Munchausen Syndrome by Proxy

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Abstract
Munchausen syndrome by proxy is one of the most difficult and rare form of child abuse. It carries substantial morbidity and mortality and comprises both physical abuse and medical neglect and is also a form of psychological maltreatment. The diagnosis relies on appropriate suspicion and careful investigation. Early recognition and appropriate intervention prevent further abuse and criminal actions. The fabrication of a pediatric illness is a form of child abuse and not merely a mental health disorder, and there is a possibility of an extremely poor prognosis if the child is left in the home. Certain factors are identified that may help the physician recognize this insidious type of child abuse that occurs in a medical setting, and physicians have to report suspicions to their state's child protective service agency. This paper highlights how Munchausen syndrome by proxy cases is handled.

Munchausen syndrome by proxy: detection, investigation and legal proceedings Munchausen syndrome-by-Proxy (MSBP), also known as Medical Child Abuse (MCA), is a mental disorder in which a parent (usually the mother) abuses her child by creating or falsifying medical symptoms, or by seeking unnecessary medical care for the child, in order to gain attention and sympathy. In 1998 the American Professional Society on the Abuse of Children (APSAC) reported that the constellation of behaviors generally referred to as Munchausen by Proxy actually includes a pediatric diagnosis of child abuse and a psychiatric diagnosis of the perpetrator. Thus Munchausen by Proxy consists of two perspectives - the pediatric and the psychological; the victim and the perpetrator. From the perspective of the child victim, the diagnosis is Pediatric Condition Falsification (PCF) and is defined as “a form of child maltreatment in which an adult falsifies physical and/or psychological signs and/or symptoms in a victim, causing the victim to be regarded as ill or impaired by others.” From the perspective of the perpetrator, the diagnosis is Factitious Disorder by Proxy (FDP) and is defined as “a psychiatric disorder which is applied to a person who intentionally falsifies signs or symptoms in a victim. The parent may exaggerate, misrepresent, or fabricate symptoms or test results, which can lead to the child undergoing numerous hospitalizations, invasive tests, needless therapies, and even surgeries. “On April 7th the Tucson Police Department arrested and charged a 21 year old mother of two with child abuse. Blanca Montana had taken the children to the University Medical Center reporting flu-like symptoms. Her son was discharged, but her infant daughter’s condition continued to deteriorate. The baby was eventually diagnosed with nine separate rare infections over the course of her hospital stay. Staff noticed that the child's condition worsened every time she was alone with her mother. They began to suspect Munchausen Syndrome by Proxy and reported their suspicions to the police. The police investigated the abuse and determined that Montano intentionally poisoned her child and had caused her illnesses. After the mother was barred from visiting the infant, the baby's condition improved significantly. It was determined that Montana had poisoned her two children in order to get attention”. (ABC news) In classical cases of MSBP, the behavior of the abusive parent towards the child is strongly and directly influenced by the responses of the doctor to the child’s “undiagnosable” disease. The term MSBP can also apply to situations where the parent in some way appears to compromise the medical care of the child. Examples include parental over treating or undertreating of such medical condition such as asthma, epilepsy and cystic fibrosis. MSBP is different from other forms of child abuse. Unlike the typical physical child abuser who seeks to release his or her own frustrations by lashing out at a child, the motivations of the MSBP abuser are more...
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