Munchausen's by Proxy Syndrome - Seminar Paper

Seminar Paper

Treatment, Diagnosing, Management and appropriate intervention of Munchausen’s by Proxy Syndrome

This seminar paper will be focusing on the topic of Munchausen’s by Proxy Syndrome (MBPS) and will aim to cover the treatment and ways in which a practical diagnosis can be made. Also, it will attempt to raise awareness and identify ways in which medical professionals can help to understand the seemingly rare but fatal condition and most importantly, ways in which to manage and apply appropriate intervention before fatality can occur.

 MPBS is a relatively uncommon condition that involves the fabrication or exaggeration of illnesses by a primary caretaker (I.E mother or father). It is considered one of the most harmful forms of child abuse and due to the chronic affects it can have on the child in conjunction with the time it can take to recognise a fabrication of an illness is prevalent, the outcome can be fatal. In MBPS, an individual (usually the mother) will attempt to deliberately jeopardise the health of another person (most often her own child). The primary caregiver will also try to maintain a long term relationship with the physician, as MBPS centres around the care giver’s need for attention.

Ninety eight percent of the perpetrators are female and over ninety percent of children who fall victim to it will die (kidshealth.org). Diagnosing MBPS is an enormous difficulty healthcare professionals are faced with and with these alarming figures it can be seen that awareness may not be at a satisfactory level at present. Doctors will usually conduct tests on the child, or even perform surgery to try and find out what the underlying cause is for these “made up” symptoms. However, there are a number of signs to look for when considering a diagnosis;

1.    A child that does not respond to medical treatment or maintain a puzzling or illogical course of diverse symptoms.

2.    Findings that are medically impossible, or do not correspond with the child’s medical history.

3.    Short term symptoms that disappear when the perpetrator is around.

4.    Look out for lack of enthusiasm when the parent is given good news regarding the child’s wellbeing.

5.    Identify when a parent is unusually calm in the face of a serious medical condition regarding the child.

6.    A parent or caregiver who appears to be medically knowledgeable or unusually interested in the medical findings presented.

A large proportion that will contribute to a correct diagnosis will rely on the common sense and intuition of the healthcare professional rather than substantial symptomatic pathological evidence. When considering a diagnosis, many of the symptoms healthcare professional will look for will be prevalent in the parent or caregiver (perhaps more so than the child). Meadow (1977) recommended a step wise approach in diagnosing Munchausen by Proxy. Some of these recommendations included the interviewing of other family members when the perpetrator was not present (for example the mother) so she is unable to validate her stories. Or admitting the child to a local hospital to primarily observe the parent-child interaction and attempting to identify a sequence of onset symptoms in conjunction with the presence of the mother.

An important responsibility medical professionals must consider after the recognition of MBPS in a patient, is how they intend to act efficiently and appropriately for the possibility of an incorrect diagnosis or possible fatality. Meadow also recommended ways in which healthcare professionals can deal with this diagnosis. Three steps have been highlighted and recognised as some of the most important to put in to this seminar paper. The first and perhaps the most important would be, prior to informing the caregiver in question, assembling a team or task force to objectively examine the records of the child. Secondly, if a multidisciplinary team agrees, hidden cameras can be used to record the interaction between the child and the suspected perpetrator in the hospital setting. Finally, prior to notifying the parent of the diagnoses, it is important to inform the local law enforcement and child protection agencies.

Having identified ways in which to recognise and manage MBPS, it is often the most arduous stage of the ordeal attempting to treat those affected. There is only one recognised type of treatment for MBPS and that is psychotherapy, which is given to the child, offended care giver and surrounding family members. The counsellor will try to help the care giver understand how she has harmed her child. Also, strategies are offered to help the caregiver manage stress, anxiety and self esteem problems, and problems in feeling in control of her life (webmd 1999). A large portion of the ongoing therapy given to the parent will focus on her development of empathy, in order for her to fully understand the affects her actions have had on her child. Unusually, this condition is not treated with any medication. The only instance medication would be used is if a pre existing condition is already prevalent (such as an anxiety or stress disorder). The primary obscurity of treating MBPS is that many of the care givers experience extreme denial, or often try to manipulate healthcare professionals who try to help them.   

In conclusion it can be seen that Munchausen’s by Proxy Syndrome can be extraordinarily problematic in regards to diagnosis and management. Insomuch as it can be an arduous task of trying to help those involved for a secondary prevention, it is clear that MBPS is not recognised as much as it should be. The lack of treatment, unrecognisable symptoms and clear lack of management techniques of the condition is undeniably below par and the statistics previously stated in this paper would do little to disregard this assumption.     

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