Munchausen Syndrome by Proxy - Assignment Example

Munchausen Syndrome by Proxy Munchausen syndrome by proxy, often abbreviated as MSbp or MBP, is the act of a caretaker intentionally exaggerating, fabricating and/ or causing physical, behavioral and/ or mental health concerns to those in their care, especially children. Also termed ‘medical child abuse’, Munchausen by proxy was named after an 18th Century German dignitary, Baron Karl Friedrich von Munchausen who was known for fabricating stories about his travels and life experiences (such as his riding cannonballs and travelling to the moon) to get attention from people. The addition ‘by proxy’ means ‘through a substitute’ denoting that it is a parent/ adult/ guardian caretaker who is inflicting symptoms in a child and not on themselves. It is a form of child abuse, and a mental disorder that warrants speedy treatment due to its deadliness. Research indicates a 6-10% mortality rate amongst MSbp victims, thus making it perhaps the most lethal form of abuse (Eminson & Postlethwaite, 2000). Munchausen by proxy differs from the Munchausen syndrome in that whereas in Munchausen by proxy, symptoms are deliberately induced in another separate individual, Munchausen syndrome on the other hand occurs when one pretends to be sick or injured on purpose. They hurt themselves, make up symptoms, push for risky operations or try to rig laboratory reports in order to gain attention. In Munchausen by proxy, the caretaker can deliberately harm the child for example by poisoning, medication, falsifying fever, withholding food, suffocation, infections, physical injury, manipulating laboratory results to indicate serious illness in order to gain attention of the medical practitioners and perpetuate a medical relationship. It is not done to achieve a concrete benefit such as financial gain. Munchausen syndromes belong to a group of conditions called factitious disorders, of which they are the most severe and chronic. Factitious disorders are either made up in another person or inflicted on self and can either be psychological or physical (Schreier & Libow, 1993). In approximately 85% of all cases of MSbp, the mother is often the culprit responsible for inflicting the illness or symptoms. However, it also possible but rare to have cases of MSbp induced by non-relatives for instance, medical professionals for a hospitalized patient, for other reasons. Most of the cases involve pre-scholars with a roughly equal number of girl and boy victims though there have been reports of Munchausen by proxy victims in children up to 16 years old. Experts believe that apart from merely seeking attention and sympathy from doctors, nurses and other health professionals, the abuse can be a result of the need for satisfaction of deceiving individual they consider more important and powerful than themselves with treatment success rates for perpetrators notoriously poor (Schreier & Libow, 1993). No one usually suspects any wrongdoing on part of the parent as they usually appear very caring, and naturally so. This makes diagnosis and identification of the case very difficult. Many such cases are never ascertained and it is feared that many deaths could indeed be occurring globally in an alarming scale from MSbp. In addition, the perpetrator is often familiar with the medical field and knowledgeable about how to induce illness on the child without necessarily raising suspicion. For hospitalized cases of children who have been victims of Munchausen by proxy, frequent hospital visits by seemingly harmless perpetrators unfortunately make the child accessible for further induction of symptoms to avoid suspicion of foul play. Medical practitioners tend to ignore the possibility that the condition could have been caused by the parent as it goes against the belief that a parent would not intentionally harm their own.A tip for medical practitioners, in order to reduce chances of being fooled, it is always advised to keep comprehensive and updated records of their patients and their medical history. This way, they can easily detect anomalies in the results and trends of illnesses. In addition, Munchausen by proxy syndrome has often been confused with anxiety resulting in exercise but non-abusive care for a child, non-compliance resulting in a child’s persisting or worsening illnesses and symptoms, and also, malingering with the aim of some external gain such as financial benefit (Eminson & Postlethwaite, 2000). Munchausen by proxy syndrome is a psychiatric condition. The parents’ or caretakers’ personal needs outweigh their ability to regard the child as a human being with feeling and rights. This could be perhaps because they themselves grew up being treated like lesser beings unworthy of any rights and respect. The perpetrator could have had a rough childhood, abused physically and/ or sexually or even hailed from homes where the only time they received any form of attention and affection was during their illnesses. The vice can also be a result of a history of losing a parent and the bitter memories that ensue, major stress (such as marital problems), difficulty forming a healthy attachment to their children, difficulty managing anger and frustration as well as having ability to overcome the more natural tendency for caretakers to protect the children under their protection (Adshead & Brooke, 2001). Estimates suggest that up to 1,000 of the 2.5 million cases of child abuse reported in the U.S. annually are MSbp related. According to a study released in 2003, which analysed 451 documented cases of MSbp, the average age of the victims was 4 years with over half of them aged 24 months and below. 