Page 1 of 11 HD 497 Lecture 8 - Neglect Slide 1 [Slide title] HD 300 Child Abuse & Neglect [Slide content] Unit 9 Munchausen Syndrome by Proxy [Audio] In this unit we are going to discuss a very bizarre type of child abuse that is termed Munchausen Syndrome by Proxy. Slide 2 [Slide title] Introduction [Slide content] • Falls under the umbrella of “facetious disorders” • Also termed “Illness Induction Syndrome” [Audio] Munchausen Syndrome by Proxy falls under the umbrella of facetious disorders and it is also termed Illness Induction Syndrome. Slide 3 [Slide title] Munchausen Syndrome [Slide content] • Named for Baron Karl von Munchausen - 18th century figure who gained fame for his tall tales about his adventures • 1951 – Dr. Richard Asher coined the term “Munchausen Syndrome” to describe patients who fabricate illness or make themselves ill. [Audio] In order to understand Munchausen Syndrome by Proxy, it is really helpful to understand what Munchausen Syndrome is itself. So, we will begin with that. Munchausen Syndrome was named for Baron Karl von Munchausen. He was an 18h century figure who gained fame for his tall tales about his adventures and in 1951, Dr. Richard Asher coined the term Munchausen Syndrome to describe patients who fabricate illness, make it up or make themselves ill. Slide 4Page 2 of 11 [Slide title] Munchausen Syndrome [Slide content] • Features: - Give plausible but fictitious medical histories - May fake or even cause their own illness - Often go from doctor to doctor and hospital to hospital - It is a bid to get attention and nurturance. [Audio] Example: A nurse was admitted to our women’s center with phlebitis in her lower leg. Interestingly, she was asking for 100 mg of Demerol every 4 hours. Having cared for many phlebitis cases before I was puzzled as to why she had so much pain. She did not have a good answer, but the next day she said “my doctor said that extreme pain is not unusual.” However, we suspected that she had makeup on her leg to mimic inflammation and requested that the doctor order wet hot packs. When the packs were removed, the makeup was on the towel, and she was discharged immediately from the hospital. This was not the first time she had pulled similar stunts. Patients, before electronic thermometers, would put their thermometer in their coffee cups of fake illness. Some patients went beyond faking it to really make themselves ill. They might rub feces into surgical wounds to keep them infected, would spit in their IV’s and use many other tricks to really make themselves sick so that they could stay in the hospital. Slide 5 [Slide title] Munchausen Syndrome by Proxy (MSbP) [Slide content] • 1977 – English pediatrician, Meadows, coined the term after finding that mothers of some of his patients had fabricated the children’s illnesses. [Audio] Now, Munchausen Syndrome by Proxy – in 1977, an English pediatrician, Dr. Meadows coined the term after finding that mothers of some of his patients had fabricated the children’s illness. We are going to be talking specifically about parents or caregivers causing illness in their children, but Munchausen Syndrome by Proxy has also been used by people who have made their pets ill and taken them into the vet or who have made disabled people or elderly people in their care ill. We are focusing right now though on children and that is usually where this term is applied is to the idea that parents have made their children sick. Slide 6 [Slide title] Diagnostic Criteria (American Psychological Association) [Slide content] • MSbP is the intentional production of physical or psychological signs and symptoms in aPage 3 of 11 person under the individual’s care. • Motivation for the perpetrator’s behavior is to assume the sick role by proxy. • External incentives (e.g., economic gain) for the behavior are absent. • The behavior is not better accounted for by another mental disorder. [Audio] The American Psychological Association provides this diagnostic criteria in order to say, yes, this is Munchausen Syndrome by Proxy. MSbP is the intentional production of physical or psychological signs and symptoms in a person under the individual’s care. The motivation for the perpetrator’s behavior is to assume the sick role by proxy and external incentives such as economic gain are absent and the behavior is not better accounted for by another mental disorder. Slide 7 [Slide title] Features of MSbP [Slide content] • The perpetrator assumes the sick role indirectly by producing or feigning illness in another. • Perpetrators are almost exclusively mothers. • Victims are usually children under age six. • Perpetrators often have training, experience, or work in health related situations. [Audio] So, the features of MSbP are the following. First, the perpetrator assumes the sick role indirectly by producing or feigning illness in another. Perpetrators are almost exclusively mothers; however, fathers do have a role to play in this illness. They basically defer to the mother and they ignore what is going on with the child. The victims are usually children under age 6. As children get older and can see that other children aren’t being treated like that with their mother, often they are big enough to resist. And the perpetrators or the mothers or caregivers often have training, experience, or work in health related situations and so they know the jargon, they know the medications, they know what to expect - the– are familiar with hospitals and doctors. Slide 8 [Slide title] Features of MSbP [Slide content] • MSbP ranges from diseases that are completely imagined to diseases that are fully induced in the child. • The motivation is to gain attention and credibility. • Prevalence – not known for sure, but appears to be more common than once thought. [Audio] Other features of MSbP. MSbP ranges from diseases that are completely imagined to diseases that are fully induced in thePage 4 of 11 child. The motivation is to gain attention and credibility and the prevalence is not known for sure, but it appears to be more common than once thought and in fact, now some hospitals are going back to look over their records for infants who came in with a diagnosis of Sudden Infant Death Syndrome because a few of those have actually been induced by the mother smothering