What is munchenhausen syndrome by proxy

The counselor on the phone can help you figure out the next steps. All calls are anonymous and confidential. Recognition of Munchausen syndrome by proxy in the child-parent relationship can prevent continued abuse and unnecessary, expensive, and possibly dangerous medical testing. Child abuse and neglect. Philadelphia, PA: Elsevier; chap 6. Dubowitz H, Lane WG. Abused and neglected children. In: Kliegman RM, St. Nelson Textbook of Pediatrics. Philadelphia, PA: Elsevier; chap Child abuse.

Textbook of Family Medicine. Philadelphia, PA: Elsevier Saunders; chap Updated by: Neil K. Editorial team. The combinations of psychoactive substances can produce extremely uncommon clinical pictures. Individuals with factitious disorder with predominant physical sign and symptoms can also be seen as substance abusers, particularly of analgesics and prescribed sedatives.

Multiple hospitalizations often lead to iatrogenic general medical conditions e. In general, individuals with factitious disorder have difficulty to maintain their job, create family ties, and stable interpersonal relationships.

The most common factitious disorders in medical and surgical clinic are shown in chart 4. Possible predisposing factors for factitious disorder can include presence of other mental disorders or medical conditions in childhood or adolescence that lead to long-term treatments and hospitalizations, resentment against medical professionals, experience in a position related to health area, presence of personality disorders, and important relationship with a physician in the past.

Information is limited about prevalence of factitious disorders, including Munchausen syndrome. However, its diagnosis is rarely reported and underdiagnosis is evident.

The disorder is reported more often among men than women. The course of factitious disorders can be limited to one or more brief episodes, but generally, it is chronic. The disorder normally occurs in the first year of adulthood, and in most of cases after hospitalization of a general medical condition or other mental disorder. Factitious disorder diagnosis must be differentiated from general real medical conditions and evident mental disorder.

Suspicion for possible mental disorders or general medical conditions that represent a factitious disorder must appear when any combination of the following factors is seen in a hospitalized patient: atypical presentation that is not classified as a general medical condition or an identified mental disorder, symptoms or behaviors present only when the individual is being observed, pseudologia fantastica, atypical behavior at hospital wards e.

In somatoform disorders, physical complaints that are not plentiful attributed to true general medical condition, but symptoms are not intentional produced. Simulation differs from factitious disorder in that motivation for production of symptoms in simulation is characterized by external incentive whereas in factitious disorder there are no external incentives. Simulation is not considered a mental disorder.

It is included in the DSM-5 and defined as intentional production of false or exaggerated physical or psychological symptoms motivated by external incentives in order to avoid mandatory military service, avoid work, obtain financial compensation, escape from criminal process, or obtain drugs. Simulation differs from factitious disorder in terms of motivation for production of symptoms.

In simulation the incentive is external while factitious disorders lack this incentive. According to DSM-5, chart 5 shows elements that strengthen the suspicion of simulation in any combination, although it is not considered a formal diagnosis criterion.

In general, treatment for factitious disorder is not based on controlled and randomized studies. In a systematic review on factitious disorders, which included 32 case reports and 13 case series, showed insufficient evidence to evaluate the effectiveness of any management technique for factitious disorders, including psychotherapy, drug treatment, behavioral therapy and multidisciplinary techniques.

No comparative analyses have been carried out between different types of therapeutic approach, although a number of techniques have been described, such as psychodynamic and behavioral techniques.

Treatment of these patients is extremely difficult; presents very low rates of adherence, poor prognosis; and few cases have improvements. It should be emphasized that most of the treatments reported in case studies or literature reviews were conducted in hospital settings, with few weeks or months of treatment, which could be an important bias in these studies.

Munchausen syndrome and Munchausen syndrome by proxy have been described in the medical literature since These are well-established terms to describe subtypes of factitious disorders. Although Munchausen syndrome has been described for more than 60 years, it is clear the scarcity of consistent studies about its epidemiology, therapeutic management and prognosis.

Most studies on factitious disorders are case reports and non-systematic literature reviews. So far few systematic and consistent studies that have sought to investigate basic issues, such as epidemiology or even clinical or psychological management of factitious disorders.

This lack of trustworthy epidemiologic studies related to these disorders is attributed to the fact that patients, when diagnosed, often do not accept their diagnosis and refuse to adhere to any treatment, and they generally continue to seek other hospitals and health services.

