Patient-Centered Medicine and Prevention of Munchausen Syndrome by Proxy

Abstract

Munchausen syndrome by proxy (MSbP) is known by many names and is considered the deadliest form of child abuse. Although the condition was named in 1976 and there is now a substantial body of scientific literature about this type of abuse, to date, patientcentered approaches to early identification, intervention, and prevention have been absent from this literature. The purpose of this chapter is to recommend patient-centered approaches to identifying MSbP in the clinical setting to facilitate prevention and early intervention. It also recommends patient-centered practices that can be implemented to reduce the MSbP-related morbidity and mortality contributed by the healthcare system. The evolving nomenclature and definition of MSbP abuse has been an obstacle to achieving scientific consensus on the topic. Yet, the body of scientific literature on the subject is large. This literature is reviewed to enumerate the healthcare system's contribution to MSbP abuse. The Haddon matrix, a public health framework, is applied to MSbP abuse in order to guide the development of recommendations of patient-centered approaches that should be implemented to reduce the healthcare system's contribution to the morbidity and mortality that MSbP victims face.

Intervention by Separation and Reunification of Victims of Munchausen Syndrome by Proxy

“…According to Wahi, et al (2017), MSBP's acts of violence were basically attempted murder, so there should be no difficulty in getting the perpetrators arrested by law enforcement after strong evidence of violence was found. Wahi's statement can also be supported by a theory in criminology, namely Choice Theory.…”

“…The fact that at least two people are involved in this syndrome, the child perpetrator and victim, makes it difficult to define. Child advocates use names that focus on the child abuse aspect of the condition, while psychologists are more interested in establishing and naming a mental health diagnosis for the offender (Wahi, et al, 2017).…”

“…According to Wahi, et al (2017), in the evolution of this understanding of MSBP violence, the main focus is often on perpetrators, not victims, even though victims experience high death rates, and many believe that perpetrators cannot be treated. Studies of child victims have been hampered by the general inability of systems designed to protect children from violence, such as the medical system and child protection systems, to successfully intervene to protect victims.…”

Don't Judge a Book by Its Cover: Factitious Disorder Imposed on Children-Report on 2 Cases

“…An early diagnosis represents a challenge for the clinician and is essential in order to limit complications and to improve the outcome. The majority of FDIA reports in the literature are mainly focused on the history of child's abuse and few describe the “red flags” for an early identification, intervention, and possibly even prevention, of FDIA abuse [ 20 ]. It is debated whether a video surveillance of the perpetrator (resulting in the recording of abuse and maltreatment) is ethical and legal [ 21 , 22 ].…”

“…It is debated whether a video surveillance of the perpetrator (resulting in the recording of abuse and maltreatment) is ethical and legal [ 21 , 22 ]. Indeed, several cases of FDIA would not have been identified without the use of video surveillance [ 20 ]. Moreover, the DSM 5 [ 12 ] suggests that an accurate differential diagnosis should always be carried out between FDIA and case of Malingering.…”