The perpetrators of medical child abuse (Munchausen Syndrome by Proxy) – A systematic review of 796 cases

Yates, Gregory P.; Bass, Christopher

doi:10.1016/j.chiabu.2017.07.008

Cited by 86 publications

(78 citation statements)

References 51 publications

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“…Bass and Jones [11] found that 64% of the 28 women diagnosed with MSbP had factitious disorder. These data coincide with the high level of psychopathology that is suspected in these mothers [74] and with the clinical cases of the four perpetrators of MSbP presented in this article. Personality disorders were a common diagnosis in all four cases, two borderlines, one dependent, and the other histrionic.…”

Section: Discussionsupporting

confidence: 89%

“…In the Rosenberg review (1987), all the perpetrators were mothers of the victims, and in the Sheridan survey [63], the mothers were perpetrators in 76.5% of the cases. A systematic search for case reports and series published since 1965 by Yates and Bass [74] yielded a sample of 796 perpetrators, of which 95.6% were the victims' mothers. Regarding the four cases presented here, all the perpetrators were the biological mothers.…”

Section: Discussionmentioning

confidence: 99%

“…The recent publication of two extensive reviews in Lancet (2014) dealing with the etiology, diagnosis, treatment, and prevention of MSbP have reignited interest in this complex syndrome [9,10]. Knowledge regarding MSbP is consolidated on the detailed study of published clinical cases and the information evidence-based medicine provides [40,53,74].…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis and Treatment of the Factitious Disorder on Another, Previously Called Munchausen Syndrome by Proxy

López-Rico

López-Ibor

Crespo-Hervas

et al. 2019

SN Compr. Clin. Med.

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In the factitious disorder (FD) on another, formerly called Munchausen syndrome by proxy (MSbP), one of the parents, the mother in 95% of the cases, fabricates or invents clinical symptoms in her child with the intention of convincing doctors and pediatricians that the child is sick. In the chapter on addictive disorders of the 5th Edition of Diagnostic and Statistical Manual of Mental Disorders, the gambling disorder was included, opening up the possibility of incorporating other problematic addictive risk behaviors in the same chapter. In this work, we intend to provide current data for improving the detection and treatment of MSbP as addictive disorder. Four clinical cases of MSbP studied by the authors are described. Retrospective analysis and semistructured interviews were carried out to assess the psychopathological profile of MSbP. The four perpetrating mothers in the cases studied had a common and characteristic psychopathological profile. These mothers falsified diseases in their victimized children, obtaining rewards from the hospitalization of their children. The continuous alteration of the mother-to-child attachment with a pathological bond, which is at the basis of therapeutic intervention together with the mothers' emotional confrontation with reality, is verified. It is proposed that the psychopathological profile of the perpetrator of FD on another corresponds to an addictive disorder, in which the hospital context is compulsively sought, providing a high degree of gratification and reward.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnosis and Treatment of the Factitious Disorder on Another, Previously Called Munchausen Syndrome by Proxy

López-Rico

López-Ibor

Crespo-Hervas

et al. 2019

SN Compr. Clin. Med.

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“…Adrenal insufficiency has been reported to remain months after removal of glucocorticoid-producing tumors; however, an adrenal insufficiency 3 years after finishing prednisolone treatment or removal of a glucocorticoid-producing tumor has not been reported in the literature to the best of our knowledge [7, 8]. One might speculate that the boy had received additional prednisolone or other glucocorticoids (for example in the sense of Munchhausen syndrome by proxy [9]). In this line, the ACTH levels were low in the first years of life not excluding overtreatment by hydrocortisone.…”

Section: Discussionmentioning

confidence: 83%

Vanishing 17-Hydroxyprogesterone Concentrations in 21-Hydroxylase Deficiency

et al. 2018

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We present a boy with a genetically proven congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. While massively elevated 17-hydroxyprogesterone (17-OHP) concentrations after birth led to the diagnosis, 17-OHP concentrations became immeasurable starting with the second year of life even though the dose of hydrocortisone was continuously decreased to ∼7 mg/m²/day. Furthermore, 17-OHP levels were immeasurable during the ACTH test and after withdrawing hydrocortisone medication. In contrast, ACTH levels increased after cessation of hydrocortisone treatment suggesting complete primary adrenal cortex failure. We discuss this case based on the differential diagnosis of complete adrenal cortex failure including other genetic causes in addition to CAH, prednisolone treatment, autoimmune adrenalitis, adrenoleukodystrophy, CMV infection, and adrenal hemorrhage infarction. The most likely disease in our boy is autoimmune adrenalitis, which is difficult to prove years after the onset of the disease. Treatment of CAH had masked the classical symptoms of complete adrenal cortex insufficiency leading to delayed diagnosis in this case.

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“…When symptoms last for a long time, without any red flags of an organic disease, with repeated and often extensive workup already performed and with unremarkable physical examination, the diagnosis of a previously unrecognised organic illness is highly unlikely, and as a matter of fact, the main differential diagnosis of this disorder is factitious disorders that are self‐imposed or imposed by another …”

mentioning

confidence: 99%

Facing somatic symptom disorder in the emergency department

Cozzi

Barbi

2018

J Paediatrics Child Health

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Somatic symptom disorder is a condition in which a patient's subjective report of physical symptoms is associated with distress; disruption of day-to-day functioning; or disproportionate thoughts, feelings and behaviours regarding the symptoms, whether or not they are associated with an identified medical condition. While somatic symptom disorder affects a considerable proportion of children and adolescents presenting to the emergency department (ED), it has not been well investigated in the ED literature, nor is there much formal training in, or guidelines for, how to care for affected patients in the ED. The aim of this paper is to highlight the historical clues commonly reported by these patients in order to try to help the emergency physicians recognise patients affected by a somatic symptom disorder. Adolescent age, the presence of daily subjective symptoms presenting daily for weeks or months, a long medical history record, an extensive diagnostic workup and, most of all, disproportionate functional impairment related to the symptoms are all features strongly suggestive of this disorder. Emergency physicians should become used to taking advantage of these clues to formulate a positive diagnosis of somatic symptom disorder according to the most recent diagnostic criteria. Emergency physicians have the unique opportunity to contribute to the correct diagnosis and treatment of these patients and to have a positive impact on their prognosis.

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The perpetrators of medical child abuse (Munchausen Syndrome by Proxy) – A systematic review of 796 cases

Cited by 86 publications

References 51 publications

Diagnosis and Treatment of the Factitious Disorder on Another, Previously Called Munchausen Syndrome by Proxy

Diagnosis and Treatment of the Factitious Disorder on Another, Previously Called Munchausen Syndrome by Proxy

Vanishing 17-Hydroxyprogesterone Concentrations in 21-Hydroxylase Deficiency

Facing somatic symptom disorder in the emergency department

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