is a form of
Psychological Disorder known as a
Factitious Disorder (the term "Munchausen syndrome" is sometimes used, incorrectly, to refer to any form of factitious disorder). Sufferers mimic real diseases, presenting a great problem to themselves and their healthcare professionals. The disorder is named after a literary figure,
Baron Munchausen , a real person who was portrayed in fiction as a famous teller of tall tales.
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In Munchausen syndrome, the sufferer feigns, exaggerates, or creates
Symptom s of
Illness es 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.
There is some controversy on the exact causes of the syndrome, but an increased occurrence has been reported in healthcare professionals and close family members of people with a chronic illness.
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.
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 ) was the first to describe a pattern of self-abuse, where individuals fabricated histories 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.
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 (FII).
Royal College Of Paediatrics And Child Health )
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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 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, 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 (judge) Collins J 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 of 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 defficient 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, a documentary film, MAMA/M.A.M.A., which questions 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, was released. The film contains an interview with Sir Roy Meadow.
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 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 seems 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.
The Queensland Court of Appeal (R v LM
{Link without Title} QCA 192), in a unanimous judgment, stated MSbP (or factitious disorder by proxy) was in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM IV). The court went on to say that MSBP had no agreed sets of symptoms or signs that allowed it to be classified into a recognised psychiatric diagnostic system, it was not a recognised medical condition, disorder or syndrome, and the court excluded evidence from a psychiatrist as "extremely prejudicial". Justice Holmes noted that the MSbP argument was inherently circular and did nothing to prove criminal conduct.
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.
- 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 Japan ese Horror Movie s, 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 '', a woman Poison s 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 Rifampin , an antibiotic that turned her urine blue (an error, as the drug should have made her urine turn orange).
- 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 FOX's '' House, M.D. '' first aired on December 13, 2005, featured a patient played by Cynthia Nixon who admitted to Munchausen syndrome after a series of false diagnoses.
- 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).
- Feldman M.D. 2004. Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder. New York: Brunner-Routledge.
- 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.
