Re: Munchausen syndrome by proxy

["Catherine Ayoub" <catherine_ayoub@xxxxxxxxxxxxxxx>]

I would refer you to work by the Munchausen by Proxy taskforce of 
APSAC which published definitional guidelines in 1998 in the Advisor. 
MBP is both a psychiatric (in the parent) and a pediatric (in the 
child victim) disorder.  The correct current DSM-IV diagnostic 
category is Factitious Disorder Not Otherwise Specified - 300.19, see 
DSM-IV, p. 475).  The definitional paper admonishes professionals to 
be careful and NOT use any form of "profile" particularly "profile " 
in the legal sense to identify this disorder. The disorder involves 
the identification of child abuse by illness falsification 
(exaggeration, fabrication or inducement of illness) and the diagnosis 
of factitious disorder by proxy in the parent perpetrator.  The first 
concern is the presence of child abuse by illness falsification which 
does not require psychiatric examination of the parent to identify. 
Evaluation should be carefully approached with the following 
in mind:

"PRELIMINARY RECOMMENDATIONS:


Pediatricians and other health care personnel should:

1) be alert to the possibility of pediatric condition falsification 
and familiar with the many possible presentations in the child.  2) 
engage in a careful review of the past medical history of the child 
to include all available past records.  3) request assistance from 
pediatric or other professionals with expertise in diagnosing 
pediatric condition falsification and factitious disorder by proxy 4) 
be fully versed in the expected presentation, course, treatment 
efficacy, and prognosis of the child's disorder 5) obtain external 
verification of as many items as possible provided in the history by 
the caregiver.

When psychological evaluations are recommended in these cases the 
mental health professional involved should:

1) be experienced with the diagnosis of  factitious disorder by 
proxy.  2) have access to as much medical information on the child 
and family as is possible.  3) thoroughly understand the diagnosis of 
child abuse by illness condition falsification.  4) obtain external 
verification of as many items as possible provided in the history by 
the caregiver."

The taskforce recommends that the word "syndrome" be removed from the 
terminology used to describe this disorder because of the differences 
in the way the term is applied in the medical and the legal 
communities.

	For further information here are the references referred to by 
the taskforce.  APSAC can provide copies of the definitional paper 
(Ayoub, C., Alexander, R., Beck, D., Bursch, B., Feldman, K., Libow, 
J., Sanders, M., Schreier, H., & Yorker, B.  Definitional issues in 
Munchausen by Proxy, The APSAC Advisor, 1998, 11:1, 7-10).



  REFERENCES


Asher, R. 1951. Munchausen's syndrome. Lancet, i, 339-341.

Alexander, R., smith, W., & Stevenson, R. (1990).  Serial Munhausen 
by Proxy.  Pediatrics, 86(4):581-585.

American Psychiatric Association. Diagnostic and Statistical Manual 
of Mental Disorders, Fourth Edition. Washington D.C., American 
Psychiatric Association, 1994.

Bools, C., Neale, B., & Meadow, R. (1994).  Munchausen syndrome by 
proxy: A Study of 	Psychopathology.  Child Abuse and Neglect, 
18, (9), pp. 773 - 788.

Kinscherff, R., &  Famularo, R. (1991).  Extreme Munchausen Syndrome 
by Proxy"  The Case for Termination of Parental Rights.  Juvenile & 
Family Court Journal, pp. 41 - 53.

Libow, J. & Schreier, H. (1986).  Three forms of factitious illness. 
When is it Munchausen by proxy?  American Journal of Orthopsychiatry, 
56: 602-661.

McClure, R.J., Davis, P.M., Meadow, S.R. & Sibert, J.B. 1996.  
Epidemiology of Munchausen syndrome by proxy on accidental 
suffocation.  Archives of Disease of Childhood, 75:57,       .

McGuire, T.L.,  Feldman, K.W. (1989)  Psychologic morbidity of 
children subjected to Munchausen syndrome by proxy.  Pediatrics, 83, 
(2), 289 - 292.

Meadow, R.. 1993.  False allegations of abuse and Munchausen syndrome 
by proxy.  Archives of Disease in Childhood, 68, 444-447.

Meadow, R. 1977.  Munchausen by proxy: The hinterland of child abuse. 
Lancet, ii, 343-345.

Schreier, H.A. (1997). Factitious presentation of psychiatric 
disorder by proxy. Child Psychology and Psychiatry Review, 108-115.

Schreier, H.A., 1996. Repeated false allegations of sexual abuse 
presenting to sheriffs: When is it Munchausen by proxy? Child Abuse 
and Neglect, 20:10, 985-991.

Rosenberg, D. 1987. Web of deceit: a literature review of Munchausen 
syndrome by proxy, Child Abuse and Neglect.  11:547-563.


On Fri, 16 Feb 2001 18:32:54 -0800 Elizabeth Charuvastra 
<lizch@xxxxxxxxxxxxx> wrote:

> I agree that we are debating terminology in the case of Munchausen 
Syndrome > by Proxy. I don't see how a definition as broad as this 
can be considered a
> syndrome, however it is increasingly being used as a "diagnosis" 
and a whole > cottage industry seems to be growing up around it. 
Juvenile courts seek > expert witnesses in the syndrome and families 
who are labeled by the medical > profession with MSP find it 
difficult to defend themselves becasue of the > very loose use of the 
profile. I don't know what the solution might be. > Perhaps more 
education of the medical profession or abandoning the use of > the 
term altogether. > > Elizabeth Charuvastra RN. > 

----------------------
Catherine Ayoub, Ed.D. Associate Professor Harvard Graduate School of 
Education &
Harvard Medical School
Larsen Hall, Rm. 711, Appian Way
Cambridge, Ma. 02138
617-496-1183
Catherine_Ayoub@xxxxxxxxxxxxxxx