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.

[Medical Child Abuse - A Guideline to Detecting this Particular Form of Child Maltreatment]. / Medical Child Abuse ­ Ein Leitfaden zur Diagnostik dieser Sonderform der emotionalen und körperlichen Gewalt.

The term Medical Child Abuse (MCA) describes a form of child abuse in which the medical system is "abused" by carrying out unnecessary medical procedures on a child. This abuse of the medical system occurs through misrepresentation, non-disclosure, fabrication, misinterpretation or active causation of symptoms by a parent. In this article, the construct ofmedical child abuse is defined and predisposing and motivational factors are examined. It also provides an overview of terms that are used synonymously or comparably in the literature and discusses the connection between MCA and Munchausen-by-proxy-syndrome.The core of the article is the presentation of an internal guideline, which was created by the interdisciplinary working group on MCA of the Clinics for Paediatric and Adolescent Medicine, the Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, the Child Protection Outpatient Clinic and the Social Services at the Charité. It also outlines possible interventions.

Medical child abuse: Medical history and red flags in French adolescents.

BACKGROUND: Medical child abuse (MCA; or Munchausen syndrome by proxy) is a severe form of adult and medical maltreatment of children. Currently, few data on MCA in adolescents exist. OBJECTIVE: To describe the clinical characteristics and medical history of children and adolescents aged 10 to 18 years with suspected or confirmed MCA in the pediatric hospital setting. METHODS: We included patients aged 10 to 18 years who were seen in five tertiary care hospitals in the Paris area and identified by physician recall such as suspected MCA between 2015 and 2021. RESULTS: We included 29 adolescents; the mean (SD) age was 12.9 (10.8-15.0) years at suspected diagnosis. Medical wandering was common, with a mean of 23 (12.8-33.2) alleged symptoms and 33 (9.2-56.8) specialized consultations in a mean of six different hospitals. The mean number of emergency visits was 11.8 (0-25.9) and radiologic exams 24.3 (5-43.6). Overall, 62 % (18/29) of the adolescents had an underlying organic pathology. The impact of MCA on quality of life was major, with a high rate of school dropout (96 %). The mean delay to the suspected diagnosis was 5.8 (2.6-9) years, and even when recognized, it was rarely the subject of a social or judiciary report (only 42 % of adolescents). In total, 50 % of the adolescents subsequently exhibited Munchausen syndrome. CONCLUSION: Adolescent MCA is poorly known among the medical profession. Increasing awareness, education and knowledge of risk factors could contribute to better care.

Medical Child Abuse: A Review by Subspecialty.

Medical child abuse (MCA), formerly called Munchausen syndrome by proxy (MSP or MSBP), occurs when a caregiver, usually the mother, falsifies or exaggerates symptoms resulting in harm to a child through inappropriate medical care. MCA is underrecognized, underreported, and results in significant morbidity and mortality. Pediatrics subspecialists should consider MCA when unusual disease presentation [THAT] do not respond to traditional treatments. This article reviews the more common diagnoses encountered in MCA cases by specialty.

Actitudes hacia el síndrome de Münchhausen por poderes / Attitudes towards Münchhausen Syndrome by Proxy

Münchhausen’s syndrome by proxy (MSBP) is a form of child abuse characterized by the primary caregiver of a minor simulating or fabricating symptoms in him/her of a physical, psychiatric type or both. The aim is to study the attitudes of the general population towards SMP, determining whether there are differences according to variables, as well as attachment, family structure, levels of anxiety, and the degree of contact with people diagnosed with mental disorders. Have been selected 268 Spanish subjects participated (153 females, M= 33.08 years, SD= 13.875) by opinion sampling. Significant differences were found in attitudes towards SMP as a function of educational level, presence of disorganized attachment indicators, family structure and S/A levels. This study contributes to the analysis of the attitudes of the general population towards the SMP and to its better understanding (AU)

Munchausen syndrome by proxy: a case report.

BACKGROUND: Inappropriately high levels of insulin secretion can cause the potentially fatal condition of persistent hyperinsulinemic hypoglycemia of infancy. Our paper focuses on another cause of severe hypoglycemia, which can be easily missed. CASE PRESENTATION: An 18-month-old Saudi female was referred to our hospital for further investigation and management of her recurrent hypoglycemic attacks as a case of persistent hyperinsulinemic hypoglycemia of infancy. During admission, we noticed multiple red flags from the history; the mother was insisting on a pancreatectomy, rather than going for a positron emission tomography scan, and most importantly, all hypoglycemic attacks occurred while the mother was around. Consequently, after further investigation, the case was diagnosed as a caregiver-fabricated illness, and the case was referred to the Child Protection Center. CONCLUSIONS: One must have a high index of suspicion to diagnose caregiver-fabricated illness. Physicians should be more attentive to prevent such a disease, which could eventually become lethal if left unnoticed.

