Munchausen syndrome is a form of psychological disorder known as a factitious disorder (the term "Munchausen syndrome" is sometimes used, incorrectly, to refer to any form of factitious disorder). Sufferers mimic real diseases, presenting a great problem to themselves and their healthcare professionals. The disorder is named after a literary figure, Baron Munchausen, a real person who was portrayed in fiction as a famous teller of tall tales.
Munchausen syndrome
In Munchausen syndrome, the sufferer feigns, exaggerates, or creates symptoms of illnesses in himself in order to gain attention, sympathy, and comfort from medical personnel. The role of "patient" is a familiar and comforting one, and it fills a psychological need in the man or woman with Munchausen's.
There is some controversy on the exact causes of the syndrome, but an increased occurrence has been reported in healthcare professionals and close family members of people with a chronic illness.
Munchausen syndrome by proxy
In Munchausen Syndrome by Proxy (MSbP, but also known as FII, or Fabricated or Induced Illness - the official name given the condition in March 2002 by the Royal College of Paediatricians and Child Health ) [1], a caregiver, usually the mother, feigns or induces an illness in another person, usually her or his child, to gain attention and sympathy as the "worried" parent. Although MSbP cases with feigned or induced physical illness receive the most attention, it is also possible in parents who emotionally abuse their child, then claim psychiatric and/or genetic problems. This is much more likely to occur in adopted, step, and foster children than those living with their birth parents.
Munchausen by proxy is a term used to describe a form of child abuse and which was coined by Sir Roy Meadow, former professor of Paediatrics at the University of Leeds, England. During the 1990s and early 2000s, Meadow's expert testimony sent many parents to prison for allegedly murdering their children through MSbP, as well as causing many potential victims to be taken into care. However, during the course of 2003 a number of high-profile acquittals brought Meadow's ideas into serious disrepute. Some experts now doubt even the existence of MSbP, despite observations on hospital surveillance cameras which have caught MSbP abusers in the act. At the time of writing upwards of 250 convictions which relied on Meadow's evidence are under review. Meadow himself is under investigation by the British General Medical Council for suspected professional misconduct.
In 2003, Sickened, an autobiographical account of the Munchausen Syndrome by Proxy abuse Julie Gregory suffered as a child, was published.
A documentary film, MAMA/M.A.M.A., which questions the validity of Munchausen Syndrome by Proxy, arguing that in many cases doctors' overmedication of infants may be the real cause of their infirmity rather than the mother's mental illness, has just been released. The film contains the last interview that the controversial Sir Roy Meadow granted.
The 1999 movie The Sixth Sense had the posthumous solving of a case of MSbP as one of its later subplots.
Clues that may indicate Munchausen Syndrome by Proxy
Caution: many of the items below are also indications of a child with a valid, but undiagnosed illness. An ethical diagnosis of MSBP must include an evaluation of the child, an evaluation of the parents and of the family dynamics. Diagnoses based only on a review of the child's medical chart are now frequently being rejected in court.
- A child who has one or more medical problems that do not respond to treatment or that follow an unusual course that is persistent, puzzling and unexplained.
- Physical or laboratory findings that are highly unusual, discrepant with history, or physically or clinically impossible.
- A parent, usually the mother, who appears to be medically knowledgeable and/or fascinated with medical details and hospital gossip, appears to enjoy the hospital environment, and expresses interest in the details of other patients’ problems.
- A highly attentive parent who is reluctant to leave her child’s side and who herself seems to require constant attention.
- A parent who appears to be unusually calm in the face of serious difficulties in her child’s medical course while being highly supportive and encouraging of the physician, or one who is angry, devalues staff, and demands further intervention, more procedures, second opinions, and transfers to other, more sophisticated, facilities.
- The suspected parent may work in the health care field herself or profess interest in a health-related job.
- The signs and symptoms of a child’s illness do not occur in the parent’s absence (hospitalization and careful monitoring may be necessary to establish this causal relationship).
- A family history of similar sibling illness or unexplained sibling illness or death.
- A parent with symptoms similar to her child’s own medical problems or an illness history that itself is puzzling and unusual.
- A suspected parent with an emotionally distant relationship with her spouse; the spouse often fails to visit the patient and has little contact with physicians even when the child is hospitalized with serious illness.
- A parent who reports dramatic, negative events, such as house fires, burglaries, car accidents, that affect her and her family while her child is undergoing treatment.
- A parent who seems to have an insatiable need for adulation or who makes self-serving efforts at public acknowledgement of her abilities.
Origin of the name
The name derives from one Baron Munchhausen (Karl Friedrich Hieronymus Freiherr von Münchhausen, 1720-1797), to whom were ascribed a series of fantastically impossible tales written by Rudolf Raspe.
In 1951, Richard Asher was the first to describe a pattern of self-abuse, where individuals fabricated histories of illness. Remembering Baron von Munchausen, Asher named this condition Munchausen's Syndrome. Originally, this term was used for all factitious disorders. Now, however, there is considered to be a wide range of factitious disorders, and the diagnosis of "Munchausen syndrome" is reserved for the most severe form, where the simulation of disease is the central activity of the sufferer's life.
In 1977, the English paediatrician Roy Meadow described a form of child abuse in which mothers deliberately induced or falsely reported illnesses in their children. He referred to this behaviour as Munchausen Syndrome by Proxy.
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Last updated: 05-07-2005 13:09:06
Last updated: 05-13-2005 07:56:04
