MUNCHAUSEN SYNDROME BY PROXY: The Potential for Medical Profession to be Co-Participants in Child Abuse.
A father brings his young son to the doctor for prescription
medications because the father suspects that the son has "classic"
attention deficit/hyperactivity disorder.
The mother relates to
the hospital emergency room with a history
of multiple respiratory, gastro-intestinal and musculo-skeletal symptoms from
which her child was suffering and insists that the child be "hospitalized" for a
"complete workup". A basic workup
in the emergency room discloses no disease, the child was not admitted but the
mother was told to have followup with a pediatrician. She returns to the emergency room two days
later with the child and more symptoms, requesting the child's admission but
having not attempted to visit a pediatrician.
A mother brings a child to the pediatrician because the
child has been losing weight. According
to the mother, multiple food allergies
was suspected by the family and the child's diet was markedly reduced (starving) in order
to prevent symptoms.
The mother brings a child to a pediatrician pointing at the
multiple bruising over the child's body
and giving a history that the child was having recent repeated
nosebleeds. The physician's examination finds the nasal
passages to be normal and the bruises have more the appearance that they were
due to trauma and not spontaneous.
What you have read are various degrees of clinical
appearances of a condition known as "Munchausen Syndrome by Proxy"(MSP).
The definition of the Munchausen
Syndrome itself without "proxy" is a patient's specific mental or
behavioral disorder in which the individual fakes a medical illness in order to
get medical attention. In "Munchausen
Syndrome by Proxy", this behavior represents medical attention directed to
another (usually a child) because of a
fictional history or frank physical or mental abuse by another person usually
the caregiver or parent. Other names
given to this state include "factitious disorder by proxy" or the
current 2013 American Psychiatric Association title "factitious disorder imposed by another".
Regardless of the title of this state, it defines the unnecessary introduction of a
child by a caregiver into the medical system for diagnosis and for the treating
a "made up" disorder. This factitious disorder imposed by the
caregiver can be related to simply the caregiver's medical ignorance and may be to some extent
unintentional, however it also can be motivated by some sort of personal
gratification and may include frank
intentional physical or mental abuse of the child to create an appearance of
the disorder.
One might conclude
that as a result of the inherent risks of unnecessary diagnosis and treatment the
medical profession could be said to be "co-participants" in the child
abuse if the healthcare providers at the outset fail to attempt to identify the
syndrome as being present.
It therefore become a duty of the initial physician
consulted to always be aware of the
possibility that their child patient may be a victim of a factitious disorder
imposed by another. If that possibility
is suspected, an active attempt to confirm
is essential before subjecting the child to hazards of unnecessary diagnosis
and treatments. This means taking a
detailed patient history from the parent but also including the parent's
medical understanding of the symptoms presented, performing a careful physical
examination, communicating with the patient's prior physicians and other
pertinent resources including pediatricians who specialize in MSP as needed for assistance in confirmation. And,
if Munchhausen Syndrome by Proxy is confirmed, it should be seriously evaluated
as child abuse and consideration for appropriate civil/legal action to be taken
for the protection of the child. Missing
to consider and investigate this diagnosis, the physician and the medical system could be
looked upon as co-participants in any damage to the child.
For more on this topic, read the statement about this issue
by the American Academy of Pediatrics and the description in Wikipedia.
After reading about this subject, can you defend the
accusation that the physicians involved could be considered as co-participants
in child abuse? And another question: as
personal matter, if you brought your child to a pediatrician, how would you
feel if you knew the doctor was surveying you as a "by proxy"
candidate? ..Maurice.
Graphic: Photo Credit: memekode on Flickr
posted by Maurice Bernstein, M.D. @ 10:46:00 AM
3 comments
3 Comments:
Is it really a good idea to teach medical students about Munchausen Syndrome, Munchausen Syndrome by Proxy, and Somatization disorder - things that lead doctors to dismiss patients symptoms and tell them their symptoms are in their heads? After all, didn't you say elsewhere you felt it was counter productive to teach students about normal traumatic reactions because it might hinder the students performance during an examination to be aware of it?
Acording to AARDA:
Almost half of those who are diagnosed with autoimmune diseases are told they are "overly concerned with their health" prior to diagnosis.
There are more people with autoimmune disease than with heart disease. (NIH statistic)
http://www.aarda.org/autoimmune-information/autoimmune-statistics/
I don't believe Somatization disorder exists. I believe that people have illnesses we can't diagnose - but that doesn't mean they aren't sick.
I do agree that learning coping strategies to deal with sickness can improve outcomes, and that poor coping strategies can lead to added distress. Part of that distress is dealing with people who don't believe they are sick. Expanding counseling options for those who are chronically ill (with our without a diagnosis) is an important health strategy due to this. But there is a big difference between "get counselling because nothing is really wrong with you" and "we can't find what's wrong with you, so we want you to work with a counselor to learn coping strategies which will help reduce your symptoms while we monitor your condition."
Bad doctors dismiss their patients when they can't figure out what's wrong. Good doctors monitor the progression of the disease so a diagnosis can be made at a later date.
Women are generally the ones most likely to complain about "illnesses that don't exist." Women are 3 - 4 times more likely to develop an autoimmune disorder then men. I think the connection is rather obvious - these women are really sick.
Important Reading (also reference for 3/4 times likely):
http://www.aarda.org/autoimmune-information/autoimmune-disease-in-women/
-JR
my experience with my mom being the basic guardian for me as a patient in psychiatry is that my mom has used her position with me to gain all leverage against me, I have tried to talk to people about the situation that I realized about my mom but every time I try to talk about my mom's abuse all people do is reply to me of how my mom loves me as if they can't contemplate that a parent could be abusive to their child, with my mom's abuse I've been hospitalized in the psyche ward 8 times over the last 9 years after having been stable since the beginning in 1994 save a week in maybe 99 for depression, something obviously changed in my mom's life that she would go over board with me the last 9 years,certain things difficult to prove unless I had someone look into it but the more provable thing such as things constantly going missing from my home are disregarded as meaningless as I know that the thefts are related to my over all situation & not even these thefts matter to anyone as if I never even mentioned those thefts,
Anonymous from today--do you think your mother has been or is creating your current or previous symptoms?
Thanks for contributing your personal experience to this blog thread. Give yourself a pseudonym for future identification if you write here again. ..Maurice.
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