Factitious Disorder Imposed on Another in Palliative Care: A Case Report.

In palliative care, many end-of-life (EOL) patients are physically dependent on their caregivers. These patients may also have difficulty expressing their needs because of their underlying disease and are vulnerable to abuse. Factitious disorder imposed on another (FDIA) describes a condition in which an individual intentionally feigns physical or psychological signs or symptoms in another person with the intention of deceiving medical providers. Although FDIA is a form of abuse that palliative care workers must be aware of because of its multiple impacts on EOL care, it has never been reported in the palliative care literature. In this case discussion, we highlight a woman with advanced dementia who was subjected to FDIA. We discuss the impact of FDIA on EOL care and the management of FDIA in palliative care.

Suspicion of Munchausen syndrome by proxy with a child's presentation of undernutrition, scurvy, and an apparent Avoidant Restrictive Food Intake Disorder.

PURPOSE: Avoidant Restrictive Food Intake Disorder (ARFID) was recently characterized in the DSM-5 classification. Potential differential diagnoses remain poorly reported in the literature. Our purpose was to present a possible Munchausen syndrome by proxy with undernutrition and scurvy, presenting as ARFID in a child. METHODS: We describe here a case of an 8-year-old boy who presented with severe undernutrition (BMI = 11.4) and scurvy leading to joint pains. The boy had had a very selective diet since early childhood, and his condition required hospitalization and enteral refeeding. Because of his specific eating behaviour, an ARFID was initially suspected. However, observation of the mother-child relationship, analysis of the child's eating behaviour, and retrospective analysis of his personal history suggested that this was not a true ARFID, and that the selective eating behaviour had probably been induced by the mother over many years, who probably maintained a low variety diet. CONCLUSION: Munchausen syndrome by proxy is a difficult differential diagnosis, which may also affect patients with ARFID symptoms, which may also present in the affected child as apparent ARFID. LEVEL OF EVIDENCE: Level V, descriptive study.

Organophosphate insecticide poisoning with monocrotophos-induced fabricated illness in a 7-year-old girl with refractory seizures over a 4-year period.

Munchausen syndrome by proxy is a form of abuse in which an adult, usually the mother, deceives health workers by exaggerating, falsifying or directly inducing psychological or physical symptoms in the child victim for psychological gratification. In 2013, the American Academy of Pediatrics coined the term 'caregiver-fabricated illness in a child' to describe this form of child abuse. A 7-year-old girl had many encounters with health workers over a period of 4 years and presented with evolving clinical features including refractory seizures and red urine for which she was followed up as a case of acute intermittent porphyria. She was later discovered to be the victim of chronic monocrotophos organophosphate poisoning by her mother. If all medical staff who manage children are to avoid becoming inadvertent participants in medical child abuse, this case report is an important reminder that a high index of suspicion is warranted in cases which present a diagnostic dilemma and who respond unexpectedly to treatment.Abbreviations AIP: Acute intermittent porphyria; APSAC: American Professional Society on the Abuse of Children; ASM: anti-seizure medication; CFIC: caregiver-fabricated illness in a child; CT: computed tomography: DVT: deep vein thrombosis; EEG: electroencephalogram: ESR: erythrocyte sedimentation rate; HDW: high-dependency ward; ICU: intensive care unit; LFT: liver function test; MBP: Munchausen syndrome by proxy; NICU: neonatal intensive care unit; RFT: renal function test; TB: Tuberculosis; UTH-CH: University Teaching Hospitals Children's Hospital.

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.

Child Maltreatment and Neglect.

Emergency medicine clinicians are mandated reporters, legally, which obligates clinicians to report any behavior suspicious for child maltreatment to local authorities. Pediatric patients often present to the emergency department with concern for physical injury and other pervasive complaints. In some cases, these injuries are nonaccidental. To appropriately advocate and protect children from further physical and emotional trauma, it is important for clinicians to recognize the signs and symptoms of child maltreatment and sexual abuse.

Evaluation and Management of Factitious Disorder Imposed on Another.

