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.

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)

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.

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.

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

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.

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.

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 by Proxy: A Qualitative Investigation into Online Perceptions of Medical Child Abuse.

In Munchausen by proxy (MBP) maltreatment, increasingly termed "medical child abuse" (MCA), a caregiver fabricates or induces illness in another. The perpetrator's goal for the behavior is to meet personal emotional needs by forcing unnecessary or misguided medical or psychological treatment. Generally, a mother is the perpetrator and her child is the victim. There is a serious lack of research into most aspects of MCA, and this study is the first to utilize the anonymity of an Internet forum to investigate victims' first-hand experiences of, and the public's opinions about, suspected and confirmed MCA. Three-hundred and fifty-six posts by 348 members were explored and coded using formal qualitative content analysis. By accessing an open-thought online forum, this paper acquired information regarding social perceptions about the nonperpetrating partners who are unaware of the maltreatment; the disturbing and counterintuitive phenomenon of MCA itself; and the resistance often faced by those who attempt to report it.

Munchausen syndrome and Munchausen syndrome by proxy: a narrative review / Síndrome de Munchausen e síndrome de Munchausen por procuração: uma revisão narrativa

ABSTRACT 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.

RESUMO A síndrome de Munchausen e a síndrome de Munchausen por procuração são condições caracterizadas pela invenção ou pela produção intencional de sinais ou sintomas de doenças, bem como alterações de exames laboratoriais. Indivíduos com esta síndrome fingem que estão doentes e tendem a procurar tratamento, sem ganho secundário, em diferentes serviços de saúde. Ambas as síndromes são condições bem descritas na literatura desde 1951. Elas são frequentemente observadas pelas equipes de saúde em clínicas, enfermarias hospitalares e prontos-socorros. Conduziu-se revisão narrativa, não sistemática da literatura, incluindo relatos de caso, séries de relatos de caso, artigos de revisão indexados no MEDLINE/PubMed de 1951 a 2015. Cada estudo foi revisado por dois especialistas em psiquiatria que, por meio de consenso, escolheram quais estudos seriam incluídos nesta revisão. Apesar da síndrome de Munchausen ter sido descrita pela primeira vez há mais de 60 anos, a maioria dos estudos conduzidos sobre esta condição são relatos de caso e revisões da literatura. A literatura é carente de estudos mais consistentes sobre epidemiologia, manejo terapêutico e prognóstico da síndrome. Sem dúvida, tais condições geram altos custos e procedimentos desnecessários nos serviços de saúde. Seu subdiagnóstico pode se dar pela falta de conhecimento das síndromes por parte dos profissionais de saúde, e à alta incidência de contratransferência aos pacientes e a outros que são expostos à alta morbidade e à mortalidade é justificada pelos sintomas impostos em si mesmo ou em terceiros.

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.

Caregiver-Fabricated Illness in a Child: A Case Report of Three Siblings.

Caregiver-fabricated illness in a child is a form of child maltreatment caused by a caregiver inducing a child's illness, leading to unnecessary and potentially harmful medical procedures and treatments. This condition can result in significant morbidity and mortality. We present the case of three siblings in Tunisia who were poisoned with chloralose by their own mother. The symptoms that the children presented with led to misdiagnoses, which resulted in the death of two of the children. Characteristics of the clinical presentation are articulated, followed by a discussion of the legal measures that apply to the offender and the role of physicians, nurses, and medicolegal experts involved in such a complex medical situation.

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.

El sindrome de Munchausen por poderes: un tipo especial de abuso infantil / Munchausen syndrome by proxy: a special type of child abuse

En el síndrome de Munchausen por poderes (SMpP), uno de los padres, en el 95% de los casos, la propia madre, inventa, falsifica y fabrica síntomas clínicos en su hijo hasta convertirle, de cara a los médicos y pediatras, en un enfermo. La última Clasificación de Enfermedades Mentales (DSM-5), ha introducido en el capítulo de Trastornos Adictivos el Trastorno por juego, abriendo la posibilidad de incorporar otras conductas problemáticas de riesgo adictivo que no se refieren a sustancias, como son los videojuegos, Internet o las compras. Por nuestra parte, proponemos que el perfil psicopatológico del perpetrador/a de un SMpP se corresponde con un trastorno adictivo, ya que tienen un comportamiento compulsivo de búsqueda del ambiente hospitalario que les supone un alto grado de gratificación y recompensa, y que se incrementa progresivamente ante nuevas situaciones de estrés. Se muestran tres casos clínicos de SMpP que pertenecen a la serie de 19 víctimas con diagnóstico confirmado del síndrome, que estudiaron los autores en un conjunto de 54 casos con sospecha de ser víctimas de Munchausen por poderes enviadas desde Pediatría al presentar los signos de alarma que definió Meadow. El propósito de este trabajo es aportar nuevos datos que faciliten una segura y adecuada intervención caso de encontrarse con esta extrafia y sutilmente peligrosa enfermedad (AU)

In Munchausen syndrome by proxy (MSBP), one of the parents, in 95% of the cases the mother per se, invents,falsifies and makes up clinical symptoms in their child until the child becomes a patient for the physicians and pediatricians. The last Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has introduced the Gaming Disorders in the chapter of Addictive Disorders, opening the way to the possibility of incorporating other problematic behaviors of addictive risk not referring to substances, such as video games, Internet, or shopping. On our part, we propose that the psychopathological profile of the author of a MSBP corresponds with an Addictive Disorder, since they share a behavior of compulsive seeking of the hospital setting that means a high grade of gratification and rewards and that progressively increases when their are new stress situations. Three clinical cases of MSBP belonging to a series of 19 victims with confirmed diagnosis of the syndrome studied by the authors in a group of 54 cases with suspicion of being victims of the Munchausen syndrome by proxy referred from pediatrics due to the presentation of Meadow-defined alarm signs are shown. The purpose of this work is to provide new data facilitating 21 safe and adequate case intervention if faced with this rare and subtly dangerous disease (AU)

Attempted Serial Neonaticides: Case Report and a Brief Review of the Literature.

Neonaticide is an infant murder occurring on the day of birth. The case reports found in the literature are often focused on the mother as the agent in the context of pregnancy denial, dissociative symptoms, or psychosis. However, this report describes a rare case of attempted serial neonaticides, in which the acts were committed by a nurse at the nursery of a referral hospital in Brazil. The authors describe a forensic psychiatric evaluation for criminal responsibility and correlate the information from this particular case with relevant forensic themes, namely neonaticide, Munchausen by proxy syndrome, and serial healthcare killers.

The clinical geneticist and the evaluation of failure to thrive versus failure to feed.

Common clinical genetic referrals for the pediatric patient include a single major or multiple minor anomalies, dysmorphic features, especially when accompanied by developmental delay or intellectual disability, and failure to thrive (FTT). This review provides pediatric definitions of FTT and the genetic differential for FTT, which includes chromosomal disorders, microdeletion/duplication syndromes, uniparental disomy/methylation disorder, disorders of DNA repair, teratogens, metabolic syndromes, and skeletal dysplasias. Three clinical genetics cases highlight challenges in deciphering the cause of FTT. The review concludes with a ten-step approach that might improve diagnostic ability in differentiating FTT cases (those with genetic or other metabolic causes) from "failure to feed," in other words FTT as the direct result of neglect and/or child abuse.