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 Hidden in Pediatric Settings: Detection and Intervention.

Medical child abuse, sometimes referred to as Munchausen Syndrome by Proxy or childhood factitious disorder, poses significant diagnostic, intervention, and ethical issues for medical and mental health practitioners alike. Psychologists working in pediatric hospitals and medical clinics should remain mindful of the health and ethical risks posed by these conditions, which are challenging to detect and treat. The surreptitious nature of the conditions and hazards they pose require an integrated medical, psychological, and child protective response. This article provides historical and clinical background on the condition along with tabular guides and recommendations to assist in detection and intervention.

Psychological Treatment of Factitious Disorder Imposed on Another/Munchausen by Proxy Abuse.

The purpose of this article is to propose management and treatment protocols for family members impacted by MBP abuse. A brief review of psychopathology, co-morbidities, MBP risk level, treatment outcomes, and rationale for treatment is presented, followed by detailed guidance regarding psychological treatment and management. We propose five components of psychotherapy for abusers, best remembered by using the acronym of ACCEPTS: ACknowledgement, Coping, Empathy, Parenting, Taking charge, and Support. Guidance for the treatment of spouses/partners of the abuser, other involved family members/friends, and child victims are also provided.

Early recognition and management of fabricated or induced illness in children.

Fabricated or induced illness (previously known as Munchausen syndrome by proxy) takes place when a caregiver elicits health care on the child's behalf in an unjustified way. Although the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders specifies deception as a perpetrator characteristic, a far wider range is encountered clinically and is included in this Review. We describe the features of fabricated or induced illness, its effect on the child, and the psychosocial characteristics of caregivers and their possible motives. Present evidence suggests that somatoform and factitious disorders are over-represented in caregivers, with possible intergenerational transmission of abnormal illness behaviour from the caregiver to the child. Paediatricians' early recognition of perplexing presentations preceding fabricated or induced illness and their management might obviate the development of this disorder. In cases of fully developed fabricated or induced illness, as well as protection, the child will need help to return to healthy functioning and understand the fabricated or induced illness experience. Management of the perpetrator is largely dependent on their capacity to acknowledge the abusive behaviour and collaborate with helping agencies. If separation is necessary, reunification of mother and child is rare, but can be achieved in selected cases. More collaborative research is needed in this specialty, especially regarding close study of the characteristics of women with somatoform and factitious disorders who involve their children in abnormal illness behaviour. We recommend that general hospitals establish proactive networks including multidisciplinary cooperation between designated staff from both paediatric and adult mental health services.

Think Again: First Do No Harm: A Case of Munchausen Syndrome by Proxy.

Apparent life-threatening events caused by Munchausen syndrome by proxy (MSP) are rare but difficult to resolve medically. Failure to properly diagnose MSP can lead to further abuse by the caregiver and increase the risk of complications due to long hospital stays and invasive tests. In this paper, we describe our experiences with a baby who ended up being diagnosed with MSP, including our initial failure to find a pathology, delay of MSP diagnosis, our growing suspicion of MSP despite technical setbacks, our actions after we confirmed MSP as the cause of his hospitalizations. We also describe the difficulties of diagnosing MSP compared to more traditional problems and explain a series of precautions and guidelines to help detect it in a timely manner.

[Munchausen by proxy syndrome]. / Le syndrome de Munchausen par procuration.

The Munchausen syndrome by proxy (MSBP) was first described in 1977 by the English paediatrician Roy Meadow. The MSBP is an extremely complicated diagnosis because of the difficulty in finding the incriminating evidence of its existence and because of the ethical issue it raises for caregivers. Its implications from a medical, psychological and legal point of view raise difficult questions for any professional confronted to it. In this article we will first present the case of a 16-year-old teenager who had been bedridden in hospital for a year, before an atypical form of MSBP was finally diagnosed, after a stay in a child and adolescent psychiatry unit. We will then discuss this case in light of a literature review on the MSBP.

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.

[Münchausen syndrome by proxy in a forensic psychiatric evaluation--the description of a case and ethical controversy]. / Przeniesiony zespól Münchausena w opinii sadowo- -psychiatrycznej--opis przypadku i kontrowersje etyczne.

