syndrome 1 Running head: Munchausen Syndrome Munchausen Syndrome by Proxy 5 References Author: Ibrahim Abdulhamid, MD, Assistant Professor of Pediatrics, Wayne State University; Director of Pediatric Pulmonary Medicine, Clinical Director of Pediatric Sleep Laboratory, Children’s Hospital of Michigan Coauthor(s): Patricia T Siegel, PhD, Assistant Professor, Departments of Pediatrics, Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine Contributor Information and Disclosures Updated: Mar 26, 2008
Mary E. Muscari, PhD, CPNP, APRN-BC Experts And Viewpoint, Medscape Nurses, April 2008 Munchausen Syndrome by Proxy 2 Munchausen Syndrome by Proxy I chose to write my paper on Munchausen Syndrome by proxy because I find it very fascinating and disturbing that people could actually harm their children or themselves for attention. Munchausen syndrome is a condition in which a person intentionally fakes, simulates, worsens, or self-induces an injury or illness for the main purpose of being treated like a medical patient.
The term Munchausen syndrome is often used interchangeably with factitious disorder. Factitious disorder refers to any illness that is intentionally produced for the main purpose of assuming the sick role, although that purpose is unknown to the “sick” person. Munchausen syndrome most appropriately describes persons who have a chronic variant of a factitious disorder with mostly physical signs and symptoms, although there are reports regarding psychological Munchausen syndrome, meaning that the simulated symptoms are psychiatric.
Persons with Munchausen syndrome intentionally cause signs and symptoms of an illness or injury by inflicting medical harm to their body, often to the point of having to be hospitalized. They may lie about or fake symptoms. They are sometimes eager to undergo invasive medical interventions. They are also known to move from doctor to doctor, hospital to hospital, or town to town to find a new audience once they have exhausted the workup and treatment options available in a given medical setting. Persons with Munchausen syndrome may also make false claims about their accomplishments, credentials.
A related condition, called Munchausen by proxy syndrome, refers to a caregiver who fakes symptoms by causing injury to someone else, often a child, and then wants to be with that person in a hospital or similar medical setting. Victims are equally divided between male and female, and children most at risk are those aged 15 months to 72 months. Older children subjected to Munchausen syndrome by proxy often collude with their mothers by confirming even the most unlikely stories about their medical histories, sometimes out of fear of contradicting their mothers and other times because of their mothers’ persuasion over time.
Some of these children believe that they are ill with a mysterious disorder that the physicians Munchausen Syndrome by Proxy 3 cannot figure out. In other cases, the child is aware that the mother’s explanation is improbable but fails to speak, fearing the mother’s revenge or that no one will believe him or her. In mild Munchausen by proxy, affected individuals fabricate medical histories for their children and lie about their children being sick rather than actively causing sickness. Their motivation is the emotional gratification they receive from medical attention.
In intense Munchausen syndrome by proxy, the person resorts to measures such as inducing vomiting, poisoning, removing blood from the child, and suffocation. The individual is able to induce severe illness in his or her own child, yet remain cooperative, concerned, and compassionate in the presence of healthcare providers. Perpetrators of MSBP may be help-seekers who search for medical attention for their children to communicate their own exhaustion, anxiety, or depression. Others may be active inducers who create their child’s illnesses through dramatic measures.
These parents are typically anxious, depressed, or paranoid. Finally, some may be “doctor addicts” who are obsessed with getting treatment for their children’s nonexistent illnesses. Perpetrators are frequently described as caring, attentive, and devoted individuals. Some can be hostile, emotionally labile, and obviously dishonest. Although they have no obvious psychopathology, perpetrators can be deceiving and manipulative. Their ability to convince others should not be underestimated.
Their abuse is premeditated, calculated, and unprovoked and they are often fascinated with the medical field. Signs and symptoms that MSBP could be present includes pattern of illness and recurrent infections without physiologic explanations, bleeding from anticoagulants and poisons: use of the caretaker’s own blood, vomiting precipitated by ipecac administration, giving them laxatives to induce diarrhea or salt administration, applying caustic substances to cause rashes on the their skin, Hematuria or rectal bleeding from trauma, CNS depression caused by drug administration.
Their illness is multisystemic, prolonged, unusual, or rare; they are also inappropriate or incongruent, the symptoms seem to disappear when the caretaker is absent, one parent is usually absent during the child’s Munchausen Syndrome by Proxy 4 hospitalization, parent is overly attached to the child, they seem to have medical knowledge/background, the child has a poor tolerance of the treatment, parent encourage doctors to perform numerous test. The causes of Munchausen syndrome are unknown.
Some experts suggest that it is a defense mechanism against sexual and aggressive impulses. Others believe it may be a form of self-punishment. Determining an exact cause is difficult because persons with Munchausen syndrome are not open and honest about their condition, making research on them nearly impossible. With MSBP a diagnosis cannot be made quickly, this syndrome is difficult to detect and confirm. In some cases video surveillance in the hospital room has been recommended to capture a parent’s misbehavior when physical abuse of the child is suspected.
In cases where symptoms have been exaggerated, hidden cameras may confirm that these symptoms do not exist. Conversely, video surveillance can also exonerate a suspected caregiver when the disease does, in fact, exist. Cameras may be used in highly suspicious circumstances, but should only be used in conjunction with carefully developed protocols that delineate the roles of child protective agencies, police, and hospital security in coordinating the use of covert surveillance systems As a health care orker I will be more able to identify the signs and symptoms, determine the necessity and benefits of the medical care. During the assessment I will be able ask if the child’s medical condition is consistent with the mother’s description. Does the objective diagnostic evidence support the child’s reported medical condition? Has anyone witnessed the symptoms? Do the negative findings reassure the mother? Is the treatment being provided to the child primarily because of the mother’s persistent demands? With this knowledge I will hopefully be able to recognize this syndrome and be a better nurse.