About munchausen syndrome by proxy (msbp)

What is munchausen syndrome by proxy (msbp)?

Munchausen syndrome by proxy (MSBP) is now classified as a somatic symptom and related disorder. It is referred to as factitious disorder that is imposed by one individual on another.

  • MSBP is characterized by feigning or intentionally producing physical or emotional symptoms in another person in order to place that person in the sick role.
  • This disorder is named after Baron Karl Friedrich von Munchausen, who was known to invent fantastic stories of his adventures, including his riding cannonballs and traveling to the moon.
  • MSBP specifically involves a caretaker describing nonexistent symptoms or inducing symptoms in a third person, usually a child they care for.
  • How often MSBP occurs is likely very much underestimated, as evidenced by it often taking years to be discovered, even being completely missed in siblings of the victim that is eventually identified.
  • Males are victims of MSBP as often as females. Women are perpetrators of this disorder the vast majority of the time, theoretically because women remain the primary caretakers of children.
  • Perpetrators of MSBP are vulnerable to also suffering from depression, anxiety, and some personality disorders.
  • While there is no specific cause for MSBP, perpetrators tend to have trouble forming a healthy attachment to their children, difficulty managing their anger and frustration, as well as having an ability to overcome the more natural tendency for caretakers to protect the children they care for.
  • Perpetrators are also more likely to have a history of either losing a parent or being abused or neglected as a child.
  • While the symptoms the victim of MSBP presents with are highly variable, they may consist of symptoms that are more easily faked or induced, like suffocation, seizure, bleeding or nausea, vomiting, or diarrhea that can be the result of poisoning.
  • Theories about what perpetrators gain from assuming the sick role through their child include seeking help, inducing symptoms, and being "addicted" to interactions with medical professionals.
  • MSBP is usually diagnosed through intensive communication between medical, mental-health, and child-protection professionals, as well as review of all available medical records and interviewing family members, school personnel, and other pertinent community members.
  • Sometimes, covertly videotaping the suspected abuser when with the child can be a useful additional diagnostic tool.
  • The treatment of MSBP involves close collaboration with professionals, family, and community members, intensive psychotherapy for the victim and the perpetrator, as well as protecting the child by either intensive supervision of the perpetrator, temporary or permanent removal of the child from the care of the abuser, and sometimes includes prosecution and incarceration of the perpetrator.
  • If left untreated, MSBP can result in the child's death or growing up emotionally and/or medically disabled.

What is Munchausen syndrome by proxy?

Munchausen syndrome by proxy (MSBP) features a caretaker covertly abusing a child by faking or causing symptoms in the child victim. MSBP is also called Munchausen by proxy (MBP), factitious disorder that is imposed by one individual on another, induced illness, or fabricated illness and is a mental disorder that belongs to the group of mental illnesses called somatic symptom and related disorders. It is characterized by a feigning or intentional production of physical or mental-health symptoms in another person for the sole purpose of placing the other person in the sick role. While the reported frequency with which it occurs seems low at one to three in 100,000, it is likely that the actual number of undiscovered MSBP cases is much higher. MSBP tends to affect males as victims as often as females. Affected individuals are usually 4 years old or younger and mothers are the perpetrators most of the time. The tendency toward maternal perpetrators may be more a result of women continuing to be the primary caregiver than any gender-based predisposition to the disorder. MSBP can take two years or more from the beginning or onset of symptoms to when it is diagnosed. Victims of MSBP are ominously found to have a sibling who is either deceased or to have had medical problems very similar to the current victim of the disorder.

This disorder was named for Baron Karl Friedrich von Munchausen. Baron von Munchausen lived from 1720-1797, was born in Germany, joined the Russian military, and was known to tell fantastic tales about the battles he participated in against the Ottoman Turks. For example, he apparently told stories about riding cannonballs and traveling to the moon. As opposed to MSBP (factitious disorder imposed on another person), factitious disorder imposed on self is a mental illness in which what are initially thought to be symptoms of illness in the sufferer are in reality a fabrication of the illness by the sufferer rather than fabrication of illness by a third person. The motivation for factitious disorder imposed on self also tends to be an attempt by the sufferer to be seen as sick (assuming the sick or patient role). Emotional problems that tend to co-occur in people with MSBP include depression, anxiety, and some personality disorders like borderline personality disorder and sociopathy.

