Co-morbidity associated with fabricated illness (Munchausen syndrome by proxy).

Abstract

Fifty six children who had been victims of fabricated illnesses and 82 of their 103 siblings were studied. In addition to the index fabrication, 64% of index children had had other illnesses fabricated by their mothers. Twenty nine per cent of the index children had a history of failure to thrive and 29% a history of non-accidental injury, inappropriate medication, or neglect. Seventy three per cent of the index children had been affected by at least one of these additional problems.Eleven per cent of the siblings had died in early childhood, the cause of death not being identified. Thirty nine per cent of siblings themselves had had illnesses fabricated by their mothers, and 17% had been affected by either failure to thrive, non-accidental injury, inappropriate medication, or neglect. First in 1977, and then subsequently, one of the authors (SRM) used the term Munchausen syndrome by proxy to describe cases in which a parent, invariably the mother, fabricated illness in her child or children and presented the problem to doctors.' 2 Since that time, the number of reported cases has increased steadily, so that in 1987 a review considered 117 cases.3 In that meta-analysis Rosenberg reported associated problems for the index child, including physical abuse in 1% and failure to thrive in 14%. Unusual deaths of siblings, and probable fabricated illnesses in other siblings, were mentioned but could not be assessed accurately because of the limitations of meta-analysis.4 Our experience is that this 'co-morbidity' of index children and siblings may be considerably more prevalent. We believe that the best way to assess this is by the systematic study of the original case records of a series of affected children and their siblings.

Caregiver-Fabricated Illness in a Child: A Manifestation of Child Maltreatment

“…8 Siblings of children who are victims of fabricated illness are also frequently abused. 24,27,28 In 1 large series, 25% of the siblings had died and 61.3% of the siblings had illnesses similar to those of the victims of fabricated illness. 10 Although mothers are most commonly the offenders, fathers, grandparents, boyfriends, and child care providers have been found responsible.…”

“…36 Children who are victims of fabricated illness can suffer significant morbidity and mortality. 21,24,27,28,37 Mortality rates of 6% to 9% have been reported, and approximately the same percentage suffer long-term disability or permanent injury. 7,10,24 By definition, all victims suffer some short-term morbidity related to unnecessary procedures or treatments.…”

Hypochondriasis by proxy in children: report of two cases

“…Esses foram muito bem descritos por Bools 7 , que dividiu suas categorias descritivas em três grupos principais de métodos de fabricação (1,2,3) e em três situações especiais (4,5,6). Nos dois primeiros grupos as crianças não são lesionadas fisicamente e diretamente pelo perpetrador.…”

“…Em alguns casos em que a mãe estava sufocando seu filho na enfermaria, notava-se uma forte ligação da mãe ao bebê, com um relacionamento que mostrava amor muito intenso. Portanto, uma mãe cuidadosa que está perto da criança todo o tempo de forma não usual, pelo excesso de cuidado e zelo, pode ser considerada uma forma de comportamento clássico da mãe na SMP 6 . Observa-se também em algumas mães um comportamento calmo e de confiança surpreendente nos médicos, apesar da condição grave das suas crianças.…”

Síndrome de Munchhausen por procuração e o pediatra: contribuições da psicanálise

“…Um estudo realizado com 54 crianças submetidas à SMP, com idade de 1 a 14 anos, revelou que em consequência da precoce exposição à violência física e emocional, comum na síndrome, estas crianças apresentavam diversos problemas comportamentais que incluíam distúrbios emocionais e de conduta, medos recorrentes, além de distúrbios do sono e evidentes características do transtorno de estresse pós-traumático (Bools, Neale, & Meadow, 1992).…”