Munchausen Syndrome by Proxy - Research Paper Example

Munchausen Syndrome by Proxy Introduction       Munchausen syndrome by proxy, which is a type of factitious disorder, is a mental sickness in which an individual acts as if another person that he or she is caring for has a mental or physical illness whilst in real sense, the person is not sick. People with this syndrome assume the character of a sick individual indirectly by producing or laying about sickness in another individual under their care, more often than not, children under 6 years of age. However, there have been incidences of adult sufferers of this disorder. It most frequently occurs with mothers, even though it can occur with fathers who deliberately harm or illustrate fictional symptoms in their children to get the concentration given to the family of someone who is sick. A person with this condition uses several hospitalizations as a means to get praise from others for her affection to the child’s care, repeatedly using the sick child as a means for developing a connection with the doctor or other health care provider (Cleveland Clinic, 2009).       Rocha (2004) describes Munchausen syndrome by proxy as a scary child welfare occurrence that presents itself in the medical arena. Many people disagree concerning the worth of regarding this condition as a psychiatric judgment of the perpetrating parent, and in its place, choose to think of it exclusively as a form of child abuse. This line of thinking appears to underestimate the exceptional nature in which these parents harm their children. This condition differs from what we term as child abuse in several ways.       Munchausen syndrome by proxy is one of the factitious disorders. These factitious disorders, inevitably involve medical and health care experts in their systems of abuse. Whether doctors wish it or not, they get involved. These disorders confront our ways of thinking about our specialized identities, our patients, and the agreement or bargain implied within the therapeutic relationship. It is in these disorders that patients characteristically and sometimes irritably, reject their emotional suffering and reject psychological explanation and help (Eminson & Postlethwaite, 2001).       There are noteworthy differences of views on whether Munchausen Syndrome by Proxy exists; however, there is proof that there exists a pattern of actions portrayed by the label of fabricated or Induced Illness by Caregivers. Various video observations have portrayed that some parents harm their child knowingly and then present the child as having a mysterious medical state. These parents then assent to, and certainly pursue, unwanted medical procedures. In addition, Pediatric research has revealed that cases of some children admitted to hospital-pediatric and emergency wards actually suffer from a mysterious illness. According to the research, the child’s parent or caregiver causes this illness, which does exist in particular – some caregivers do fabricate or stimulate illness in children (Higgins, et al., 2005).       Hans & Lissy (2000) argue that Munchausen syndrome by proxy constantly involves a bogus story from the parent concerning the child's illness. Occasionally, the perpetrator also formulates signs and sometimes inflicts direct harm on the child, thus inducing illness. Many pediatricians realize the irritation of handling inflicted diseases in healthy children. Unfortunately, a complete diagnosis of Munchausen by proxy syndrome oftentimes takes over a year. Due to such a long period, there are certainly increased upsetting consequences for the victim. A false history alone can cause immense suffering for the child. This situation often culminates to death as most of the victims die prior to the correct diagnosis.       The psychological mechanisms that stimulate a parent to harm a child in this manner appear varied, although the consequence and needless medical assessments or treatment remains the same. One view is that the main motivating factor is the need for attention and recognition of the parent as the dedicated parent of a sick child, or a parent might have a psychological need to mislead physicians or other authority figures. On the other hand, as a wrong trick to get attention from the physicians, an over-worried and emotionally upset parent may overstate a child’s medical condition. In addition, a maladaptive coping mechanism involving love and illness or reflecting a life-long pattern of a pathological approach toward illness can explain the condition. The behavior is present in family factors such as paternal disconnection or a deep lack of compassion because of a personal history of abuse (Siegel & Duquette, 2007).       Abdulhamid (2006) indicates that there are several warning signs that alert healthcare workers to the likelihood of Munchausen syndrome by proxy. These include unproductive or poorly tolerated treatments, aversion to a wide range of foods and medications, and surprisingly, prolonged and mysterious symptoms. Symptoms that begin or occur only in the presence of the perpetrator and a clinical presentation involving unusual and numerous symptoms and illnesses are other warning signs. On laboratory tests, patients generally have ordinary or negative results, and consequently, their illnesses do not respond to established medical treatments.       Diagnosing Munchausen syndrome by proxy is very hard due to the lying that is involved. Doctors often exclude any likely physical illness as the cause of the child’s symptoms, and repeatedly use various diagnostic tests and processes before considering a diagnosis of the disorder. A thorough evaluation of the child’s medical history as well as an examination of the family history and the mother’s medical history might provide hints to suggest the disorder. This is done if there is no established physical cause of the symptoms. Definitely, the most significant or helpful part of the diagnosis is probably the evaluation of all old records that can be obtained. Although this is time-consuming, it is a very vital task that if forgotten, the diagnosis is mostly missed (Cleveland Clinic, 2009).       