AIM: Presentation of the difficulties in diagnosing Münchausen syndrome by proxy. METHOD: Comparison of four different conclusions in forensic psychiatric opinions issued in one case, due to the need of answering to the questions of the court, in what periods and why was the deterioration of the child's health, in connection with an allegation that the mother has acted to his detriment. In the first medical-legal opinion the treating physician, while being the head of the ward and the person informing the police of the action against a child by the mother, recognised Münchausen syndrome by proxy. The second opinion was delivered by a psychologist, who stated that the mother distinguished the introspective attitude characterised by excessive, exaggerated accuracy, thoroughness, and did not give a unambiguous answer to the questions of the court. In the third opinion the experts accepted that the functioning of the subject does not create a threat to life and health of the child. The fourth opinion developed by the authors of this paper noted that in the analysed medical records of the childs' hospitalisation, no arguments were found to recognise Münchausen syndrome by proxy. RESULTS. In the conducted extended ambulant study of the subject and the analysis of the medical documentation of the 31 hospitalisations of the child showed that the improvement of the child's health was not associated in exclusion of pushing aside the mother from the child, but was the result of the consistency of the therapeutic treatment team, the continuation and the modification of the treatment. CONCLUSIONS: In appointing the expert, the art. 196 of the Code of Criminal Procedure should be considered, which states that the expert should not be the treating doctor, because his opinion loses value impartiality. Diagnosis of Münchausen Syndrome by proxy itself stirs up numerous controversies..

[The unbearable reality of the child: Münchhausen's syndrome by proxy]. / L'enfant réel ou l'insupportable: le syndrome de Münchhausen par procuration.

The hypothesis of Münchhausen's syndrome arises through a clinical situation. The patient is unable to consider the question of "being a mother". The child takes the place of a real, unbearable object, which she evacuates or which can disappear. This maternal suffering requires psychotherapeutic care.

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.].

Expect the unexpected: favourable outcome in Munchausen by proxy syndrome.

Munchausen by proxy syndrome (MBPS) is a form of child abuse wherein the mother fabricates or produces illness in her child. The condition is hard to diagnose and few successful interventions have been described. Long-term outcome is associated with high family disruption, reabuse, mortality and morbidity. We report on a six-month-old girl that experienced eight hospital admissions within five months. Symptoms of repeated vomiting, bloody diarrhoea and acute life-threatening events (ALTE) were never substantiated. Finally, blood in diapers and napkins presented by the mother was shown to be of maternal origin. When confronted, the mother agreed to psychiatric admission. Following five months of treatment, her mental state stabilised and she entered supported living. She remained separated from the child, who was given to the father and developed normally on close paediatric follow-up. We report a definite diagnosis and successful intervention in MBPS. The case highlights characteristic features of this entity and illustrates that a favourable outcome depends on early intervention with separation of the child and perpetrator, as well as concomitant long-term psychiatric treatment.

Munchausen Syndrome by Proxy: balancing ethical and clinical challenges for healthcare professionals Ethical consideration in factitious disorders.

Munchausen syndrome by proxy is a relatively rare behavioral disorder affecting a child's primary caregiver, typically the mother. Ethical dilemmas that physicians may face in such situations mainly concern the medical options for best protecting the child's welfare, that are important, in clinical pediatric practice, because critical conflicts might arise between health professionals and parents. In such cases, the physician's primary obligation is to protect the children involved, whose family environment may be essential to their wellbeing. Ev- ery ethical choice should be tailored to a given child's story, which should be viewed as a whole, considering the possible consequences for the family balance, and taking the complexity of the emotional and psychological dimensions of children's relationship with their parents into account. Specific protocols, discussion of clinical cases, open communi- cation of feelings will help doctors to deal more effectively with the families involved and ensure that treatment decisions are made in the child's best interest.

An Overview of Munchausen Syndrome and Munchausen Syndrome by Proxy.

Munchausen syndrome and Munchausen syndrome by proxy are complex diseases that are difficult to diagnose and treat. To assist in this process, an overview of diagnostic criteria with common characteristics and red flags are discussed, with case studies illustrating identification and diagnosis of these disorders. Treatment options are addressed within the context of each of these complex syndromes. The provider's knowledge of diagnostic criteria and treatment options for Munchausen syndrome and Munchausen syndrome by proxy promotes better outcomes for patients. Without an early diagnosis and intervention, the patient is at high risk for severe complications, including organ failure and mortality.

Munchausen syndrome and Munchausen syndrome by proxy: a narrative review.

The Munchausen syndrome and Munchausen syndrome by proxy are factitious disorders characterized by fabrication or induction of signs or symptoms of a disease, as well as alteration of laboratory tests. People with this syndrome pretend that they are sick and tend to seek treatment, without secondary gains, at different care facilities. Both syndromes are well-recognized conditions described in the literature since 1951. They are frequently observed by health teams in clinics, hospital wards and emergency rooms. We performed a narrative, nonsystematic review of the literature, including case reports, case series, and review articles indexed in MEDLINE/PubMed from 1951 to 2015. Each study was reviewed by two psychiatry specialists, who selected, by consensus, the studies to be included in the review. Although Munchausen syndrome was first described more than 60 years ago, most of studies in the literature about it are case reports and literature reviews. Literature lacks more consistent studies about this syndrome epidemiology, therapeutic management and prognosis. Undoubtedly, these conditions generate high costs and unnecessary procedures in health care facilities, and their underdiagnose might be for lack of health professional's knowledge about them, and to the high incidence of countertransference to these patients and to others, who are exposed to high morbidity and mortality, is due to symptoms imposed on self or on others.

