Excerpt from Munchausen Syndrome by Proxy
Synonyms, Key Words, and Related Terms: Munchausen syndrome by proxy, factitious disorder by proxy, pediatric condition falsification, PCF, MSBP, child abuse, Polle syndrome, fabricated symptoms, factitious symptoms, invented symptoms, child neglect
In 1977, Englishman Roy Meadow published the first report of a new form of child abuse. He coined the term Munchausen syndrome by proxy (MSBP) after the syndrome that first had been reported by Asher in 1951. This term is applied when an adult, usually the mother, presents a false history to the physician regarding a child who is not suffering from any of the fabricated symptoms. This history causes the physician to perform unnecessary diagnostic procedures that do not result in any specific diagnosis. MSBP has been called Polle syndrome, named after Baron von Munchausen's only child. In 2002, a new terminology, pediatric condition falsification (PCF), was suggested by the American Professional Society on the Abuse by Children (APSAC).
Today, many reports of such cases are in the literature. Some mothers invent symptoms, and others induce symptoms (eg, using ipecac to induce vomiting, overdosing a child with medication, lacerating the urethra to produce hematuria). Fabricated symptoms are not observed by anyone other than the mother.
In 1995, the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) included a definition for factitious disorder by proxy, which is now the accepted psychiatric category for MSBP. The definition includes the following:
- Intentional production or feigning of physical or psychological signs or symptoms in another person who is under the individual's care.
- The motivation for the perpetrator's behavior is to assume the sick role by proxy.
- External incentives for the behavior, such as economic gain, avoiding legal responsibility, or improving physical well-being, are absent.
For excellent patient education resources, visit eMedicine's Children's Health Center and Mental Health and Behavior Center. Also, see eMedicine's patient education articles Child Abuse and Munchausen Syndrome.
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