Diagnosis and management of Munchausen's Syndrome by Proxy

Abstract

A systematic literature review was conducted to identify and synthesise the relevant literature on the epidemiology, presentation, assessment and management of Munchausen's Syndrome by Proxy (MSP). This included collating information from published and unpublished sources. The purpose of the review was to provide an overview of the status of research into MSP. The results indicated that there are common areas of research and theorising on MSP. These areas were divided up into the following categories: definitions of MSP, diagnosis and recognition of MSP and management of MSP. The results of the literature review were summarised using the above-mentioned categories. The most widely accepted definitions of MSP included the International Classification of Diseases (10th edition) (ICD-10), (1994), Rosenberg (1987), The Diagnostic and Statistical Manual (4th edition) (1994) and Kelly and Loader (1997). The most common presentations of MSP identified included seizures, diarhhea, apnea and fevers. The most common forms of assault identified included suffocation, giving of drugs and poisoning. Mother-perpetrator features, child-victim features and family features were identified as categories used to help with the identification of MSP. Appropriate management of MSP included careful consideration of child protection factors with the emphasis on comprehensive assessment and management.

A practitioner's complaint and proposed direction: Munchausen syndrome by proxy, factitious disorder by proxy, and fabricated and/or induced illness in children.

“…A list of FDBP characteristics that appear frequently in the literature has been provided in Table 1 for direct comparison between an alleged perpetrator diagnosis (FDBP) and a child maltreatment dynamic. We relied heavily on the work of Rogers (2004) and Artingstall (1995), the DSM–IV–TR 's (American Psychiatric Association, 2000) research criteria, and Rosenberg's (1987) description of MSBP in formulating this list of FDBP characteristics, as well as the criteria found in Korpershoek and Flisher (2004); Rand and Feldman (1999); Siegel and Fischer (2001), and other literature. Other points are cited as well that are not so closely tied to the work above; some appeared only in certain articles, and for others there is some level of disagreement surrounding the question as an indicator of FDBP…”

“…Citing Pankratz's (1998Pankratz's ( , 1999) key criteria for diagnosing MSBP, Rand and Feldman articulated some of the steps that were absent in these cases: "Although the mothers had psychological problems, neither was attempting to assume the sick role by proxy, and neither had engaged in active deception" (p. 96). As Korpershoek and Flisher (2004) stated, "A misdiagnosis of MSP could have hefty implications for the alleged perpetrator" (p. 4). This diagnostic imprecision has contributed to recent literature that has not only been critical of this set of individual/dynamic diagnoses but has offered steps toward clarifying matters, with Korpershoek and Flisher's further caveat, "whilst not recognizing the syndrome could have serious implications for the child" (p. 4).…”

“…a 6. Background or training in medicine (I, E; Artingstall, 1995;Chiczewski & Kelly, 2003;Korpershoek & Flisher, 2004;Siegel & Fischer, 2001). 7.…”

“…There are natural limitations on time and resources that are practical considerations, and for this reason this article will not be held out as a comprehensive review of the subject (see Rogers, 2004, and Sheridan, 2003, for such reviews). In fact, by one count listed in the literature, there were over 300 articles and four books as of the year 2000 (Korpershoek & Flisher, 2004, p. 1). While this voluminous literature exists, unfortunately, as Rogers (2004) and Sheridan (2003) described, this literature consists primarily of anecdotal case studies and little systematic controlled research.…”