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Munchausen Syndrome by Proxy - Munchausen Syndrome by Proxy Symptom, Cause, Treatment
Munchausen's Syndrome is a recognized psychiatric disorder. Munchausen syndrome is a form of psychological disorder, named after the fictional representation of the German baron, Karl von Münchhausen, and his affinity for telling tall tales. It is described as a factitious disorder in which sufferers feign disease, illness, or psychological trauma despite varying degrees of personal risk, in order to draw attention or sympathy to themselves, is applied when an adult, usually the mother, presents a false history to the physician regarding a child who is not suffering from any of the fabricated symptoms.
Symptoms of Munchausen Syndrome by Proxy
Typical presentations of Munchausen Syndrome by Proxy(MSBP) include the following:
- Bleeding from Coumadin poisoning, phenolphthalein poisoning, exogenous blood exsanguination of child, and use of colored substances to simulate bleeding
- Seizures
- Poisoning with phenothiazines, hydrocarbons, salt, and imipramine
- Apnea produced via carotid sinus pressure and suffocation. Covert video surveillance in cases of suspected child abuse has demonstrated that in many cases parents were inflicting abuse by suffocation.
- CNS depression produced via drugs (eg, insulin, chloral hydrate, barbiturates, aspirin, diphenhydramine, tricyclic antidepressants, acetaminophen, hydrocarbons)
- Diarrhea and vomiting secondary to ipecac, laxatives, and salt administration
- Fever via falsification of chart records or actual temperature
- Rash from drug poisoning, scratching, caustics, or skin painting
- Hypoglycemia from insulin or hypoglycemic agents
- Hyperglycemia reports (from testing other individuals with diabetes)
- Hematuria or guaiac positive stools produced by traumatic injury to the urethra or
Causes of Munchausen Syndrome by Proxy
The MSBP sufferer is often a mother who deliberately harms her child with the intention of gaining the attention of the medical services. Emergency evaluation of these cases must be based on symptoms, with specific tests aimed at detecting the potential method by which factitious symptoms are being induced. These children are often hospitalized with groups of symptoms that don't quite fit classical disease findings. Frequently, the children are made to suffer through unneccessary tests, surgeries, or other uncomfortable procedures. Tests that emergency physicians may consider include the following:
- Urine toxicology screening
- Chemistry panels
- Electrocardiogram (ECG)
- Drug levels for suspected poisoning agents (eg, aspirin, acetaminophen, anticonvulsants)
- Cultures
- Coagulation tests
- Head CT scan
Treatment of Munchausen Syndrome by Proxy
The affected parent should not be accused directly, but offered help. Children who are subject to Munchausen by Proxy Syndrome are typically preschool age, although there have been reported cases in children up to 16 years old. Once the syndrome is recognized, the child needs to be protected and removed from direct care of the parent. Because this is a form of child abuse, the syndrome must be reported to the authorities. Psychiatric counseling will be recommended for the parent involved, but since the disorder is rare, very little is known about effective treatment.
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