Rocha (2004) asserts that during diagnosis, there might be a propensity to over-test patients to safeguard against likely malpractice litigation due to lack of running all diagnostic tests, and probably missing the detection of something. Moreover, according to their training, doctors, particularly in hospital settings, examine the origin of symptoms through diverse tests and procedures and do not take collective histories.       There are several assessment procedures for this condition. The first step is to study the history to decide the fabricated and genuine events.  After this, the next step is looking at the sequential relationship between illness events and the presence of the mother. The third step is checking the details of the social, individual, and family history that the mother has given.  Lastly, the doctor should make contact with other family members and look for the intention for the behavior. With respect to modern type of the disorder, the assessor must make a determination as precise as possible regarding abuse to a child.  The assessor should insist on access to all individuals and records that will facilitate the checking of the history given by the mother or other adult complainant.  In some cases, the person accused of abusing the child is a relative outsider and it may not be possible to assess that person (Rand, 1990).       Hans & Lissy (2000) suggests that there are numerous ways to get a quick diagnosis for this condition. Heightened understanding is the most significant key. The clinician should always deem the likelihood of Munchausen syndrome by proxy if a patient has serious, long-lasting, inexplicable symptoms and does not react to existing treatment. Frequent extensive physical tests may disclose clues for the correct diagnosis. It is vital to collect widespread data on the patient's medical history from one of the child's caregivers and from other professionals and relatives. An examination of the medical history of the mother and siblings is very helpful, since it may disclose significant hints. If it is possible, the examiner can observe the child closely to see whether the symptoms vanish while separated from the parents         Abdulhamid (2006) argues that the health care worker have to validate the reliability of the signs and symptoms, establish the need and benefits of the medical care, and query who is the mastermind of the assessments and treatments. This is according to the American Academy of Pediatrics Committee on Child Abuse and Neglect. To make the diagnosis, there must be the recognition of the existence of the two key factors: harm or possible harm to the child from too much interference and a caregiver who is inducing illness or pursuing needless treatment. The drive of the perpetrator is not crucial in diagnosing the abuse. This is because the perpetrator may not necessarily inflict the illness to the child with any motive.       Health care professionals prescribe diagnostic tests and treatments that are potentially harmful despite the precise nature of the duplicity. In medical diagnosis, complete certainty is a rare thing and physicians have all known pragmatic therapy to be efficient. However, on occurrence, the well-meaning but mistaken pursuit of an ever-more-indefinable diagnosis for this disorder or effective treatment can lead medical staff into a moral dilemma. Potentially injurious medical care can range from medical or even surgical involvements and a diagnostic search that delicately encourages and facilitates a caregiver's vision through a full range of persistent tests. On the other hand, a child may present to the doctor with an ordinary diagnosis but one that appears defiant to an increasingly hostile array of treatment routines. The failure to regard factitious disease in the differential diagnosis is the common factor in all (Stirling, 2007).       This disorder can cause serious long-term and short-term complications, including numerous hospitalizations, the death of the victim and constant abuse. The perpetrator may continue abusing the child or inducing illness as he or she becomes addicted and used to it. Research suggests that the death rate for victims of this disorder is about 10 percent this means that about this percentage of all the people diagnosed with the disorder ultimately dies. In some cases, a child casualty of Munchausen Syndrome by Proxy learns to correlate getting concentration to being sick and develops Munchausen syndrome him or herself later in life (Cleveland clinic, 2009).       As Abdulhamid (2006) asserts, children subjected to Munchausen syndrome by proxy present with induced physical disorders and fabricated psychological signs since the effects are not only physical. Children subjected to Munchausen syndrome by proxy can have long-term expressive and psychological disorders similar to those getting other forms of abuse. Children might have behavioral problems, including feeding disorders in infants; hyperactivity, pulling out, and resistance behaviors in preschoolers; and adaptation symptoms in older children and adolescents. Older children frequently bear and collaborate with their parents in their own abuse and induce medical illnesses of their own       Rocha (2004) points out that prevalence rate of this disorder are hard to establish since the amount of consciousness among medical professionals is unidentified. It might be that doctors are conscious of the probable certainty of the disorder, but are just not seeing it in their patients, or it could be that the doctors are merely unconscious of the likelihood that it exists. This condition can in fact flourish in modern medical practice since modern medicine is investigation-oriented and tremendously controversial. By understanding that this disorder is a form of child abuse taking place in a medical setting, a clear position is defined for the system that is at present in place in our states to protect children. There is authorization of child protective services organizations to safeguard children abused sexually, physically, or psychologically, regardless of whether the abuse happens in the home or the hospital. When taking into account treatment for child abuse happening in a medical setting, the fundamental principles used in any other form of child abuse case should be applied .the basic principles are to make sure the child is safe, ensure the child's future protection and permitting  treatment to occur in the slightest restraining setting possible (Stirling, 2007).       