75% of the victims were below 6 years old with average period from onset of symptoms to diagnosis of MSbp at a staggering 22 months! 6% of the victims eventually succumbed to their illnesses, mostly from apnea or anorexia, while another 7% suffered long-term to permanent injury. About half of the victims had siblings and about 25% of the victims’ known siblings were dead. In most instances (76%), the perpetrator was the mother with 61% of other siblings exhibiting symptoms similar to the victims’ (Schreier & Libow, 1993). The most frequently reported problems were apnea with 26% of the cases, anorexia (24.6%), diarrhea (20%), seizures (17.5%), blue skin (11.7%), behavior (10.4%), asthma (9.5%), allergy (9.3%) and fevers (8.6%). Other notable symptoms included vomiting, bleeding, rash, infections, and failure to thrive with most of them being relatively easy to induce/ fake as they are generally subjective (Schreier & Libow, 1993). There are various ways of diagnosing cases of Munchausen by proxy syndrome. A combination of several indicators observed at a time is the best way to go about diagnosing a case. Basing one’s suspicion on just one symptom of MSbp could be disastrously misleading and therefore it is always necessary to find ways of proving beyond doubt that a child is being abused. And as such, diagnosing Munchausen by proxy is very difficult. Some of the approaches that can be taken include taking note of a child with multiple medical complications and not responding to treatment or is following a persistent and an unusual course. Also, short-term symptoms that tend to improve or subside when victim is not with perpetrator, for example when hospitalized, should cause for concern (Eminson & Postlethwaite, 2000). A caregiver/ parent who appears medically in-tuned (and often involved in a healthcare field such as nursing) and is fascinated/ enjoying the hospital environment and the attention the child receives should be cause for alarm. Such a parent is very helpful in the hospital setting, highly appreciated by the staff and seen as a devoted and self-sacrificing individual. The adult with MSP often will not leave the bedside and will discuss in medical detail symptoms and healthcare provided as evidence that they are good caretakers often basking in adulation and making ceaseless efforts with view for public adoration and acknowledgement (Eminson & Postlethwaite, 2000). A parent who is overly supportive, angry or dissatisfied with the doctors, exhibiting a curiously persistent belief that child is sick even amid positive results showing no medical problems is another sign of MSbp. Such a parent would even go further and shop for doctors who believe them. Basically, worsening symptoms are generally reported by the perpetrator and not witnessed by the hospital staff, that is, they lie about symptoms. Such a person should be investigated and monitored keenly.Other pointers to MSbp cases are demonstrated in circumstances where the other parent (usually the father) is not involved in the child’s treatment even in cases where the child’s treatment is serious. Occurrence of another child in the family having had an unexplained illness or death is another pointer (Adshead & Brooke, 2001). The chances of getting prosecution in this case often depend on whether there is sufficient undeniable evidence proving the suspicions otherwise the perpetrator will simply deny any wrongdoing whatsoever. Covet video tapping especially of the hospital rooms has been handy overtime in proving such cases. In a recent survey, when cameras where strategically hidden in children’s hospital rooms, perpetrators were filmed switching medications, injecting children with urine to trigger an infection, or placing drops of blood in urine specimen to alter laboratory results. In addition, apart from merely separating child from perceived perpetrator to observe trend of symptoms, a child old and bold enough to testify against such crimes would be very pivotal in determining such cases. A thorough analysis of medical records and specimen analysis helps unearth discrepancies and prove mischief, for example if blood samples fail to match (Adshead & Brooke, 2001). I personally haven’t experienced or heard of an instance of MSbp and during my research I learnt a lot about the subject, ranging from current statistics, potential causes, prevention, detection and treatment. I also learnt that suspected cases can be promptly reported to the relevant authorities and child protection agencies and victim and suspected perpetrator separated as investigations are undertaken. Upon proof or admission of MSbp, the perpetrator ought to be accorded the necessary psychiatric help. If the child is old enough to recall such malevolence especially from a parent, they too must be counseled and mentored appropriately to avoid future misdemeanors on their part. Munchausen by proxy syndrome is very deadly and damaging; a silent and often unnoticeable vice we all must be on the keen look out for. References Adshead, G., & Brooke, D. (2001). Munchausen's syndrome by proxy current issues in assessment, treatment, and research. London: Imperial College Press. Eminson, M., & Postlethwaite, R. J. (2000). Munchausen syndrome by proxy abuse: a practical approach. Oxford: Butterworth-Heinmann. Schreier, H. A., & Libow, J. A. (1993). Hurting for love: Munchausen by proxy syndrome. New York: Guilford Press. Read More