Munchausen by proxy refers to an individual who abusively and compulsively falsifies physical, psychiatric or developmental disorders in a child or adult victim in order to satisfy a psychological need. Factitious disorder imposed on another refers to the psychopathology in the abuser. Psychologists in medical settings may: (1) identify patients they come to suspect as being victims or perpetrators of MBP, (2) conduct or assist in clinical or forensic evaluations; (3) offer recommendations for clinical case management, and/or (4) provide treatment or referrals. The purpose of this paper is to provide guidance to psychologists and other mental health professionals in medical settings who may encounter individuals with this potentially lethal form of psychopathology.

Munchausen by Proxy Syndrome Associated with Fecal Contamination: A Case Report. / Fekal Kontaminasyon ile Ortaya Çikan Munchausen by Proxy Sendromu: Bir Olgu Sunumu.

Factitious disorder imposed on another, also known as Munchausen Syndrome by Proxy (MSBP), is a serious form of child abuse that is difficult to diagnose. In general, signs and symptoms are fabricated or produced by the mother or the caregiver. Delay in diagnosis may cause serious morbidity and mortality. Here, we present the case of an 18-month-old boy who was admitted to the Paediatric Infection Clinic with a diagnosis of acute gastroenteritis. When on intravenous fluid therapy, he developed high fever and subsequently, polymicrobial growth was determined in his blood. He was later diagnosed with MSBP. Despite being a rare condition, MSBP is a disorder that is often overlooked and may have fatal outcomes. Early diagnosis is very important in this disorder, which is considerably difficult to diagnose. In suspected cases, interdisciplinary team work is necessary to prevent adverse consequences.

Revisión sistemática del síndrome de Münchhausen por poderes o trastorno facticio impuesto a otro: psicobiografía de la perpetradora, el proceso de peregrinación hospitalaria y signos de alarma en la víctima / The Münchhausen syndrome by proxy: a systematic review. psychobiography of the perpetrator, hospital pilgrimage process and victims' red flags

INTRODUCCIÓN: En 1977, Roy Medow acuña y describe el síndrome de Münchhausen por poderes como una enfermedad mental en la que una cuidadora miente al doctor sobre la salud de su hijo mediante la fabricación de signos físicos, la alteración del historial médico o la inducción de síntomas. En la actualidad, es recogido en el DSM-5 bajo el nombre de trastorno facticio impuesto a otro. Se estima que afecta a 0.2 - 2 cada 100.000 niños menores de 16 años. OBJETIVO: Aportar información sobre la psicobiografía de la perpetradora diagnosticada de trastorno facticio impuesto a otro, con el objetivo de establecer un perfil de sospecha en aquellas presentaciones médicas inusuales en la práctica clínica. MÉTODOS: Revisión sistemática de los artículos publicados desde el año 2000 en la base de datos PubMed, que incorporen los términos "Münchhausen syndrome by proxy" y "factitious disorder". Se incluyeron libros y documentos, artículos de revistas científicas y revisiones en inglés y castellano. Se excluyeron aquellos artículos con una muestra menor a 20 casos analizados. RESULTADOS: La perpetradora se dibuja generalmente como la madre de la víctima en la mayoría de los casos, con unos antecedentes vividos de maltrato infantil y de abusos de distinta índole. Gran parte de estas, recibieron atención psiquiátrica en la infancia, y también en la vida adulta. Suelen presentar comorbilidades psicopatológicas, en especial el trastorno facticio impuesto a uno mismo y los trastornos de personalidad, sobresaliendo el límite. Por otro lado, la víctima es habitualmente un menor de 5 años, con una morbimortalidad importante. La peregrinación hospitalaria, la necesidad de ingresos hospitalarios prolongados, así como la realización de intervenciones invasivas, son consecuencias evidentes en estos menores. CONCLUSIONES: Si bien es cierto que en esta revisión se han arrojado cifras al respecto, no sería correcto utilizar estos resultados categóricamente, ya que se han dado casos en la literatura médica de perpetradoras que no eran figuras femeninas, y de víctimas que no eran menores. Para futuros estudios, sería interesante observar a nivel retrospectivo la aparición de patología psiquiátrica en las víctimas y valorar la posibilidad de la repetición de determinados roles de maltrato

