Munchausen syndrome by adult proxy: A review of the literature

Abstract

BACKGROUND Munchausen syndrome by proxy (MSBP), more formally known as factitious disorder imposed on another, is a form of abuse in which a caregiver deliberately produces or feigns illness in a person under his or her care so that the proxy will receive medical care that gratifies the caregiver. Although well documented in the pediatric literature, few cases of MSBP with adult proxies (MSB‐AP) have been reported. This study reviews existing literature on MSB‐AP to provide a framework for clinicians to recognize this disorder. METHODS We searched Ovid MEDLINE, Ovid EMBASE, PubMed, Web of Knowledge, and PsychINFO, supplemented by bibliographic examination. RESULTS We identified 13 cases of MSB‐AP. Perpetrators were caregivers, most (62%) were women, and many worked in healthcare. The age range of the victims was 21 to 82 years. Most were unaware of the abuse, although in 2 cases the victim may have colluded with the perpetrator. Disease fabrication most often resulted from poisoning. CONCLUSIONS MSB‐AP should be included in the differential diagnosis of patients presenting with a complex constellation of symptoms without a unifying etiology and an overly involved caregiver with suspected psychological gain. Early identification is necessary so that healthcare providers do not unknowingly perpetuate harm through treatments that satisfy the perpetrator's psychological needs at the proxy's expense. Journal of Hospital Medicine 2015;10:32–35. © 2014 Society of Hospital Medicine

Early death in Munchausen syndrome: A case report

“…This disorder is more often reported among men than women and frequently occurs in early adulthood. Possible predisposing factors are represented by long‐term treatments or hospitalizations in childhood or adolescence resulting from medical conditions, the presence of grievances against medical professionals, work experience in health care and personality disorders …”

“…Possible predisposing factors are represented by long-term treatments or hospitalizations in childhood or adolescence resulting from medical conditions, the presence of grievances against medical professionals, work experience in health care and personality disorders. 6 Folks and Freeman described three features of MS: (a) fake recurrent illnesses; (b) wandering; and (c) fantastic pseudology, described as a sort of pathological lie aimed at self-gratification which represents a symptom ranged between conscious deceit and delusion, without the patient losing touch with reality. 7,8 Individuals with MS complain predominantly of physical symptoms and often abuse analgesics, sedatives, and other drugs to produce symptoms that suggest mental disorders.…”

Factitious disorder: a case report and literature review of treatment

“…Discussion and review of literature Several factors can predispose for FD such as the presence of other mental health problems (eg depression), health conditions in childhood or in adolescence that result in continuous treatments or repeated hospitalisations, bitterness against doctors and existence of a personality disorder. 6 Very often, patients suffering from FD have experienced abandonment and/or abuse (emotional, physical, etc) in childhood. 7 Plenty of patients who have FD have features compatible with EUPD.…”

From Interference to Factitious Disorder: Slippery Slope or Tip of the Iceberg? The Case of a Difficult Guardian of a Head-Injured Adult

“…When a patient's longitudinal course appears atypical, factitious disorder (FD) and factitious disorder imposed on another (FDIA) should be considered in the differential diagnosis. In FDIA, caregivers fabricate or induce signs and symptoms in a dependent person, meeting their own psychological needs through the attention from medical personnel caring for their dependent, most of whom are children but rarely, can be compromised adults [7,8] like Mr. A.…”