Thesis (M.S.)--Boston University / Munchausen Syndrome by Proxy (MSBP) is a term given to a situation which presents criteria for both Pediatric Condition Falsification (PCF) and factitious disorder by proxy (FDP). According to the Diagnostic and Statistical Manual of Mental Disorders-IV text revision (DSM-IV-TR), in child abuse cases where FDP is a result of PCF, then the nomenclature, MSBP, can be used interchangeably to describe such an event. Currently, in a situation that is diagnosed as Factitious Disorder by Proxy, the perpetrator of such an event is diagnosed as having Factitious Disorder Not Otherwise Specified (FD-NOS). An obvious issue stemming from this is the confusion over what should be diagnosed and remedied, i.e., the situation, the perpetrator, and/or the victim. Due to the convoluted and often controversial definition of such an event, as well as the criteria for diagnosis, it is proposed here that a new definition be adopted to explain this form of child abuse. With this novel definition, the symptoms of this psychological disorder of the perpetrator are observed in the victim. Under this new definition, the psychiatric term "Factitious Disorder by Proxy" would be used as a mental diagnosis of the caregiver, wherein the symptoms manifest in that of the victim. Additionally, an addendum to the type of symptoms exhibited in the child is proposed to include that of the exacerbation of symptoms in children with valid pre-existing conditions. An extensive literature review was performed to support the proposal for changing the criteria and diagnosis of FDP in the DSM. The implications of this change would greatly benefit not only the psychiatric, medical, and legal realm, but the forensic community as well.

Patienter som lider av Münchhausens syndrom hittar på symtom och/eller skadar sig själva i syfte att få uppmärksamhet från sjukvårdspersonal. Det är en svårdiagnostiserad störning som är till skada för individen och hela sjukvårdssystemet. Det har gjorts få undersökningar om Münchhausens syndrom och därför intervjuades fem läkare för att öka kunskapen om Münchhausens syndrom och få svar på vilka möjligheter läkare har att kunna identifiera denna störning, samt vilka åtgärder som då kan bli aktuella. Resultatet visade att läkarna ansåg sig vara för lite insatta om Münchhausens syndrom och att de inte kunde vara helt säkra på att patienten inte hade de besvär som patienten påstod sig lida av. Det fanns heller ingen handlingsplan ifall läkarna misstänkte att en patient inte talade sanning om sitt hälsotillstånd. Kunskap och medvetenhet var två viktiga faktorer för att kunna identifiera och behandla patienter med Münchhausens syndrom. Urvalet kan ha påverkat studiens giltighet.

Munchausen By Proxy Syndrome is a form of child abuse whereby parents induce symptoms of real illness, or falsely report symptoms, to initiate medical treatment for their children. Following a review of the literature with respect to case management, the author presents for study a case followed from initial suspicion to resolution two years later. The management of this case is compared to what the literature would suggest is the ideal practice. Areas of weakness are found to be the average social worker's lack of knowledge about the syndrome, due to its rarity, agency unpreparedness to deal with a case, over-reliance upon medical opinion and a lack of advice as to the long term likelihood of family reunification. Recommendations are made for the field of social work, child protection in particular.

No description available.

Munchausen syndrome is a rare condition in which the patient repeatedly seeks medical care for factitious illnesses. Cardiac Munchausen syndrome was first reported in 1953 and later referred to as cardiopathia fantastica. It is characterized by clinical manifestations of acute cardiac disease that are feigned and recurrent. Cardiopathia fantastica can have a variety of presentations similar to true cardiac disease. Most cases have presented with chest pain simulating acute coronary artery disease, but arrhythmias, hypertensive crises, abnormal biochemistry, and electrocardiographic findings have also been noted. These patients are willing to undergo expensive, invasive, and risky procedures to evaluate their simulated illness. This condition is likely to be significantly underreported. In some patients, the presence of abnormal findings that are clinically insignificant may complicate the investigative approach. Patients with this disorder consume a disproportionate amount of health care dollars and sometimes are left with residual deficits as complications of invasive procedures. In this review, we discuss the recognition, manifestations, and treatment of cardiopathia fantastica.

Factitious disorder (FD) imposed on self is a psychiatric disorder characterized by the intentional feigning of symptoms or the self-inflicted production of symptoms in the absence of an obvious external reward. Previously known as Munchausen syndrome, this term is now reserved for severe, chronic, or dramatic cases. Multiple theories for the pathogenesis of FD have been proposed, but most studies point to the behaviors exhibited as a coping mechanism to address emotional stress and resolve unmet psychosocial needs. This case report describes a 31-year-old male who frequently presented to several Emergency Departments at hospitals within the Appalachian region with intentional ingestion of foreign objects. These scenarios ultimately required the patient to undergo approximately 32 esophagogastroduodenoscopy (EGD) and 28 gastroscopy procedures over the course of two years. The patient also had a significant history of suicide attempts by prescription medication overdose, although clinical workup and laboratory confirmation of such ingestion was varied. After two years of these frequent ED presentations, the patient was evaluated for FD upon voluntary admission to an inpatient psychiatric facility. Due to the need for anesthetic agents in the frequent EGD's performed on this patient, the possibility of drug-seeking as the motivating factor for this patient’s behavior and the possibility of a co-occurring substance use disorder were considered. Suicidality in FD and the lack of case reports and reliable research on the topic makes a challenging diagnosis and clinical course even more complex. Additionally, the clinical management of FD is unique, and no reliable studies have detailed an effective treatment plan. Thus, to add to the literature, the treatment and outcome to date for the patient presented here and the suicidal ideation and intentional overdoses complicating this case are discussed. Continued research and reporting of FD cases will help guide clinicians in the treatment and management of this challenging diagnosis.

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.

In this dissertation, the author provides an account of his therapeutic interaction and experience, as an intern clinical psychologist, in working with a patient in psychotherapy who was eventually diagnosed with a “factitious disorder”. This study descriptively addresses how the therapeutic interaction impacted upon the therapist’s thinking of the process both diagnostically and in terms of therapeutic goals. This study consists of a single case, qualitative research design. It concerns the interactions and experiences of the therapist with a specific patient (diagnosed with a factitious disorder) in the context of a multidisciplinary academic hospital setting. The study aims to be predominantly descriptive of this therapy, and as such employs the psychological phenomenological method of Giorgi (1985) in order to provide a specific description of the situated structure of the therapy. As such, this study is able to contribute to the sparse psychological and therapeutic information available on factitious disorders. There are few detailed accounts of actual therapeutic interactions – specifically from a psychological perspective – for patients diagnosed with factitious disorders. The specific description of the situated structure of the therapy is also compared to the available literature on factitious disorders. Although the aim of this study was not evaluative in nature, the author does provide some tentative comments on the aetiology and therapeutic considerations for factitious disorders – with regards to this particular case. The author suggests a strong link to personality and character deficits underlying factitious behaviour. The author further suggests the importance of acknowledging the “sick role”; allowing for “face-saving” strategies; providing consistency (on behalf of the therapist); and the setting of rigid, overt, therapeutic boundaries in the psychotherapeutic treatment of factitious disorders. / Dissertation (MA (Clinical Psychology))--University of Pretoria, 2005. / Psychology / unrestricted