Munchausen Syndrome by Proxy: Symptoms and Causes

Unfortunately, there are many children who are mistreated every day in our society. There are several forms of child abuse and multiple classifications. In general terms, we can specify the following types of abuse: physical, psychological, sexual and neglect.

In 2002, an epidemiological study was carried out in Spain that confirmed the existence of 11,148 minor victims of mistreatment in the family sphere. 86.37% of these minors suffered neglect, 35.38% psychological abuse, 19.91% physical abuse and 3.55% sexual abuse..

However, as in almost any epidemiological study, there are "submerged" data and only the tip of the iceberg is glimpsed. In this article we are going to talk about a form of child abuse that is very difficult to diagnose, we could even call it "hidden child abuse": Munchausen Syndrome by Proxy.

• Related article: "Münchhausen syndrome: causes, symptoms and treatment"

What is Munchausen Syndrome by Proxy?

Munchausen Syndrome by proxy (MPS), or according to the DSM-5 factitious disorder

applied to another, it constitutes a particular form of high-risk child abuse, difficult to diagnose, since it often goes unnoticed for a long time, even years. It is a syndrome whose incidence has increased due to greater knowledge of it and professional awareness.

According to the DSM-5, it is a disorder characterized by the falsification of physical or psychological signs or symptoms, or induction of injury or illness, in another, associated with deception. It is a mental disorder that typically it is appreciated in adults who are in the care of other dependents to them (usually defenseless, which makes sense). The victims of this disorder are often minors, and it is considered a form of child abuse.

The parents of the child (generally, according to epidemiological studies on the subject, the mother) simulate the existence of diseases or cause symptoms in the minor with the aim of receiving medical assistance, some of them of high risk and cost. It appears that one of the parent's goals is to misrepresent her child to others as a sick, vulnerable, dysfunctional, and/or troubled person.

Experts in the study of this disorder state that the parent continues the deception even without receiving any visible benefits or rewards in return. The most serious consequences of this syndrome are serious physical and psychological complications for the child and, ultimately, her death.

• You may be interested: "Confabulations: definition, causes and frequent symptoms"

Symptoms and signs

Symptoms or signs are usually inconsistent, often unexplained, and resistant to all treatment, since the parent executes them deliberately and recurrently. Some examples are:

• Repeated suspicious incidents that threaten the life of the minor or the victim.
• Poisoning and apnea.
• Bleeding or hemorrhaging.
• Various infections generated by diverse and sometimes uncommon organisms.
• Medical history with little coherence and logic: Victims usually spend a lot of time in hospital with mixed, contradictory and vague diagnoses, the causes are almost never clear.
• The caregiver takes the victim very frequently to the doctor or to various doctors, until they feel enough satisfaction and attention.
• There are no witnesses in the family who have seen the various symptoms reported by the mother, since they only occur in her presence.
• The symptoms that the minor presents often disappear in the hospital, however, they reproduce again in the minor's home, especially when they are in the care of one of the parents.
• The signs or symptoms occur comorbidly with the caregiver present.
• Families with a history of sudden infant death or other serious problems in the child.
• The caregiver may have been seen performing somewhat suspicious acts that may imply a deterioration in the victim.

As we have mentioned before, the diagnosis of this syndrome is a challenge for the clinician: it is difficult to detect it when the mother tends to go to different hospitals, since for health professionals the observed facts will be isolated. Although pediatricians are trained to assess the credibility of certain accounts, they do not tend to make the initial assumption that it is such an elaborate lie.

History of Munchausen Syndrome by Proxy

PMS is a variant of Munchausen Syndrome., term introduced for the first time in 1977 by the English pediatrician Roy Meadow. At that time, this professional described patients who had this syndrome as people who had spectacular, strange medical histories, with inventions and lies, with the aim of achieving the medical care.

Interestingly, in that same year two authors, Burman and Stevens, described a case in which a mother who suffered from Munchausen Syndrome (today Factitious Disorder) was displacing it in his two children little ones. This phenomenon was called "Polle Syndrome", synonymous in its day with Munchausen Syndrome by Proxy.

• Related article: "Factitious Disorders: Symptoms, Causes and Treatment"

Causes and motivations

The causes of Munchausen Syndrome by proxy are still unknown. Studies on the subject that have interviewed perpetrators suggest that they were abused in childhood, or suffer from Factitious Disorder.

The causes are not known, but yes progress has been made in studying the motivations of the parents involved. In the first place, the person who suffers from this syndrome does not act with the aim of obtaining material or economic benefits. Paradoxically, they can invest large amounts of their money, effort and sacrifice in the "care" of their victim, despite the fact that they are inflicting great damage.

In short, his motivations lie in an excessive need for attention, care, compassion, pity, and/or recognition by the medical staff and others for their great dedication to the victim. In addition, it seems that there is a relationship of pathological ambivalence towards the victim (of care vs. possible hidden rejection).

Treatment

What should be done in these situations? How should professionals who detect such a case proceed? Can the father or mother who has this syndrome continue to care for her child?

There is no single appropriate way to act, and less when there can be a judicialization of the problem. Ultimately, the one who can receive more collateral damage is the minor (The other children in the family must also be evaluated, if they exist).

In these cases, The most important thing will always be the best interests of the minor. Clinicians must ensure the certainty of the diagnosis and save the child in cases more serious (separating him prudently from the family, for example), contacting services social. It is very important to collaborate with other professionals and carry out a multidisciplinary intervention.

Confession by the perpetrator is usually infrequent. That is why the treatment is usually complex due to the father's difficulties in recognizing his problems and trying to give them a coherent explanation. Necessarily, the father who suffers from Munchausen Syndrome by Proxy must commit himself to psychotherapy, family therapy and/or the taking of psychoactive drugs.