Munchausen syndrome by proxy: A narrative review and update for the dentist and other healthcare professionals.

Munchausen syndrome by proxy (MSbP) is a form of abuse in which a caregiver with Factitious Disorder Imposed on Another (FDIA) fabricates or induces signs or symptoms in a person under their care to satisfy a self-serving psychological need. Unnecessary clinical evaluations, procedures, and treatments that are initiated based on falsification by the abuser inadvertently add to the trauma experienced by the victim. It is a form of abuse and the impact on victims can be severe, sometimes fatal, and far-reaching such as prolonged neglect and extension to affected siblings. The long-term exposure to MSbP may predispose the victim to eventually developing factitious disorder imposed on self (FDIS). While MSbP often involves child victims, elderly, adults, and pets have also been reported as victims. MSbP can be a diagnostic challenge, and the important keys to timely identification of MSbP include the ability to detect deception by caregivers through awareness, clinical suspicion, and careful review of available health records; it also involves collecting collaborative information from other relevant healthcare providers including dentists, schoolteachers, and social workers. To date, there are limited published cases of MSbP with oral findings. This paper provides a narrative review of the current understanding of MSbP with a section on cases with oral findings. This paper aims to increase awareness about the clinical presentations and management considerations for MSbP among dentists and other healthcare professionals.

The perpetrators of medical child abuse (Munchausen Syndrome by Proxy) - A systematic review of 796 cases.

INTRODUCTION: Little is known about the perpetrators of medical child abuse (MCA) which is often described as "Munchausen's syndrome by proxy" or "factitious disorder imposed on another". The demographic and clinical characteristics of these abusers have yet to be described in a sufficiently large sample. We aimed to address this issue through a systematic review of case reports and series in the professional literature. METHOD: A systematic search for case reports and series published since 1965 was undertaken using MEDLINE, Web of Science and EMBASE. 4100 database records were screened. A supplementary search was then conducted using GoogleScholar and reference lists of eligible studies. Our search yielded a total sample of 796 perpetrators: 309 from case reports and 487 from case series. Information extracted included demographic and clinical characteristics, in addition to methods of abuse and case outcomes. RESULTS: Nearly all abusers were female (97.6%) and the victim's mother (95.6%). Most were married (75.8%). Mean caretaker age at the child's presentation was 27.6 years. Perpetrators were frequently reported to be in healthcare-related professions (45.6%), to have had obstetric complications (23.5%), or to have histories of childhood maltreatment (30%). The most common psychiatric diagnoses recorded were factitious disorder imposed on self (30.9%), personality disorder (18.6%), and depression (14.2%). CONCLUSIONS: From the largest analysis of MCA perpetrators to date, we provide several clinical recommendations. In particular, we urge clinicians to consider mothers with a personal history of childhood maltreatment, obstetric complications, and/or factitious disorder at heightened risk for MCA. Longitudinal studies are required to establish the true prognostic value of these factors as our method may have been vulnerable to publication bias.

Spitting in the ear: a falsified disease using video evidence.

We present the case of Munchausen's syndrome by proxy (MSBP) in which the mother spat and placed blood in her child's ear, and videoed the result, in order to gain the attentions of the medical profession. This is the first case report of this kind and may represent a disturbing trend in the use of digital photography and video to support factitious illnesses.

Munchausen syndrome by proxy: unusual manifestations and disturbing sequelae.

Since the initial description of Munchausen Syndrome by Proxy (MSBP) (Meadow, 1977), numerous cases have been reported varying from as simple as the complaint of a nonexistent symptom to those as complicated as altered laboratory tests leading to the false diagnosis of cystic fibrosis (Orenstein & Wasserman, 1986; Rosenberg, 1987). We report three findings previously unreported: esophageal perforation, retrograde intussusception, and tooth loss. Bradycardia has been previously reported associated with suffocation (Meadow, 1984), but in our case may have been caused by carotid artery massage. We also suggest possible induction by the mother of premature rupture of fetal membrane leading to delivery of infected infants.

Lesiones orales en víctimas del síndrome de munchausen por poder / Oral lesions in victims of munchausen syndrome by proxy

Resumen La presente es una revisión bibliográfica de casos publicados de niños con manifestaciones orales de maltrato físico, específicamente del Síndrome de Munchausen por poder. Tiene como objetivo resumir y presentar las características de las lesiones de víctimas del Síndrome, utilizando las principales bases de datos de publicaciones científicas. Se encontraron 9 casos, en todos ellos la victimaria fue la madre. Las lesiones se localizaron en la mucosa orofaríngea, las encías, la lengua, el paladar y los labios; fueron causadas por sustancias tóxicas administradas por vía oral o por compresión manual de la boca. En dos casos la víctima falleció. Se registró la muerte previa de 6 hermanos de las víctimas. Finalmente, se propone un esquema de evaluación odontológica forense para establecer o descartar que las lesiones de la cavidad oral sean parte del Síndrome.

Abstract This is a literature review of published cases of children with oral manifestations of physical abuse, specifically of Munchausen Syndrome by proxy. It is intended to summarize and present the characteristics of injuries of victims of the Syndrome, using the main databases of scientific publications. 9 cases were found, all of them the perpetrator was the mother. The lesions were found in the oropharyngeal mucosa, gums, tongue, palate and lips; they were caused by toxic substances administered orally or by manual compression of the mouth. In two cases the victim died. The previous death of 6 brothers of the victims was recorded. Finally, a forensic dental evaluation scheme intends to establish or rule out that lesions of the oral cavity are part of the syndrome.

Witchcraft's syndrome: Munchausen's syndrome by proxy.

A 28-year-old man presented to the Dermatology Outpatient Department with a complaint of a burning sensation and soreness over his left cheek and left ear of 10 days duration. It had started suddenly one morning when he woke up from sleep. He noticed a large blister with intense redness over his left cheek, associated with a burning sensation. There was a history of similar episodes over the past year, and all were sudden in onset, involved the cheeks, and were noticed after waking up from sleep. The patient volunteered that the episodes were always associated with a drinking spree the previous night. The individual was a healthy man with a wife and two children. The patient had been dependent on alcohol for the past year, and had been consuming alcohol for many years. On examination, there was an eschar occupying almost the entire cheek, with a few scattered lesions over the left tragus and left external ear. Peripheral scarring was noted with hyperpigmentation. While the angle of the mouth was superficially involved on the left side, the oral mucosa was normal. The right cheek also showed a few areas of scarring with patches of alopecia. There were no similar lesions elsewhere on the body. The peculiar history and the morphology of the lesion, that defied any classical diagnosis description, prompted us to interrogate both the man and his wife with regard to any serious differences. After much persuasion and on assurance of secrecy, the wife admitted that her husband was an alcoholic and was neglecting his family. When her efforts to prevent his drinking failed, she resorted to this drastic measure. Each time he passed out after a drinking bout, she poured acid on his cheek, hoping that the sequelae would frighten him from drinking. The acid was readily available to her as she used it for domestic cleaning. The couple were sent for psychiatric evaluation as Munchausen's syndrome by proxy (MSBP) or witchcraft's syndrome (WS) was suspected. Detailed psychiatric evaluation, together with psychometric assessment, revealed that the patient had an alcohol dependence (Axis-I diagnosis) and had a cyclothymic personality. Severe marital discord due to alcohol dependence had been present for the past 2 years. Evaluation of the patient's wife revealed that she was under significant psychologic distress. She showed major depressive symptoms with a histrionic personality. She revealed that she had resorted to using the corrosive out of frustration and anger over the behavior of the patient while he was in an inebriated state. The couple are currently undergoing psychiatric treatment.