Munchausen Syndrome by Proxy

Image via Wikipedia

Data found onMunchausen Syndrome by Proxy was found to be congruent amongst most researchers. Munchausen Syndrome by Proxy is one of the most complicated forms of child abuse due to deceit. If MSPB is left untreated, the cycle of abuse will continue from childhood into adult perpetrators. MSBP has been discovered in males, females, and health-care workers.

Munchausen Syndrome by Proxy was described almost thirty years ago by Roy Meadow. He described Munchausen Syndrome by Proxy as a psychological disorder in which a person intentionally inflicts harm or exaggerates an illness in others in order to seek treatment (Schreier 2002). Munchausen Syndrome by Proxy has also been described as fabricating illnesses or intentional inducing illnesses to a child by a parental figure to seek medical attention for them self or the child (Terry 2004).

MSBP was added in 1994 to the DSM-IV under fictitious disorders and is described as a personality disorder with the intent to cause harm in others in order to seek treatment and gain attention from health care professionals (Abdulhamid 2006). Researchers have found that the average age of MSBP victims is between one and one-half years of age and six years. This age group is typical because the risk of the child fighting back is minimal (Smith-Alnimer 2003).

Health Care Professionals as MSBP Perpetrators

An interesting fact came to light while doing initial research was that members of the health care system are more likely to get away with abusing children by fabricating illnesses by under medicating, or over medicating the child. Many times ventilator settings get changed and IV tubes get tapered with. This happens because of the unlikelihood that they would be accused of the abuse due to their role as a health care professional or the established relationship the perpetrator has with medical staff (Terry 2004).

More research demonstrates concurrence by claiming that although perpetrators have knowledge about health care procedures, their medical knowledge is incomplete. Many times the perpetrator is left alone in the patient’s room, when the doctors and nurses return there are more complaint’s about observing the patient having fits or seems in distress (Fulton 2000).

Indicators of MSBP in Males and Female Parents

Although rare, fathers can be Munchausen Syndrome by Proxy perpetrators.

Journal of American Academy of Pediatrics describes a young father who repeatedly brought his new born child in to the emergency room for numerous complaints of nighttime apnea. This child was in and out of the hospital numerous times in the first two months of life. The father was always present during these “episodes” and put himself in the forefront of the attention of the medical staff. He was often more direct and cold with the medical staff unlike female Munchausen Syndrome by Proxy perpetrators. The wife also accompanied the husband and child to the emergency room, but she stayed out of the way. It typically takes longer for the warning signs for MSBP to show up in males due to the rarity of male MSBP cases (Makar & Squier, 1990).

Researchers have noted that nighttime apnea and seizure episodes are a common symptomatic complaint in MSBP cases. In MSBP cases, nighttime apnea and seizure episodes are often induced by manual strangulation (Ian Mitchell, Brummitt, J., Deforest, J., & Fisher, Geoff, 1993). Researchers describe the indicators of Munchausen Syndrome by Proxy for male and female perpetrators as the parent is disconnected with the child and more interested in the treatment. The parent is excessively willing to put the child through painful and invasive procedures.

Typically, only one parent accompanies the child while in the hospital. The parent seems to know more about treatment on the child’s condition than medical staff. I want a chest x-ray, EEG scan, ECT done on my child. The parent dominates doctors’ time. Parents who have had multiple children that have died as a result of SIDS should be a warning sign to health care officials as Munchausen Syndrome by Proxy abuse.

Also, one of the most common indicators is that the child’s condition seems to improve when the parent leaves the room (Parrish and Perman 2004). Many times the Munchausen Syndrome by Proxy perpetrators appear more interested in the hospital staff than their own child (Fulton 2000).

Researchers claim that detection for this form of child abuse is extremely difficult due to the privacy laws. Many times health care workers must make a decision of saving the life of a Munchausen Syndrome by Proxy victim is important enough to risk a privacy violation. Privacy risks often make medical staff uncomfortable even though hospital security monitors have been used successfully to monitor and detect for MSBP abuse. The same system also has help clear parents of accusations of MSPB abuse.

