Munchausen syndrome
From Wikipedia, the free encyclopedia
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It has been suggested that this article be split into articles entitled Munchausen syndrome and Munchausen syndrome by proxy. (Discuss) |
| ICD-10 | F68.1 |
|---|---|
| ICD-9 | 301.51 |
| DiseasesDB | 8459 33167 |
| eMedicine | med/3543 emerg/322 emerg/830 |
| MeSH | D009110 |
Munchausen syndrome is a form of psychological disorder, named after the fictional representation of the German baron, Karl von Münchhausen, and his affinity for telling tall tales. It is described as a factitious disorder in which sufferers feign disease, illness, or psychological trauma despite varying degrees of personal risk, in order to draw attention or sympathy to themselves. The term has also been used to refer to medical professionals who purposely cause inflicted injury or discomfort to a patient so they are able to later treat or heal the patient and receive attention or compliments from co-workers; commonly referred to in modern parlance as "playing god".
The current DSM (DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders - 4th edition - Text Revision) calls this disorder "Factitious Disorder by Proxy".
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[edit] Munchausen syndrome
In Munchausen syndrome, the sufferer feigns, exaggerates, or creates symptoms of illnesses in himself or herself in order to gain investigation, treatment, attention, sympathy, and comfort from medical personnel. The role of "patient" is a familiar and comforting one, and it fills a psychological need in people with Munchausen's. Also known as Wilhide's syndrome
There is some controversy on the exact causes of the syndrome, but an increased occurrence has been reported[citation needed] in healthcare professionals and close family members of people with a chronic illness such as manic depression.
Individuals with the Munchausen pattern of behaviour may be admitted to many hospitals under many medical teams and amass costs sufficient to provide care for hundreds of other people.
[edit] Origin of the name
The name derives from one Baron Munchhausen (Karl Friedrich Hieronymus Freiherr von Münchhausen, 1720-1797), to whom were ascribed a series of fantastically impossible tales written by Rudolf Raspe.
In 1951, Sir Richard Asher (father of Jane Asher and Peter Asher) was the first to describe a pattern of self-harm, where individuals fabricated histories, signs, and symptoms of illness. Remembering Baron von Munchausen, Asher named this condition Munchausen's Syndrome. Originally, this term was used for all factitious disorders. Now, however, there is considered to be a wide range of factitious disorders, and the diagnosis of "Munchausen syndrome" is reserved for the most severe form, where the simulation of disease is the central activity of the sufferer's life.
[edit] Fabricated and Induced Illness (Munchausen Syndrome by Proxy)
In 1977, the English pediatrician Roy Meadow, professor of Paediatrics at the University of Leeds, England, described a form of child abuse in which mothers deliberately induced or falsely reported illnesses in their children. He referred to this behaviour as Munchausen Syndrome by Proxy. Its formal name since March 2002 is now Fabricated or Induced Illness (FII) according to the Royal College Of Paediatrics and Child Health.[1]
In FII a caregiver, usually the mother, feigns or induces an illness in another person, usually her or his child, to gain attention and sympathy as the "worried" parent. Although Munchausen Syndrome by Proxy (MSbP) cases with feigned or induced physical illness receive the most attention, it is also possible in parents who emotionally abuse their child, then claim psychiatric and/or genetic problems. FII is a form of child abuse.
During the 1990s and early 2000s, Roy Meadow was called as an expert witness in several murder cases where FII was at issue, some of which resulted in parents being convicted of murdering their children and imprisoned. In addition, several children were taken into care. During 2003 a number of high-profile acquittals brought Meadow's ideas into serious disrepute. Some people deny even the existence of FII, despite observations on hospital surveillance cameras which have caught abusers in the act. Around 250 cases resulting in conviction in which Meadow was an expert witness were reviewed, with few changes. Meadow was investigated by the British General Medical Council over one aspect of one case - the statistical likelihood of sudden infant death syndrome occurring twice in a family. The GMC in July 2005 came to a verdict of guilty of "serious professional misconduct" which High Court judge Mr Justice Collins described at appeal as "irrational" and set aside. The case had almost nothing to do with SIDS, since neither prosecution nor defence suggested that the children involved suffered SIDS, and Collins' judgement raises important points concerning the liability of expert witnesses - his view is that referral to the GMC by the losing side is an unacceptable threat and that only the Court should decide whether its witnesses are seriously deficient and refer them to their professional bodies. The case of Dr Jayne Donegan may also be relevant to this.
There are now more than 2,000 reports of FII in the professional and lay literature, with 10 books devoted to the subject. These reports reaffirm that MSbP is not simply a Western phenomenon; reports have come from developing countries throughout the world.