A case of Munchausen syndrome by proxy with subsequent stalking behavior.

A case of Munchausen syndrome by proxy (factitious disorder by proxy) wherein the patient presented with symptoms of severe borderline personality disorder and questionable psychotic symptoms is discussed. This patient was also adjudicated for harassing and stalking a child protective services worker assigned to her case. Issues pertaining to possible feigning of psychotic symptoms were addressed in her inpatient treatment. Despite doubts concerning the veracity of some of her psychotic symptoms, the patient responded well to clozapine, and she was subsequently able to stay out of the psychiatric hospital for longer periods and make a reasonably good adjustment to living in a group home. After refusing to continue with clozapine therapy because of weight gain concerns, her adjustment declined.

Munchausen's syndrome and other factitious disorders.

Factitious disorders including Munchausen's syndrome are likely encountered by all clinicians during their career. Neurologic presentations are common, especially with Munchausen's syndrome by proxy. An appropriate index of suspicion and nonjudgemental confrontation and psychiatric consultation facilitate a successful clinical approach. Redefining the factitious illness as psychiatric with continued involvement of a primary physician and family support are also keys to successful management. Underlying psychiatric syndromes need to be assiduously evaluated and steadfastly treated. Prognosis is best for patients who do not meet criteria for Munchausen's syndrome or who have psychosocial supports and less severe personality pathology.

The central venous catheter as a source of medical chaos in Munchausen syndrome by proxy.

PURPOSE: The aim of this study was to determine what percentage of childhood central venous catheters (CVC) are placed in victims of Munchausen syndrome by proxy (MSBP) and to evaluate the clinical indications and complications of CVCs in MSBP. METHODS: Study design was by retrospective chart review. Data were obtained from the regional children's hospital and regional child abuse consultation network. Patients in the MSBP series were all children who on consultation were determined to be victims of MSBP, from 1974 through 1996. Patients in the central catheter series were all children who had central venous catheters placed 1991 through 1995, excluding children whose catheters were placed for cancer chemotherapy or for chronic renal failure. Consultation records of MSBP cases were abstracted noting the clinical characteristics of victims and perpetrators. Hospital procedure codes were reviewed for children who had CVCs placed. Those who had discharge diagnostic codes that commonly require CVC placement were not reviewed, but charts of children with diagnoses not usually requiring CVCs were evaluated. Descriptive statistics and chi2 and Fisher's Exact test were used for comparisons. RESULTS: Sixteen of ninety-three (17%) of MSBP victims had central lines, including two deaths caused by assault through the lines. Line sepsis occurred in 9 of 16 (56%) patients. Primary reasons for CVC were for administration of medicines that can normally be administered orally or subcutaneously (7) or for severe nutritional depletion (8). All but one of the children had symptoms of multiple organ system involvement. Siblings had frequently been victimized. The mean age of symptom onset was 19 months, yet the mean age at diagnosis was delayed until 82 months. All perpetrators were the mother. Fathers were usually physically or emotionally unavailable. Nearly one third of mothers had prior medical training and one third had themselves been victims of prior physical or sexual abuse. Ten of fifteen mothers previously exhibited Munchausen behavior themselves. Of children at our institution who had central venous catheter placement, 8 of 709 (1.1%) were MSBP victims. CONCLUSIONS: CVCs are frequently placed in MSBP victims for physiological problems, malnutrition, or failure to respond to normal treatments. Surgeons should consider requesting systematic evaluation for MSBP in patients seeking CVC placement for diagnoses not usually requiring CVCs lest they become unintentional collaborators in abuse of these children.

Concerns about research and prevention strategies in Munchausen Syndrome by Proxy (MSBP) abuse.

There would seem to be three motives for research into Munchausen Syndrome by Proxy (MSBP) abuse; first to enhance treatment; second to enhance our understanding of the psychopathology of those who carry out the abuse; and third to find interventions to prevent its occurrence. We will argue that only the first justification is valid. The second and third should be questioned for several reasons including: MSBP abuse is the wrong kind of event to think of in terms of categorical diagnosis; rare events are inherently difficult to predict; and better research targets are available. We propose that research energy would be more productively directed towards furthering our understanding of somatization and certain problematic aspects of modern pediatric practice. We offer suggestions as to appropriate areas for research.

Munchausen Syndrome by Proxy: a nursing overview.

Munchausen Syndrome by Proxy is a common but often undetected form of child abuse in which a parent fabricates or falsifies an illness in the child and then presents the child for medical treatment, disclaiming knowledge as to the etiology of the illness. Nurses are instrumental in the early identification and detection of Munchausen Syndrome by Proxy. A case study emphasizes the role of nurses as part of the multidisciplinary approach. Use of the nursing process demonstrates comprehensive care in management.