BACKGROUND: In 1977, Roy Medow named and described Münchhausen's syndrome by proxy as a mental illness in which a caregiver lies to the doctor about his child's health situation by making physical signs, altering the medical history or inducing symptoms. Currently, it is collected in DSM-5 under the name of factitious disorder imposed on another. It is estimated to affect 0.2 - 2 per 100,000 children under the age of 16. OBJECTIVE: Provide information about the psychobiography of the perpetrator diagnosed with factitious disorder imposed on another, with the aim of establishing a suspicious profile in those unusual medical presentations in clinical practice. METHODS: Systematic review of articles published since 2000 in the PubMed database, incorporating the terms "Münchhausen syndrome by proxy" and "factitious disorder". Books and documents, articles from scientific journals and reviews were included, in both English and Spanish. Those articles whose sample was less than 20 analyzed cases were excluded. RESULTS: The perpetrator is generally portrayed as the victim's mother in most cases, with a vivid history of child abuse and abuse of various kinds. Most of them received psychiatric care in childhood, and also during adult life. They usually present psychopathological comorbidities, especially factitious disorder imposed on self and personality disorders, especially the Borderline personality disorder. On the other hand, the victim is usually a child under the age of 5, with significant morbimortality. Hospital pilgrimage, the need for prolonged hospital admissions, as well as invasive procedures, are obvious consequences in these minors. CONCLUSIONS: Although it is true that figures have been produced in this review, it would not be correct to use these results categorically, since there have been cases in the medical literature of perpetrators who were not female figures, and of victims who were not minors. For future studies, it would be interesting to retrospectively observe the appearance of psychiatric pathology in victims and assess the possibility of the repetition of certain roles of abuse

Fabricated or induced illness: From "Munchausen by proxy" to child and family-oriented action.

BACKGROUND: In fabricated or induced illness (FII), a child is harmed due to caregiver(s) behaviour and actions, carried out to convince mainly doctors that the child's physical and/or psychological health is more impaired than in reality. Harm is caused directly by the caregivers(s) and also often inadvertently by doctors' responses. OBJECTIVES: To describe: dynamics underlying FII; wider definition of FII; alerting signs for early recognition of possible FII; respective responsibilities of health, social care, education. METHODS: Literature review, clinical experience, expert opinion. RESULTS AND CONCLUSIONS: Caregivers are motivated by gain from having their child treated as ill, and/or by erroneous beliefs about their child's health, either way needing medical confirmation about their contentions. Their behaviour is therefore directed primarily towards doctors. Most cases of FII present unexplained discrepancies between caregiver reports/actions and independent observations of the child. More rarely, the child has actual signs of illness, induced by the caregiver, occasionally fatal. Children are harmed in all aspects of life: health, daily functioning including education, and psychologically. Harm emanates directly from the caregiver(s) but also unintentionally from medical responses. Illness induction and clear deception by the caregiver require immediate child protection. Otherwise, the initial focus is on assessing the child's current health and functioning rather than caregiver's mental health. If, beyond verified illness, there is no medical explanation for the child's reported ill-health, the family require help to function better. This requires co-ordinated, multidisciplinary rehabilitation and long-term monitoring. If caregivers refuse rehabilitation, child protection is required. Several unanswered questions remain.

Pulling the Wool Off Our Eyes: Medical Child Abuse.

Medical child abuse (MCA) continues to remain a challenging form of abuse to recognize, diagnose, and manage. The perpetrators of MCA have some common features that may heighten the suspicion that a child is the victim of MCA. Once suspected, the development of a multidisciplinary care plan that incorporates all subspecialists and health care providers involved in the child's care is essential. A structured approach to record review can clarify the concerns and discrepancies as well assist in potential future testimony. The use of overt or covert video surveillance systems are potential modalities to aid in making the diagnosis of MCA. If called to testify, it is helpful to understand the court system. Risks to the child from MCA are great and include a high level of long-term morbidity and mortality. Understanding this diagnosis and having a plan in place to address it when suspected can prevent further harm to the child. [Pediatr Ann. 2020;49(8):e354-e358.].

Caregiver-fabricated illness in a child prescribed long-term opioids and benzodiazepines.

Caregiver-fabricated illness in a child (CFIC) can result in unnecessary, potentially harmful medical investigations and treatment. As pediatric pain has historically been undertreated, the movement for more compassionate treatment has led to an increase in analgesic prescribing in children and adolescents. Overall, this has been a positive change but this may also lead to unintentional harm, partic-ularly if CFIC is not considered as a possibility in the presentation. We present a case in which CFIC was associated with long-term prescribing of opioids, benzodiazepines, and other central nervous system depressants.