Munchausen by proxy: A case, chart series, and literature review of older victims

Awadallah, Nida S.; Vaughan, Aaron; Franco, Kathleen; Munir, Farah; Sharaby, Na'ama; Goldfarb, Johanna

doi:10.1016/j.chiabu.2004.11.007

Cited by 42 publications

(32 citation statements)

References 29 publications

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“…[11][12][13] Allegations of sexual abuse have also been fabricated. [14][15][16] Some of the forms of fabricated illness reported in more recent literature include hypernatremic dehydration, 17 immunodeficiency, 18 celiac disease, 19 and Gaucher disease. 20 A retrospective review of calls to the National Poison Data System from 2000 to 2008 for pharmaceutical exposures that were coded as "malicious" and occurred in a child younger than 7 years revealed 1437 cases (average of 160 cases/ year).…”

Section: Spectrum Of Presentationsmentioning

confidence: 99%

“…30 In addition, older children have been reported to fabricate illness, both by falsifying symptoms and/or signs of illness, without adult collusion. 18,25,31,32 Although a discussion of the etiology for such behavior by caregivers is beyond the scope of this report, it is important for clinicians to be aware of some of the caregiver risk indicators for fabricating illness in a child. These include caregivers who (1) appear to need or thrive on attention from physicians, 13 (2) insist that the child cannot cope without the parent' s ongoing attention, 13 (3) are either directly involved in professions related to health care 3 or at least are very knowledgeable medically and have a familiarity with medical terminology, and (4) have a history of factitious disorder or somatoform disorder.…”

Section: Epidemiologymentioning

confidence: 99%

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Caregiver-Fabricated Illness in a Child: A Manifestation of Child Maltreatment

Flaherty¹,

MacMillan²

2013

Pediatrics

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Caregiver-fabricated illness in a child is a form of child maltreatment caused by a caregiver who falsifies and/or induces a child’s illness, leading to unnecessary and potentially harmful medical investigations and/or treatment. This condition can result in significant morbidity and mortality. Although caregiver-fabricated illness in a child has been widely known as Munchausen syndrome by proxy, there is ongoing discussion about alternative names, including pediatric condition falsification, factitious disorder (illness) by proxy, child abuse in the medical setting, and medical child abuse. Because it is a relatively uncommon form of maltreatment, pediatricians need to have a high index of suspicion when faced with a persistent or recurrent illness that cannot be explained and that results in multiple medical procedures or when there are discrepancies between the history, physical examination, and health of a child. This report updates the previous clinical report “Beyond Munchausen Syndrome by Proxy: Identification and Treatment of Child Abuse in the Medical Setting.” The authors discuss the need to agree on appropriate terminology, provide an update on published reports of new manifestations of fabricated medical conditions, and discuss approaches to assessment, diagnosis, and management, including how best to protect the child from further harm.

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Section: Spectrum Of Presentationsmentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Caregiver-Fabricated Illness in a Child: A Manifestation of Child Maltreatment

Flaherty¹,

MacMillan²

2013

Pediatrics

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“…We are also intrigued by some examples of complex deceptive speech which we cannot yet fully characterize. For instance, a caretaker suffering from Munchausen by proxy attempts to deceive physicians into believing her ward suffers from some chronic disease (Awadallah et al, 2005). This case is interesting from a modeling standpoint as there appears to be an ulterior motive, but there is no theory about what that motive itself is.…”

Section: Resultsmentioning

confidence: 98%

Mindreading deception in dialog

Isaac

Bridewell

2014

Cognitive Systems Research

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This paper considers the problem of detecting deceptive agents in a conversational context. We argue that distinguishing between types of deception is required to generate successful action. This consideration motivates a novel taxonomy of deceptive and ignorant mental states, emphasizing the importance of an ulterior motive when classifying deceptive agents. After illustrating this taxonomy with a sequence of examples, we introduce a Framework for Identifying Deceptive Entities (FIDE) and demonstrate that FIDE has the representational power to distinguish between the members of our taxonomy. We conclude with some conjectures about how FIDE could be used for inference.

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“…The caregiver is commonly the patient's mother, is often highly adept at manipulating the healthcare system, and appears exceedingly invested in their child's health, thus making it very difficult to recognize that the patient is being abused [14,15]. If the proxy becomes aware of the falsification of symptoms, they may be pressured to become complicit in the feigning behaviors, possibly such as possibly in the case of Twinkle [11,13]. A safe and supportive health care environment in which a child might feel secure to confide in a physician regarding abuse experiences is essential but not always possible [16].…”

Section: Factitious Disordermentioning

confidence: 99%

“…Falsification of symptoms may involve actively inducing the illness, altering medical records or specimens, or falsely reporting symptoms [13]. Affected patients are usually found to have manifestations not fitting into a current disease model or that are unresponsive to treatments.…”

Section: Factitious Disordermentioning

confidence: 99%

Bleeding from the eyes and through intact skin: Physiologic, structural, spiritual, or faked?

Bezner

Buchanan

2013

American J Hematol

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Patients with an apparent bleeding disorder can usually be diagnosed by a careful history, physical examination, and screening laboratory tests. However, at times the constellation of bleeding signs and symptoms fail to be explained by test results and/or our current understanding of hemostatic mechanisms. One such patient is the subject of the current report. She is a 13‐year‐old female with a history of striking bleeding manifestations, including spontaneous hemorrhage from her eyes, scalp, hands, and feet. She was evaluated by one of the authors at a teaching hospital in Mumbai, India in March 2009 during the filming of a National Geographic Channel documentary characterizing puzzling medical disorders encountered in India. Given her unusual bleeding manifestations, she received international media attention at the time. National Geographic and a film company in the United Kingdom subsequently expressed interest in highlighting the patient to document her seemingly rare hematologic disorder and contacted the American Society of Hematology to identify an American hematologist to further investigate the case. With consent of the family and collaboration with a hematologist practicing at a teaching hospital in Mumbai, filming commenced during March 2009 in an attempt to capture the patient's diagnosis and the cultural and medical milieu in which the bleeding events occurred. Am. J. Hematol. 88:713–716, 2013. © 2013 Wiley Periodicals, Inc.

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Munchausen by proxy: A case, chart series, and literature review of older victims

Cited by 42 publications

References 29 publications

Caregiver-Fabricated Illness in a Child: A Manifestation of Child Maltreatment

Caregiver-Fabricated Illness in a Child: A Manifestation of Child Maltreatment

Mindreading deception in dialog

Bleeding from the eyes and through intact skin: Physiologic, structural, spiritual, or faked?

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