The Munchausen syndrome by proxy refers to a pathology characterized by physical and emotional abuse in which the simulation or production of symptoms is directed towards a child, which involves taking him or her to health treatments and unnecessary surgeries. The difficulties in the diagnosis of this form of abuse and the emotional aspects involved highlight the destructive effects in the infancy subjectivity due to the lack of loving capacity protecting and prioritizing the child demands. Psychoanalysis offers a differentiated view, comprehending that the mother attempts to elaborate her own psychic conflicts by the repetition of traumatic experience. There is a necessity of comprehension of the instinct destructivity presented in the maternal unconscious dynamics revealed in the modality of caring which is reflected in violence. / El Síndrome de Munchausen by proxy se refiere a una patología caracterizada por el abuso físico o emocional, en donde la simulación o producción de síntomas es direccionada al hijo, llevando a tratamientos de salud y cirugías innecesarios. Las dificultades diagnósticas de este tipo de abuso y los aspectos emocionales implicados llaman atención por los efectos destructivos en la subjetividad infantil, fruto de una falla en la capacidad de amar, proteger y priorizar las demandas del hijo. El Psicoanálisis ofrece una mirada que retrata un intento de elaboración de los propios conflictos psíquicos por la vía de la repetición de vivencias traumáticas. Así, se percibe la necesidad de una comprensión de la destrucción pulsional presente en la dinámica inconsciente materna revelada por esta modalidad de cuidado que se traduce en violencia.

Annually, more than 15 million U.S. children witness intimate partner violence (IPV) in their homes between caregivers. Witnessing IPV during childhood has been associated with increased risk of adulthood IPV victimization, although this relationship has most commonly been examined among older populations of white adults (McKinney, Caetano, Ramisetty-Mikler, & Nelson, 2009; Straus, 1989; Whitfield, Anda, Dube, & Felitti, 2003), not minority women who experience a disproportionately high burden of IPV victimization (Breiding, Chen, & Black, 2014). It also is unclear whether there are specific characteristics of childhood witnessing of IPV that may aid in understanding the increased probability of IPV victimization observed among young, minority women. This study examined associations between four characteristics of childhood witnessing of IPV (direction of violence witnessed, academic disruption, fearfulness, and frequency) and adulthood physical and sexual IPV victimization. Further, psychosocial moderators of these associations were examined. Existing data collected from 315 women residing in North Philadelphia were analyzed. Overall, 28% of women witnessed IPV during childhood and nearly one in four women reported IPV victimization. Among these women there was diversity with regards to the characteristics of witnessing reported. Unadjusted associations observed that women who witnessed bidirectional IPV, experienced academic disruption, or reported fearful witnessing were significantly more likely to experience adulthood IPV victimization than women who did not witness IPV during childhood. After adjusting for covariates, these witnessing characteristics were no longer significantly associated with adulthood IPV victimization; however, the risk of adulthood IPV victimization was consistently related to current depressive symptoms and substance use. Modest support for effect modification by low self-esteem was observed. A significant difference in the predicted probability of adulthood IPV victimization was observed among women reporting bidirectional childhood witnessing of IPV and high self-esteem in adulthood compared to women reporting bidirectional witnessing and low self-esteem (difference=0.51, 95% CI: 0.06, 0.95, p=0.027). Childhood abuse was associated with greater probability of adulthood IPV victimization regardless of the frequency of childhood witnessing of IPV (aOR=5.8, 95% CI: 2.2, 13.6). Given the high prevalence of childhood witnessing of IPV observed in this study, these findings highlight the importance of screening for childhood IPV witnessing. In addition, these results suggest particular groups of urban women who may be at highest risk for adulthood IPV victimization, including those experiencing depressive symptoms, substance use, and a history of childhood abuse. Identifying adolescents and young adults with these characteristics and providing early prevention services may reduce the probability of future IPV victimization among young, sexually active urban women. Additionally, examining the role of low self-esteem during child- and adulthood may inform efforts to prevent IPV victimization. These findings highlight the need for prospective, longitudinal studies of urban children and adolescents to examine the complex causal pathways between childhood witnessing of IPV, psychosocial characteristics, and adulthood IPV victimization. / Public Health

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Most children exposed to interpersonal violence experience multiple forms of victimizations that are more predictive of trauma symptomatology than single traumatic incidents. This exploratory study seeks to extend research that suggests a child’s intrinsic strengths may help mitigate the development of serious psychiatric symptoms for children experiencing multiple interfamilial victimizations. Utilizing a diverse clinical sample (N= 106) of children 7 to 18 years of age who were exposed to multiple family traumas or to non-interpersonal traumas, path analysis models (moderation, mediational, and moderated mediational) were employed across potential explanatory or attenuating demographic factors (age, ethnicity, and gender) to ascertain the associations between multiple interpersonal maltreatment types experienced, childs’ behavioral and emotional strengths, and their posttraumatic stress symptomatology and/or behavioral and emotional difficulty symptoms. / text