Munchausen By Proxy

Munchausen by proxy syndrome is a mental illness and a form of child abuse. The care taker of a child, most often a mother, either makes up fake symptoms or causes real symptoms to make it look like the child is sick. 

The causes of Munchausen syndrome are unknown. Some experts suggest it is a defence mechanism against sexual and aggressive impulses. Others believe it may be a form of self-punishment. Determining an exact cause is difficult because people with Munchausen syndrome are not open and honest about their condition, making research on them nearly impossible. Risk factors for Munchausen syndrome and Munchausen by proxy include a background in day care or healthcare in the involved parent, marital problems between parents, or personality disorders for example, borderline personality disorder.   

Individuals with Munchausen syndrome intentionally produce or exaggerate symptoms. They may lie about or fake symptoms, or alter the results of tests by contaminating samples such as urine. Signs and symptoms of Munchausen syndrome may include the following: 

• Dramatic medical history of serious illnesses, often with inconsistent details of the problem  

• Symptoms that fit a diagnosis too perfectly or lack of signs that go with symptoms (for example, no signs of dehydration, but the person complains of diarrhoea and vomiting) 
• Symptoms that change or worsen once a treatment has begun  
• History of seeking care at numerous doctor offices or hospitals  
• Eagerness to undergo exams, tests and procedures  
• Reluctance to let healthcare professionals contact previous healthcare professionals or family and friends  

• Evidence of multiple surgical scars  

Depending on the symptoms, almost any laboratory test can be used to determine if the symptoms result from a true disease process. Test results inconsistent or atypical of the claimed illness may be an indication of Munchausen syndrome.  

Imaging studies (such as x-rays or scans) may be beneficial in diagnosing Munchausen syndrome. Many claimed medical problems, such as tumours, which can be easily viewed with imaging tests.  

Initially, the medical care of people with Munchausen syndrome is aimed at relieving the claimed symptoms and any injury made by the person to induce the symptoms. Treating people who have Munchausen syndrome is difficult because they are often unwilling to admit they have it. The treating doctor must be very judicious with massive diagnostic tests or surgeries, yet try not to miss serious medical conditions. 

Medications can be useful if conditions exist along with the Munchausen syndrome. Serotonin reuptake inhibitors can benefit people with Munchausen syndrome who also often have (comorbid) depression, and at least theoretically, low-dose anti-psychotics, which can help those with coexisting borderline personality disorder. 

People with Munchausen syndrome can induce or develop authentic illnesses requiring surgery, but further surgical procedure should be treated with great caution. Psychotherapy of various types (strategic, psychodynamic, cognitive) have been reported anecdotally to be of benefit in selected cases. 

People with Munchausen syndrome are rarely treated successfully. They are reluctant to seek treatment for the psychological problem are generally unwilling to undergo psychiatric treatment. The self-inflicted illnesses and injuries of people with Munchausen syndrome can cause serious consequences. These individuals often undergo several unnecessary surges throughout their lifetime. 

The prognosis for Munchausen syndrome by proxy is very poor if the child involves lives in the home. The overall mortality rate is difficult to assess, but is thought to be between 6% and 10%, however, it can be as one-third when poisoning or suffocation are involved. There is also a high rate of chronic illness (morbidity) in siblings of children with Munchausen.  

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