Researchers unfortunately have found that since Munchausen Syndrome by Proxy victims under go many unnecessary procedures; the mortality rate is approximately nine percent (Smith-Alnimer 2003). If Munchausen Syndrome by Proxy continues to go undetected, the cycle of abuse will likely continue as the victim assumes the role of the perpetrator (Epstein, Markowitz, Gallo, Holmes, & Gryboski 1987).

Classification of Child Abuse

Researchers have classified child abuse into levels of severity from A to D. Level A is the most acute form of child abuse, while level D is classified as the mildest form of abuse none as unintentional neglect often stemming from lack of parental education. Class “A” form of child abuse is intentional, often planned with a motivation for the perpetrator’s benefit. Munchausen Syndrome by Proxy would fall into this category even if the perpetrator does not immediately recognize that they are doing harm (Golden, Samuels, & Southall 2003).

Further evidence suggests that intentional incidences of Munchausen Syndrome by Proxy abuse falls within a Class “A” form of abuse (Rand 1990). A noted earlier, the DSM-IV recognizes Munchausen Syndrome by Proxy as a personality disorder. The DSM-IV also categorizes Munchausen Syndrome by Proxy into four categories. MSBP falls into the fourth category (Cleveland Clinic 2006).

Many times MSBP starts with family conflict such as in divorce cases involving custody battles. The perpetrator purposely seeks medical attention for the child to accuse the other spouse of child abuse. The perpetrator believes that if the medical officials and the court believe the fabrication of abuse, this would be enough to gain sole custody of the child (Rand 1990).

Responsibilities of Health Care and Social Work Professionals

Nursing care responsibilities for detecting Munchausen Syndrome by Proxy abuse include but not limited to conducting an interview with a child without coaching into what may have happened. The only coaching shall be helping the child to distinguish between make believe and the truth. It’s critical to check for evidence to support the child’s statements because many times the child enables the parent by verifying the symptoms. The nurse also attempts to regain the child’s trust which has been damaged as a result of being victimized by a parent whom they should have been able to trust.

The nurse also needs to be neutral and non confrontational when working with the MSBP parent. The treatment staff should discuss the problem with the parent without warning from the nurse. This allows the staff to ask questions without the parent being able to fabricate another story (Helen, Papas-Kavalis & Smith-Alnimer 2003). Social Workers have the difficult tasks of detangling the evidence and if MSBP is discovered, then the conclusion must be made known to the parents. The number one priority is to stop the abuse and protect the child, so intervention and plans for treatment are made right away. The next step is to treat the family as a whole with therapy and parental education. Once this is done, then the goal is to return the child back to the parents if possible. If this is not possible, then the child is removed from the home. Research has shown that when the family starts out with 24 hour in home care and educates the family on proper independent living, in time the family is able to come together as a cohesive family unit (Berg, & Jones 1999).

Treatment Plan for MSBP

Once Munchausen Syndrome by Proxy has been diagnosed, researchers have suggested that psychotherapy (counseling that focuses on thought and behavior modification) be implemented in the treatment plan. These people need to develop and establish relationships with people that are not associated with being sick. Munchausen Syndrome by Proxy perpetrators are extremely difficult to treatment due to the individuals being accomplished liars. They may have spent a life time in deceit because they may have been MSBP victims themselves. Treatment can only be successful if the perpetrator is able to recognize fact from fiction and is a willing participant in the therapy and recovery process (Cleveland Clinic 2006).

For other related conditions, diseases, and disability resource article see Chris Stonecipher’s:

Disability Resources and Advocates http://www.socyberty.com/Disabled/Disability-Resources-and-Advocates.262063

Also check out my friend Lost in Arizona’s Scary Diseases http://www.healthmad.com/Conditions-and-Diseases/Scary-Diseases.175171

and Lauren Axelrod’s Friends Revolution blog www.laurenaxelrod.blogspot.com