What are the symptoms for munchausen syndrome by proxy (msbp)?

The specific signs and symptoms of Munchausen syndrome can be extremely varied, from heart symptoms like fainting and chest pain, to Ear problems seen by specialists in that area, to overtly psychiatric symptoms like hallucinations. The most common physical symptoms tend to include:

  • belly pain,
  • diarrhea,
  • nausea and vomiting,
  • trouble breathing, and
  • outs.

Although the specific symptoms that the individual complains of are nearly limitless, sufferers may have in common a pattern of certain behaviors. These behaviors include:

  • seeking treatment at several care providers and hospitals,
  • providing inconsistent medical history,
  • having symptoms that are exaggerated, vague, and/or inconsistent with test results,
  • having an illogical course to their illness, usually worsening,
  • an unwillingness to allow current health care professionals to talk to family members or previous care providers,
  • being excessively pleased to be subjected to multiple tests and procedures, as well as seeming happy to receive a medical diagnosis and have an excessive desire to receive medications.

People with this condition may also engage in self-injury, altering test results, and have predictable relapses. Interestingly, the symptoms of Munchausen syndrome are very similar in children and adolescents as they are in adults.

What are the causes for munchausen syndrome by proxy (msbp)?

Although there is no specific cause for Munchausen syndrome, like most other mental disorders, it is understood to be the result of a combination of biological vulnerabilities, ways of thinking, and social stressors. Little is known about the specific biological risk factors from which individuals with Munchausen syndrome are more likely to suffer.

Psychologically, sufferers of this mental illness may have an increased need for control, an imbalance in the level of self-esteem (either low or excessively high), and a tendency to suffer from depression, anxiety, or substance-abuse disorders.

Personality traits of individuals who have a history of feigning or inducing symptoms in themselves include some that are in common with borderline personality disorder (for example, if the person dissociates or has another disturbance in their identity/sense of self; has unstable relationships, recurrent instances of self-mutilation, and/or experiences recurrent thoughts or attempts at suicide) or antisocial personality disorder (for example, a tendency to lie, disregard the safety of themselves or others, and to have little empathy for others).

What are the treatments for munchausen syndrome by proxy (msbp)?

As the diagnosis of MSBP concludes and moves into treatment, the involvement of a comprehensive child-protective-services team is considered of key importance. As with any other instance of child abuse, achieving and maintaining the safety of the child with the least amount of disruption possible (in the least restrictive setting) is a central focus. If professionals, family members other than the perpetrator, and community support systems can successfully maintain the safety of the victim and any other child in the home, that may be encouraged. However, if keeping the child in the same home is deemed to put him or her at continued risk of harm, steps will likely be taken to move the victim and/or other children in the home to a safer environment rather than attempting any such in home remedies. With effective treatment progress by the victim and the abuser, professionals may consider slowly reintroducing the child to the home while closely monitoring the child's safety. In the event that such reintegration is not possible, the child might be permanently placed outside the home of the perpetrator. In severe cases, professionals may seek the prosecution and incarceration of the perpetrator and permanently prevent the abuser's access to the victim.

In working with the child, therapists often teach the victim techniques for changing dysfunctional ways of behaving while helping the child understand the underlying feelings and motivations for those behaviors. While psychiatric medications like antidepressant, anti-anxiety, mood stabilizer, and antipsychotic medications may be used to alleviate specific symptoms for the perpetrator or victim, medication by no means cures the illness completely.

Individual psychotherapy for both the perpetrator of MSBP and the victim, as well as family therapy for members of the household involved are often incorporated into the treatment program. At the same time, the ongoing use of medical services is closely monitored by medical, mental-health, and child-protection professionals. Sometimes, the primary-care doctor will be notified by the insurance company of future use of medical services by the MSBP victim. The professional might also be notified when the child is absent from school. Access to such information is either granted through child protective services or by a parent. School officials may agree not to excuse an absence unless approved by the primary-care physician.

What are the risk factors for munchausen syndrome by proxy (msbp)?

Risk factors for people with Munchausen syndrome include:

  • enduring a significant negative event (trauma) during their childhood (such as a serious illness of themselves,
  • a close family member or friend), having a grudge against the medical profession or having been themselves the victim of neglect,
  • physical or sexual abuse, or other forms of childhood maltreatment.

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