The fact that patients frequently do not adhere to and do not cooperate with the treatment or even deny that they have a psychiatric disorder rather than a clinical pathology constitutes a factor that undoubtedly makes it difficult to conduct epidemiological studies or clinical trials to establish therapeutic modalities such as psychotherapy or pharmacotherapy.

This fact is an important limitation both to our study and studies included in our review. Munchausen syndrome and Munchausen syndrome by proxy are associated with high morbidity, and some reports on mortality have been published.

Of note is that patients with this syndrome consume resources and time of health care teams because of the unnecessary evaluations and procedures. These disorders can be associated with iatrogenesis if factitious disorder is not detected by the physicians or even by health interdisciplinary team in the hospital or outpatient unit. In addition, when patients with factitious disorders are recognized which occurs frequently , they are rejected by health professionals that countertransference situations are seen; the health professionals discuss these situations in interdisciplinary teams or even during psychiatric or psychological consultations.

The general hospital setting in which patients are hospitalized and assisted by an interdisciplinary team with intensive care, theoretically, is the ideal environment to identify the disorder, start management and take adequate measures, especially in the case of abuse of a child, a senior or disabled person. Munchausen syndrome and Munchausen syndrome by proxy are often not identified and diagnosed by physicians and other health professionals.

The lack of identification may lead to many unnecessary laboratory tests and procedures which may prolong hospitalizations and increase costs of health systems. So far, no effective treatments have been demonstrated through well-conducted studies, and no diagnostic criteria exist; these facts may explain the little knowledge of students and health practitioners about these conditions.

Munchausen syndromes as well as Munchausen syndrome by proxy are variants of factitious disorders. They are challenging conditions in Medicine despite the current technology and knowledge on mind-body boundaries.

National Center for Biotechnology Information , U. This is a disorder in which a person causes or falsely reports his or her own symptoms. Doctors aren't sure what causes it, but it may be linked to problems during the abuser's childhood.

Abusers often feel like their life is out of control. They often have poor self-esteem and can't deal with stress or anxiety. The attention that caregivers get from having a sick child may encourage their behavior. Caregivers may get attention not only from doctors and nurses but also from others in their community. For example, neighbors may try to help the family in many ways—such as by doing chores, bringing meals, or giving money.

Checking a child's medical records for past tests, treatments, and hospital stays may help a doctor or nurse find out if a health problem is real. Child protective services, law enforcement, and doctors are all involved in treatment for Munchausen syndrome by proxy. Caregivers who have this condition need long-term counseling.

They may resist treatment or deny that there is a problem. Medicines are used only when the caregiver has another health problem, such as anxiety disorder, along with MSBP. Even after treatment, caregivers may repeat their behavior. So doctors, counselors, and family members need to closely watch how the caregiver interacts with his or her children. For victims, the first step is to protect the child by moving him or her into safe custody. Then a doctor will monitor the child for symptoms.

Most of the time, the child's symptoms stop after the child is away from the caregiver. Some children need counseling or other help. MSBP is child abuse. If you suspect that a child is a victim, don't confront the suspected caregiver. It might make the problem worse. Instead, think about these options:. Accusing a mother, father, or caretaker of intentionally creating symptoms or making a child sick is a serious matter.

Medical professionals will look for symptoms and other incriminating evidence before doing so. Doctors also can evaluate medical records. They can look for patterns that suggest something is off. For example, a child who has been seen for many different illnesses during a short period of time should trigger suspicion. If MSP is suspected, health care providers are required to report it. Unfortunately, there is no way to prevent MSP. The caregiver must recognize that his or her feelings about illness are not normal.

In those situations, seeking help could prevent them from harming a child. It is usually up to others to recognize the behavior and stop it before it escalates.

If you believe a child is in danger or is currently a victim of MSP, contact a health care professional, the police, or child protective services. Safety of the child is the No. The child should be treated for any medical problems they are having and protected from further abuse. They may need to be removed from the care of the affected caregiver. Psychological treatment may be necessary as the child recovers.

Treatment of the mother, father, or caregiver involved is not as straightforward. Many times, this person will deny playing a role, even when evidence proves it. They often have blurred what is true and what is not.

Until they are ready to recognize the truth, it will be difficult for them to get better. Psychotherapy is recommended for persons who have MSP. During these counseling sessions, the therapist helps the caregiver identify the feelings that caused his or her harmful behavior. Over time, the caregiver can learn to change that behavior. Someone living with Munchausen syndrome by proxy has a serious mental illness. It is a form of child abuse.