In 2003, Sickened, an autobiographical account of the Munchausen Syndrome by Proxy abuse Julie Gregory suffered as a child, was published.
In 2003, the documentary film MAMA/M.A.M.A. was released, which questioned the validity of Munchausen Syndrome by Proxy, arguing that in many cases doctors' overmedication of infants may be the real cause of their infirmity rather than the mother's mental illness. The film contains an interview with Sir Roy Meadow. [www.munchausenmovie.com] is the official site for the film.
[edit] Clues that may indicate Fabricated or Induced Illness
Caution is required. Many of the items below are also indications of a child with organic, but undiagnosed illness. An ethical diagnosis of MSbP must include an evaluation of the child, an evaluation of the parents and of the family dynamics. Diagnoses based only on a review of the child's medical chart are now frequently[citation needed] being rejected in court.
- A child who has one or more medical problems that do not respond to treatment or that follow an unusual course that is persistent, puzzling and unexplained.
- Physical or laboratory findings that are highly unusual, discrepant with history, or physically or clinically impossible.
- A parent who appears to be medically knowledgeable and/or fascinated with medical details and hospital gossip, appears to enjoy the hospital environment, and expresses interest in the details of other patients’ problems.
- A highly attentive parent who is reluctant to leave their child’s side and who themselves seem to require constant attention.
- A parent who appears to be unusually calm in the face of serious difficulties in their child’s medical course while being highly supportive and encouraging of the physician, or one who is angry, devalues staff, and demands further intervention, more procedures, second opinions, and transfers to other, more sophisticated, facilities.
- The suspected parent may work in the health care field themselves or profess interest in a health-related job.
- The signs and symptoms of a child’s illness do not occur in the parent’s absence (hospitalization and careful monitoring may be necessary to establish this causal relationship).
- A family history of similar or unexplained illness or death in a sibling.
- A parent with symptoms similar to their child’s own medical problems or an illness history that itself is puzzling and unusual.
- A suspected emotionally distant relationship between parents; the spouse often fails to visit the patient and has little contact with physicians even when the child is hospitalized with serious illness.
- A parent who reports dramatic, negative events, such as house fires, burglaries, or car accidents, that affect them and their family while their child is undergoing treatment.
- A parent who seems to have an insatiable need for adulation or who makes self-serving efforts at public acknowledgement of their abilities.
[edit] Prevalence by gender
It has been noted that MS applies mostly to men whereas FII perpetrators are disproportionately females. One study showed that in over 90% of cases of Munchausen by proxy, it is the mother who is the abuser (Vennemann et al., 2005). In other cases, the MSbP abuser is another female caregiver. Fathers have been the perpetrators in a handful of professional reports. The female preponderance may be attributed to the typical socialization pattern which encourages females to seek the sympathy and assistance of others while males who do so are considered to be "weak". It is not known whether this predilection to seek sympathy also has a gender-based genetic component. Neuropsychological testing of perpetrators has shown either normal results or nonspecific abnormalities.
MSbP may also be attributed to another prevalent socialization pattern, that which places females in the primary caretaking role.
[edit] Munchausen Syndrome and Munchausen Syndrome by Proxy in popular culture
- In the 1976 movie Sybil, Sybil's mother may have been suffering from Munchausen syndrome by proxy, abusing her daughter frequently. This, however, could also be a case of PTSD, or may also have been from suffering schizophrenia.
- The 1999 movie The Sixth Sense had the posthumous solving of a case of MSbP as one of its later subplots.
- Also, Takashi Miike's 2003 One Missed Call, an arguably deconstructionist take on the recent wave of Japanese horror movies, has a MSbP case at the heart of its revenging ghost tale.
- In the Eminem song "Cleanin' Out My Closet", the rapper names himself as a "victim of Munchausen syndrome," accusing his mother of using him for drug-seeking purposes when he was young.
- In an episode of NBC's Law & Order: Special Victims Unit, a woman poisons her granddaughter with mercury to induce symptoms similar to those associated with leukemia and claims she has been suffering from MSbP.
- In one of Douglas Preston and Lincoln Child's Pendergast novels, Dance of Death, a character is accused of suffering from an unusual form of MSbP—committing murders in order to garner attention solving them.
- First airing October 11, 2005, an episode of FX's Nip/Tuck features a patient suffering with Munchausen syndrome. She cuts herself to mimic the injuries left by the show's infamous face-slasher The Carver (and later actually becomes one of his victims).
