Munchausen Syndrome By Proxy
Fabricated or induced illness (FII), or factitious disorders, originally and more commonly known as Munchausen syndrome or Munchausen syndrome by proxy (MSbP), are insidious disorders in which injury is deliberately and gradually inflicted upon a person usually for gaining attention or some other benefit.
The caregiver is usually a parent, guardian, or spouse, and the victim is usually a child or vulnerable adult. Although cases with feigned or induced physical illness receive the most attention, it is also possible for a perpetrator who emotionally abuses a victim to simulate and fabricate conditions that appear to be psychiatric or genetic problems.
Caution is required in the diagnosis of FII. Many of the items below are also indications of a child with organic, but undiagnosed illness. An ethical diagnosis of MSbP must include an evaluation of the child, an evaluation of the parents and of the family dynamics. Diagnoses based only on a review of the child's medical chart can be rejected in court.
* A child who has one or more medical problems that do not respond to treatment or that follow an unusual course that is persistent, puzzling and unexplained.
* Physical or laboratory findings that are highly unusual, discrepant with history, or physically or clinically impossible.
* A parent who appears to be medically knowledgeable and/or fascinated with medical details and hospital gossip, appears to enjoy the hospital environment, and expresses interest in the details of other patients’ problems.
* A highly attentive parent who is reluctant to leave their child’s side and who themselves seem to require constant attention.
* A parent who appears to be unusually calm in the face of serious difficulties in their child’s medical course while being highly supportive and encouraging of the physician, or one who is angry, devalues staff, and demands further intervention, more procedures, second opinions, and transfers to other, more sophisticated, facilities.
* The suspected parent may work in the health care field themselves or profess interest in a health-related job.
* The signs and symptoms of a child’s illness do not occur in the parent’s absence (hospitalization and careful monitoring may be necessary to establish this causal relationship).
* A family history of similar or unexplained illness or death in a sibling.
* A parent with symptoms similar to their child’s own medical problems or an illness history that itself is puzzling and unusual.
* A suspected emotionally distant relationship between parents; the spouse often fails to visit the patient and has little contact with physicians even when the child is hospitalized with serious illness.
* A parent who reports dramatic, negative events, such as house fires, burglaries, or car accidents, that affect them and their family while their child is undergoing treatment.
* A parent who seems to have an insatiable need for adulation or who makes self-serving efforts for public acknowledgment of their abilities.
In Munchausen syndrome, the affected person exaggerates or creates symptoms of illnesses in themselves in order to gain investigation, treatment, attention, sympathy, and comfort from medical personnel. In some extremes, people suffering from Munchausen's Syndrome are highly knowledgeable about the practice of medicine, and are able to produce symptoms that result in multiple unnecessary operations. For example, they may inject a vein with infected material, causing widespread infection of unknown origin, and as a result cause lengthy and costly medical analyses and prolonged hospital stay. The role of "patient" is a familiar and comforting one, and it fills a psychological need in people with Munchausen's. It is distinct from hypochondria in that patients with Munchausen syndrome are aware that they are exaggerating, while sufferers of hypochondria actually believe they have a disease.