Psychiatric Treatment of Factitious Illness in an Infant (Munchausen by Proxy Syndrome)

Abstract

Child psychiatric evaluation and treatment is described for a single case of Munchausen by proxy syndrome with a good outcome. The literature is reviewed, and the medical management of the case summarized. With careful case selection and preparation and with modifications to existing treatment approaches, we conclude that the generally poor prognosis for this condition may be improved. Safe rehabilitation of the child to the family can be a reasonable treatment goal in selected cases.

Factitious Disorder By Proxy: The Role of Child Mental Health Professionals

“…The research, although anecdotal, suggests there is often a family culture of illness behaviour and family myths related to illness (Griffith, 1988;Richtsmeier & Waters, 1984). Three generations of women in a family using physical symptoms to communicate distress and elicit help have been described (Black & Hollis, 1996). Nicol and Eccles (1985) suggest that these families are characterised by a pattern of dominance and submission, with submissive members withdrawing into over-concern with health .…”

“…To prevent further abuses, intergenerational cycles of exploitation may need to be disrupted. This is crucial when there is continuing victimisation of the perpetrating parents in a similar pattern within their family of origin (Black & Hollis, 1996;Boszonnenyi-Nagy & Spark, 1973 ;Griffith, 1988).…”

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

“…The prognosis is generally bad when a child is returned to a parent who repeatedly denies his/her responsibility for the child's symptoms (Black and Hollis, 1996). The general maxim that no parents could be considered safe for rehabilitation of their children unless they begin by admitting their responsibility for the harm done (eg Bentovim, 1992) is particularly appropriate to cases of FDBP.…”

“…The study shows that at the core of her problems seemed to be an abusive relationship with her own dominating father and this 'unfinished business' was the target of an intervention taking place over a 10 month period with a 15 month follow-up which indicated that there was no further abuse. Black and Hollis (1996) present a very detailed description of their treatment of a family where factitious disorder started when a 10-week-old baby was hospitalised with whooping cough. After two days he was developing diarrhoea and vomiting, showed rapid loss of fluids and the beginnings of some neurological symptoms.…”

Hospital Protocol for the Evaluation of Munchausen by Proxy

“…Needless to say, some parents deny their abusive behavior and refuse treatment. There are some reports of successful treatment with families who are able to admit to the abusive behaviors and engage in therapy (Black, & Hollis, 1996;Parnell, & Day, 1998;Sanders, 1996).…”