- An episode of ABC-TV's Grey's Anatomy first airing October 16, 2005, features a patient diagnosed with Munchausen syndrome. She is betrayed taking Amitriptyline, an antidepressant that turned her urine blue.
- An episode of ITV's The Brief first aired on October 21 2005, featured a defendant (a nurse) played by Jennifer Ellison who exhibited the classic symptoms of Munchausen syndrome by proxy.
- An episode of The X-Files (The Calusari, 2X21) featured Agent Dana Scully suspecting Munchausen syndrome by proxy in unexplained events surrounding a young child and his family.
- An episode of FOX's House, M.D. first aired on December 13, 2005, featured a patient played by Cynthia Nixon who admitted to Munchausen syndrome after being tricked into taking Rifampin, an antibiotic that turned her urine orange, but who was later additionally diagnosed with a bacterial infection.
- An episode of NBC's Law & Order: Special Victims Unit (S07E15), first aired on Tuesday February 7, 2006, featured a woman, played by Rebecca DeMornay, who suffered from Munchausen syndrome.
- An episode of NBC's Conviction (S01E03), first aired on Friday March 17, 2006, featured a young girl who committed suicide arguably in part because of her mother's Munchausen's Syndrome by Proxy (this is only an inference, as the word "Munchausen" is not used).
- An episode of NBC's ER (TV series) first aired on Thusday February 3, 2000, included a subplot in which a mother insists that her son undergo numerous tests and exploratory surgeries, against the advice of the E.R. doctors. The word "Munchausen" is not used, and Munchausen's Syndrome by Proxy can only be inferred.
- In Every Time I Die song Romeo A Go-go, "munchausen by proxy of a muse" comes up in the opening song of their third album "Hot Damn!", a song about a night in the intensive care unit.
- In the episode of JAG "Silent Service", Harm and Mac investigate a series of health problems that occurred in a nuclear submarine which led to the accidental destruction of a ship. It turns out that they were all caused by a corpsman who suffered from Muchausen Syndrome by proxy.
- In the Drawn Together episode "Unrestrainable Trainable", Princess Clara gets Munchausen by Proxy when she receives accolades for nursing Wooldoor Sockbat back to health, causing her to begin deliberately keeping him sick with drain cleaner and a variety of other methods. The bottle of drain cleaner she uses is shown with a warning label, "Caution: Not to be used for Munchausen's by proxy".
- In an episode of the British series Doctors (TV series) first aired on Wednesday 15th November 2006, a woman is diagnosed with Munchausen's syndrome after repeatedly faking illness in the form of stomach pain. She cuts herself to put blood in her urine, and has surgical scars on her stomach from previous medical investigations. She then pretends to attempt suicide when in actual fact she only took four tablets.
[edit] See also
[edit] External links
- AsherMeadow - Providing support and resources to the Munchausen Syndrome by Proxy Community.
- Dr. Marc Feldman's Munchausen Syndrome, Malingering, Factitious Disorder, & Munchausen by Proxy Page - Page offering information on Munchausen and its many other names. Offers information on Dr. Feldman's books and his email address for interested parties.
- Heart-to-Heart - A forum intended to "expose the Munchausen Syndrome by Proxy agenda."
- House of Mirrors - A "child of Munchausen by Proxy's" memoir by Julie Gregory.
- MAMA/M.A.M.A:MSBP MOVIE - A movie following three families arguing they do not have Munchausen Syndrome by Proxy.
- Munchausen Syndrome by Proxy Reconsidered - Offering information on Eric G. Mart, Ph.D.'s book.
- Psych Forums: Munchausen by Proxy Forum - Forums about the general discussion of Munchausen Syndrome by Proxy.
[edit] Notes
- ^ Roberts, Yvonne. "What makes mothers kill?", The Observer, 2002-04-21. Retrieved on 2006-08-25.
[edit] References
- Feldman M.D. 2004. Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder. New York: Brunner-Routledge.
- Fisher, Jill A. 2006. Playing Patient, Playing Doctor: Munchausen Syndrome, Clinical S/M, and Ruptures of Medical Power. Journal of Medical Humanities 27 (3): 135-149.
- Fisher, Jill A. 2006. Investigating the Barons: Narrative & Nomenclature in Munchausen Syndrome. Perspectives in Biology and Medicine 49 (2): 250-262.
- Vennemann B., Große Perdekamp M., Weinmann W., Faller-Marquardt M., Pollak S., and Brandis M. 2005. A case of Munchausen syndrome by proxy with subsequent suicide of the mother. Forensic Science International, In Press, Corrected Proof. Abstract available.
