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A case study of the munchausen syndrome by prox

Received 2000 Feb 11; Accepted 2000 Feb 22. This article has been cited by other articles in PMC.

Munchausen Syndrome by Proxy: A Clinical Vignette

Abstract Munchausen syndrome by proxy is the act of one person fabricating or inducing an illness in another to meet his or her own emotional needs through the treatment process. The diagnosis is poorly understood and controversial.

  • Arch Pathol Lab Med;
  • The investigators described the case of a 14-year-old African-American girl some information has been changed to protect the patient's identity who presented with diarrhea, constipation, and generalized abdominal pain;
  • A case with unexplained bleeding from multiple sites;
  • In this particular case that proved impossible to do because "the mother was not leaving the child's bedside," he added;
  • Munchausen is not to be confused with 9 Anxiety resulting in excessive but nonabusive care for a child Noncompliance resulting in a child's persisting or worsening illness Malingering with the goal of some external gain e.

We report here the case of a 6-year-old boy who presented with possible pneumonia, nausea, vomiting, and diarrhea and whose mother was suspected of Munchausen syndrome by proxy. Munchausen syndrome by proxy, the act of one person fabricating or producing an illness in another in order to meet his or her own emotional needs via the treatment process, is a poorly understood and controversial diagnosis.

While many refer to it as a psychiatric disorder, described by DSM-IV 1 provisional research criteria as an extreme manifestation of factitious disorder by proxy Table 12, 3 others argue strongly that it is more accurately described as medical abuse. According to his mother, the child had been coughing and wheezing for the past 6 days. In addition, the mother stated that the child had a temperature of 103.

The child had been treated with home albuterol nebulizers and antibiotics for 3 days. Over the last 24 hours, the child developed nausea, vomiting, and diarrhea. A sibling in the house had been diagnosed with bronchitis.

Munchausen by Proxy: A Case Study of Abuse

The child had a prior workup that showed negative results for hyperglycemia. Current medications included methylphenidate, 20 mg twice per day; the albuterol nebulizer treatments; and amoxicillin, 250 mg 3 times per day. He had no known drug allergies. Family history was positive for a mother with neurofibromatosis and insulin-dependent diabetes mellitus. There was also a family history of asthma.

The child lived with his parents and 1 sister. There were no smokers in the household, but there was an inside dog. They had central heat, and the boy's immunizations were current.

Physical examination revealed a well-nourished, well-developed, lethargic, and ill-appearing boy who was uncooperative and somnolent during the initial examination. His temperature was 96. Results of cardiovascular examination were normal, and his lungs were clear to auscultation with no wheezing noted.

Although the neurologic examination was difficult to assess secondary to the child's lethargy, he did move all extremities. Owing to mental status a case study of the munchausen syndrome by prox, a computed tomography scan of the head was performed with normal results. The child was admitted for further evaluation. Following multiple injections of intravenous i.

The patient's blood sugar level then normalized for the next 48 hours. On day 3, the child's mother was informed that administration of i. That night, the child's blood sugar level dropped into the high 40s despite repeated attempts to treat with i.

Curiously, once the day shift started, the child's blood sugar level again normalized. Very early the next morning, the child's blood sugar level once again dropped, this time into the 30s, with poor response to appropriate measures.

Munchausen syndrome by proxy: a review and case study.

Growth hormone, cortisol, insulin, C peptide, and lactate levels were measured. The child's blood sugar level continued to fluctuate despite aggressive management. Of interest is that at one time during this episode, the i. Upon inspection, the tubing had a hole that looked like it was created by a needle. Once the blood sugar level normalized again, dextrose was removed from the i. Without the mother's knowledge, however, the i.

The child's subsequent blood sugar levels remained normal. Suspicions that the mother was injecting some of her insulin into the child's i.

The mother also voiced concern that her child was becoming a diabetic just like her, and the child knew how to perform his own finger prick for glucose monitoring. Behavioral aberrations on the part of the mother were also noted, as evidenced by her remaining curled up in a fetal position on the parent's bed during her child's most severe hypoglycemic episode.

On the fifth day of admission, the mother was removed from the room and the child's blood sugar level subsequently remained normal.

The mother subsequently expressed concern about her child's blood sugar level and confessed to covert administration of insulin. The child was removed from the mother's custody and made a full recovery. The most common illness presentations are seizures, failure to thrive, vomiting and diarrhea, asthma and allergic reactions, and infections.

Typical warning signs of Munchausen syndrome by proxy include 7, 8 Persistent or recurrent illness that cannot be explained Discrepancies between clinical findings and history Symptoms that occur only when the mother or suspected perpetrator is present Symptoms or treatment course that is not clinically consistent A working diagnosis that is less plausible than Munchausen syndrome by proxy A mother who welcomes even painful medical tests for her child, is constantly at the bedside, and has previous medical experience, yet seems less concerned than the medical staff about the health of her child Family history of sudden or unexplained infant death It is important, however, to differentiate Munchausen syndrome by proxy from similar concerns.

MUNCHAUSEN

Munchausen is not to be confused with 9 Anxiety resulting in excessive but nonabusive care for a child Noncompliance resulting in a child's persisting or worsening illness Malingering with the goal of some external gain e. This separation may also prove to be an important first step in protecting the victim from further injury, which is of primary importance.

While referral to additional treatment specialists may be of value, overall review of the case history by a physician unfamiliar with the patient may help clarify concerns regarding possible abuse. Medical professionals, trained to provide supportive care for patients and their families, are particularly vulnerable to deceitful parents who give the appearance of being exemplary caregivers.

Evaluation of previous medical records for the patient and any siblings may suggest illness patterns. A detailed social history can be helpful in identifying dysfunctional family dynamics, and involvement of a multidisciplinary treatment team can be instrumental in further assessing the situation and initiating any necessary legal action. As always, it is important to carefully and objectively document all findings in the medical record.

This patient saw doctors in five different states.

Diagnostic and Statistical Manual of Mental Disorders. Munchausen syndrome by proxy and factitious illness: Eur Child Adolesc Psychiatry. Munchausen by proxy syndrome: Munchausen syndrome by proxy: Munchausen syndrome by proxy. Misdiagnosis of Munchausen syndrome by proxy: