Munchausen Syndrome for Procura

Generality

The Münchausen syndrome by proxy is a rare psychiatric and behavioral disease, as a result of which the affected subjects cause symptoms (or simply invent them) at the expense of people dependent on their care; all for the sole purpose of attracting attention.

Found more frequently in mothers of children under the age of 6, the Münchausen syndrome by proxy is a particular variant of the more famous Münchausen syndrome.

At present, the precise causes of Münchausen syndrome by proxy are unclear; the experts, however, attribute the onset of the disease in question to three possible circumstances: a particularly troubled childhood, the stress deriving from particular sentimental situations or the presence of some personality disorder.

The symptoms of Münchausen syndrome by proxy are abnormal behaviors, which affect more or less markedly the health status of those who depend on the patient (the so-called "victim" of those suffering from Münchausen syndrome by proxy).

Diagnosing Münchausen syndrome by proxy is not at all easy and requires many investigations by doctors, psychiatrists, psychologists and social workers.

Treatment is mainly based on cognitive-behavioral psychotherapy.

Brief review of Münchausen syndrome

Münchausen's syndrome - also known as a fictitious disorder or hospital addiction - is a psychiatric and behavioral disorder, which causes the affected person to complain about diseases and non-existent symptoms, for the sole purpose of putting themselves in the spotlight and passing for a patient.

In other words, subjects with the Münchausen syndrome try in every way to place themselves at the center of the scene, and they do it by inventing physical or psychological problems or deliberately hurting themselves.

The experts have not yet fully clarified the causes: someone claims that, at the origin, there is a childhood trauma; someone else believes, instead, that the psycho-behavioral illness in question derives from a personality disorder.

The symptoms consist in very particular behaviors, such as for example self-production of physical damages, altering diagnostic tests, undergoing invasive and dangerous treatments, etc. without reason.

The diagnosis of Münchausen syndrome is not at all easy, because patients can pretend very well.

In order to heal, it requires considerable collaboration on the part of the patient, who must realize what he has and need help.

What's this?

The Münchausen syndrome by proxy is a psychiatric and behavioral disorder, which causes those affected to cause symptoms or to make invented ones, in people dependent on their attention and care, for the sole purpose of attracting attention.

Generally, the Münchausen syndrome by proxy sees as protagonists an adult - who is the person seeking attention and the bearer of the psycho-behavioral disease in question - and an individual of young or very young age, who is the victim; however, there are also cases of Münchausen syndrome by proxy in which the victim is also an adult (often unable to provide for himself).

The Münchausen syndrome by proxy is a particular variant of the traditional Münchausen syndrome; the term "by proxy" means "through a substitute".

The most typical examples

The most typical example of Münchausen syndrome by proxy is that of mothers who, to put themselves at the center of attention as "a person who cares for someone else" (in English, is the " caregiver "), voluntarily cause symptoms in own children, becoming in effect the cause of the poor health of the latter.

Another important example - though decidedly less common than the previous one - is that of caregivers, nurses and doctors who, to draw attention to themselves, voluntarily harm the health of people who in reality should look after, elderly, in the first case, and sick, in the case of medical and paramedical personnel.

It is a form of abuse

The Münchausen syndrome by proxy is not only a psycho-behavioral disease, but is also a form of law-abusing abuse .

As a form of abuse, it can be: juvenile, if the victim is a child or a young teenager, on the elderly, if the victim is a person of advanced age, and on patients, if the victim is an individual admitted to a hospital or a clinic.

Epidemiology

The Münchausen syndrome by proxy can affect anyone; however, statistical studies have shown that it is decidedly more common in mothers of children under the age of 6.

Quite frequently, people with Münchausen syndrome by proxy also suffer, or suffered in the past, from the more traditional Münchausen syndrome.

According to the Cleveland Clinic - a renowned US academic medical center - at least 1, 000 of the 2.5 million cases of child abuse in the United States are connected to the Münchausen syndrome by proxy.

Causes

There is still little clarity about the precise causes of Münchausen syndrome by proxy.

According to the most reliable theories, the development of this particular psycho-behavioral disease could depend on:

A particularly troubled childhood, characterized by a severe affective trauma (eg: premature loss of a parent), by an emotional trauma (eg, history of physical violence, lack of attention by parents, etc.) or by a disease for which have been given long medical care .
A situation of particular stress, such as separation from a spouse, the discovery of suffering from a serious illness, etc.
A personality disorder, or a mental health problem for which the patient has abnormal behaviors and thoughts. According to the experts, personality disorders related to Münchausen syndrome by proxy and the traditional Münchausen syndrome are: antisocial personality disorder, borderline personality disorder and narcissistic personality disorder.

Symptoms and complications

The symptoms of Münchausen syndrome by proxy coincide with the behaviors and expedients used by the person with this particular psycho-behavioral disorder, to pass the person under his responsibility as sick and, in this way, draw attention to of himself.

The actions of the "caregiver" against the "victim"

To make his "victim" a more or less real patient and put himself in the spotlight, the individual with Münchausen syndrome by proxy adopts some typical behaviors, which are:

Emphasize a trivial malaise of the "victim", to the point of describing it as a very serious symptom, or inventing one or more disorders. To become credible and hide the truth, the "caregiver" tends to go alone to the treating physician, so that the latter does not have the opportunity to personally visit the "victim" and have an effective response to the symptom or the reported symptoms;
Manipulate the results of a "victim's" laboratory test, with the intention of making people believe that a certain disease is in progress. The most classic of manipulations is the addition of glucose in a urine sample, to suggest the presence of diabetes;
Heat the thermometer just used by the "victim", in such a way as to suggest that a feverish state is in progress;
Reduce the amount of food provided to the "victim", with the intent to make them lose weight and induce a state of malnutrition;
To poison the "victim" by repeated secret administrations (for example through food or drinks) of drugs or substances harmful to the health of the human organism;
Procure an infection with the "victim".

Models of abuse in Münchausen syndrome by proxy

According to experts, there are 6 patterns of abuse in Münchausen syndrome by proxy, ranging from the least to the most severe:

Exaggerate, invent or manipulate a symptom by altering a diagnostic test to suggest the presence of a disease.
In an absolutely voluntary way, reduce the dose of food administered to the "victim" or interfere with the latter's nutritional intake.
Induce a mild symptom, such as an episode of skin irritation using an irritating chemical.
Poison the "victim" with substances of low toxicity, such as laxatives to promote diarrhea.
Poison the "victim" with highly toxic substances, such as insulin to induce hypoglycemia.
Suffocate the "victim" to cause unconsciousness.

Other characteristic compartments

To complete the picture of the characteristic behaviors of individuals with Münchausen syndrome by proxy, we take as an example the most widespread situation, namely that in which the sick person is the mother of a child. Usually, in these situations, the patient is characterized by:

An extreme interest in medicine, which leads her to develop an excellent knowledge of the most common diagnostic tests and surgical interventions;
The insistent will to want to establish a close relationship or friendship with the medical personnel who are treating the child;
His interference, often inappropriately, in the discussions of the medical staff, who is evaluating the health conditions of the son or daughter (ie the "victim");
The tendency to contradict the doctors, if they did not detect in the child or in the daughter what she reported;
Demonstrations in public of extreme devotion to the son or daughter. It is not clear whether the patient is acting conscientiously or not, however this behavior is useful for concealing her psycho-behavioral disorder;
The continuous encouragement of doctors, to subject their son or daughter to a certain diagnostic test or to a certain surgical intervention;
An anomalous tranquility in hospital environments and while the son or daughter is subjected to treatments for the symptoms that she herself has procured;
The marked tendency to frequently change the family doctor, because she is dissatisfied with the services rendered by the latter (the real reason is that the family doctor does not find what she has said and this annoys her).

Curiosity : often mothers with Münchausen syndrome by proxy have a job in health facilities, such as medical clinics, hospitals, etc. This would explain, in part, why such individuals possess an excellent knowledge of all existing diagnostic tests and surgical interventions.

Complications

With extreme behavior, those who suffer from Münchausen syndrome by proxy can drastically prejudice the health condition of their "victim", if not actually cause their death.

Diagnosis

Diagnosing Münchausen syndrome by proxy is quite complex, even for an experienced doctor. This is due to the fact that people with this disease know how to hide their problems very well, and they know different ways, all very effective, to cause damage to their "victims" without arousing the slightest suspicion.

According to the reliable opinion of doctors and psychiatrists, in order to recognize a case of Münchausen syndrome by proxy it is essential to analyze in detail every minimum behavior of the alleged patient and the effects that the behavior of the latter has on the potential "victim".

The diagnosis of Münchausen syndrome by proxy requires the involvement and collaboration of various professional figures, including: doctors, social workers, psychiatrists and psychologists .

The recognition of a Münchausen syndrome case by proxy requires the patient to be reported to the police.

How do doctors work if they have any suspicion?

If a doctor suspects an individual, he generally proceeds as follows.

First of all, it assesses the physical state of health of the alleged "victim" through appropriate clinical examinations, with the intent to highlight any inconsistencies with what was stated by his "caregiver", or the individual suspected of suffering Münchausen syndrome by proxy .

So, if there are actually inconsistencies, it focuses on the clinical history of the "victim", looking for possible influences from the "caregiver" (in the case of a child, for example, the fact that he has carried out diagnostic tests of any kind, in spite of a not serious or even normal state of health, it can be very suspect).

At this point, even if the analysis of the "victim's" clinical history favors a diagnosis of Münchausen syndrome by proxy, the doctor asks for help from a mental illness expert - usually a psychiatrist - and a social worker .

The expert in mental illness has the task of investigating the psychiatric profile, childhood and sentimental life of the alleged Münchausen syndrome patient, with the intention of understanding whether, on the part of the latter, there is a need to receive third-party attention.

The social worker, on the other hand, is in charge of contacting the family members and closest friends of the alleged "caregiver" and potential patient, to find out about the behavior of the latter in daily life, outside the hospital environment and in relation to of the "victim" (for example, it is an indication of Münchausen syndrome for procuring the fact that the potential patient never gives the possibility to someone else to take care of the alleged "victim").

A definitive diagnosis of Münchausen syndrome is possible only after all the aforementioned investigations: the doctor will formulate it, which started the various researches, after a careful consultation of the professionals involved.

How to recognize a case of Münchausen syndrome by proxy from the "victim":

It has a history of repeated injuries, illnesses and hospitalizations. This must arouse suspicion especially when the person concerned is very young;
The symptoms that should manifest, according to his "caregiver", do not receive confirmation from any diagnostic test carried out;
The symptoms that he should manifest, according to his "caregiver", do not correspond to any real illness;
He has very little relationship with the rest of the world, except with his "caregiver". If he is a child, for example, he is often absent from school, due to illness, and does not participate in any recreational activity for people of his age;
The disorders he suffers improve when he is admitted to a hospital (when the "caregiver" cannot intervene), but they get worse at home (when instead the "caregiver" has full freedom to act);

Therapy

Once the doctor and his collaborators have verified that they are in the presence of a Münchausen syndrome case by proxy, their priority is to secure the "victim", removing it from the false care of those presenting the aforementioned psycho-behavioral disease, and entrusting it to a trusted guardian.

Only after having secured the "victim", the doctor and the collaborator can devote themselves to the treatment of the true patient: the Münchausen syndrome patient by proxy. For this subject, the therapeutic plan focuses mainly on a particular form of psychological therapy, called cognitive-behavioral psychotherapy .

The treatment of Münchausen syndrome by proxy is very complex, as patients have great difficulty realizing that they are people in need of specific medical care.

Only the awareness on the part of the patient that he is a person with serious problems can allow healing to be achieved.

During the therapeutic course of the Münchausen syndrome patient by proxy, it is very important to support close relatives and friends, who must not isolate the sick relative, but stay close to him, especially in the worst moments.

How does cognitive-behavioral psychotherapy work?

Cognitive-behavioral psychotherapy aims to teach the patient how to identify, dominate and prevent problem behaviors (in specialized jargon, "inactive behavior" or "distorted thoughts"), induced by a mental illness.

Furthermore, it helps in providing a method for identifying the so-called "symptomatology triggers", ie the factors that trigger pathological behaviors.

Cognitive-behavioral psychotherapy includes a part "in the studio", with the psychotherapist, and a part "at home", reserved for the exercise and improvement of the techniques of domination and prevention.

The recovery of the "victim"

If the abuses suffered have compromised their physical health, the "victims" of persons with Münchausen syndrome by proxy need adequate medical care.

Moreover, for some of them, a psychological recovery program is also indispensable, which convinces them that they are not seriously ill, but only people who have received violence.

The adoption of a psychological recovery program is more common among elderly or at least adult "victims"; in fact, the young "victims" are more easily able to return to a normal life.

Prognosis

Healing from Münchausen syndrome by proxy is not at all easy and could take years of psychological therapies.

Moreover, even with the recovery, the quality of life of the former patients could be compromised, due to the possible penal sanctions against them.

The prognosis for the "victim"

Reliable statistical studies suggest that the mortality rate, among the "victims" of people with Münchausen syndrome by proxy, is 10% (ie 10 cases out of 100 of Münchausen syndrome by proxy are fatal for those who suffer abuse).