Mason (2009) agrees that the primary concern in cases of Munchausen syndrome by proxy is to guarantee the protection and safety of the child. This may demand that the child be placed in the care of another person. Actually, managing a case concerning Munchausen syndrome by proxy frequently requires a team that includes foster care organizations and law enforcement, social workers, as well as the health care providers. Moreover, the emergency physician should not make this diagnosis but should be the one to advocate admission to the hospital for the initiation of correct workup. In the case of Munchausen syndrome by proxy, the child may present with a life-intimidating, induced condition or may be entirely asymptomatic with a factitious history given by the caregiver. Putting the history and physical findings together in a coherent fashion is the challenge for the physician. This is predominantly hard in the child abuse victim, particularly when the caretaker might not be giving an honest history. Involving several medical colleagues in the assessment may be helpful.  Discussing the case with other physicians who have seen the child and accessing the records of preceding visits is very necessary to assist in making this hard diagnosis.       The approach taken in modern-type Munchausen Syndrome depends on the relationship between the parties. For instance, if the perpetrator is the child's mother and the assumed abuser is the child's father, or if the perpetrator is someone other than the mother and the assumed abuser is a relative stranger.  If it is a divorce condition and the disorder is brutal, it may be suitable to place the child with the accused, who is frequently the father. These would be situations where the father has been an excellent parent who has been considerably involved with the children.  In order to perform this work, judicial support, administration and implementation is required, with precise restrictions on the mother's contact with the children. Theoretically, at least, progressive therapy of less brutal cases may be supportive if the mother is encouraged, if she displays minimal anti-social tendencies, and the treatment is part of a holistic, well-administered case plan observed by the court or child defensive Services. If it is a divorce case and therapy is specified, there should be possibly only one therapist, minimizing the disorder perpetrator's chances for manipulation. The problem with supervision and monitoring is that there is frequent congestion in caseworkers and the court system and there may be numerous changes in personnel (Rand, 1990).  Conclusion       Munchausen syndrome by proxy is a disorder that has had much contention and debate in the medical field. In cases of this disorder, the primary aim of treatment should be the protection of the child from abuse and mistreatment. This disorder has been very difficult to diagnose due to the insincerity presented by the perpetrators. The diagnosis of this condition often takes a very long time since it involves long processes. A victim (usually children) may be at a risk of getting other related long-term disorders and complications. Some of the children however adapt to the condition and some even assist their parents in inducing illness. There should be clear strategies in diagnosing the disorder including a thorough review and examination of the family history. Child protection agencies, health care providers and the legal professionals must value the particular issues involved in this form of child abuse. References Abdulhamid, I. (2006). Munchausen Syndrome by Proxy. Retrieved from http://emedicine.medscape.com/article/917525-overview Cleveland clinic. (2009). Munchausen Syndrome by Proxy. Retrieved from http://my.clevelandclinic.org/disorders/factitious_disorders/hic_munchausen_syndrome_by_proxy.aspx Eminson, M. & Postlethwaite, R. J. (2001). Munchausen Syndrome by Proxy Abuse: A Practical approach. The British Journal of Psychiatry, 178, 5, 481-482. Hans, H.J & Lissy, H. (2000). Manifestations of Munchausen Syndrome byProxy in Pediatric Gastroenterology. Journal of Pediatric Gastroenterology & Nutrition, 31, 2, 208-211. Higgins, D. et al. (2005). A new name for Munchausen Syndrome by Proxy: Defining Fabricated or Induced Illness by Carers. Retrieved from http://webcache.googleusercontent.com/search?q=cache:4zB0BflydMUJ:alecomm.com/attachments/008_ Mason, J.D. (2009). Munchausen Syndrome by Proxy. Retrieved from http://emedicine.medscape.com/article/806735-overview Rand, D.C.  (1990). Munchausen Syndrome by Proxy: Integration of Classic and Contemporary Types. IPT Journal, 2, 2, 2-4. Rocha, D. (2004). The Phenomena of Phantom Illness: A Discussion of MunchausenSyndrome by Proxy. Retrieved from http://docs.google.com/viewer?a=v&q=cache:PVBrZ6jsowAJ:www2.luc.edu/socialwork/praxis/pdfs/vol4 Siegel, P.T & Duquette, D. N. (2007). Munchausen by proxy: a collaborative approach to investigation, assessment and treatment. Retrieved from http://webcache.googleusercontent.com/search?q=cache:jXgT_hc5AEwJ:www.michigan.gov/documents/ Stirling, J. (2007). Beyond Munchausen Syndrome by Proxy: Identification and Treatmentof Child Abuse in a Medical Setting. Pediatrics Journal, 119, 5, 1026-1030.    Read More