Munchausen Syndrome by Proxy in health care workers

Abstract

The literature on Munchausen Syndrome by Proxy (MSP) is reviewed to assess the extent of existing knowledge and the incidence of this syndrome among health care workers. Although use of this diagnosis appears to be increasing and broadening, it was not until the Beverly Allitt case in the United Kingdom in 1993 that this syndrome was used to explain the behaviour of a health care worker who harmed people in his/her care. However, a review of available details of previous health care workers accused of murder reveals that five shared some of the distinctive features of MSP. Although care must be taken when applying diagnoses, in view of the risk of morbidity and mortality which MSP poses for the people involved, it is important that health care workers become more informed and involved in understanding and detecting MSP.

A rare case of serial killing by poisoning

“…[2,8] The case also underscores the importance of considering initially every aberrant finding in cause-of-death investigations (such as a detection of drugs outside the patient's treatment, as in the first and fourth murder in this series) as a sign of a wilful act and in need of a detailed account. This emphasizes the importance of the observations made by those who work in the frontlines of patient care.…”

“…There are also some aspects indicating a professional version of Münchhausen Syndrome by Proxy [2,4] : she was typically the person who called for help after the incidents she herself had created; she participated eagerly in resuscitation or treatment, giving (falsified) information on what had happened, and thus misguiding the diagnosis and treatment. During the court proceedings she categorically denied having done anything wrong.…”

Factitious Disorder by Proxy and the Abuse of a Child with Autism

“…Other carers have been involved and health workers have been implicated in several incidents (eg Repper, 1995), including apparently dedicated nurses (Spink, 1994). Loader and Kelly (1996) present a compelling case study narrative approach, indicating that a key antecedent is the relationship between the mother and the child's doctors.…”

Murder and the ICU

“…It is believed that healthcare workers who suffer from this share many of the characteristics of other groups diagnosed with the condition such as a previous history of abuse and self-harm [5]. Analysis at the time of the Allitt enquiry suggested that three of the above cases (New York, Florida, Texas) [6] may have features of Munchausen's syndrome by proxy, but this is by no means a universal finding.…”