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This research paper is about the signs and symptoms, etiology, diagnosis, treatment ,prognosis and prevention of Munchausen Syndrome and Munchausen Syndrome by Proxy.
Munchausen syndrome (MS) is defined by Murray (1997) as characterized by a patients’ chronic and relentless pursuit of medical treatment for combinations of symptoms of consciously self-inflicted injury and falsely reported symptomatology (p.1). Unlike malingerers, these patients are symptomatic not because they want to avoid a certain commitment or responsibility, but because the attention and care provides some sort of satisfaction for a psychological need. On the other hand, Murray (1997) defines Munchausen Syndrome By Proxy (MSBP) as a form of child abuse (p.1), wherein the parents induces medical illnesses in one’s child in order to obtain medical attention for the child or in times, the parent themselves.
The term Munchausen Syndrome, according to Wikipedia (2006) was first used in medical literature by Richard Asher in 1951, a British Psychiatrist who dealt with self-abuse patients made up stories of their medical condition. He found similarity between these patients that tell amazing tales of their medical condition with that of Baron Munchausen. Baron Karl Friedrich von Münchhausen, a German serving the Russian military in 1750 (Wikipedia, 2006), told of his amazing adventures during the war with the Turks.
Though they may have truth in them, exaggeration of the account has been made in publishing The Adventures of Baron Munchausen, thus the similarity with MS patients. After twenty-six years from when Asher first used the term, in 1977, Dr. Roy Meadow, an English pediatrician used Munchausen Syndrome by Proxy to describe a form of child abuse where mothers deliberately induce or deceptively reported sickness of their children in order to gain attention for themselves of their child.
A leading American Psychiatrists, Dr. Charles Ford summarizes the work of several colleagues in a list of potential etiologies for MS (1996, p. 164). The earliest observed reason for demonstrating Munchausen behavior was to seek for food and shelter by the homeless. Thus, being hospitalized meant a place to stay. Some would have the desire for a specific drug and thus would display symptoms of a specific illness. Sometimes the motivation of MS patients would be just to fool the physician into administering the drug. In which case a deeper psychological etiology suggest those that have a need for attention, seek gratification from dependency or those that derive satisfaction at being respected, important, and powerful. Ford (1996) provides an example of a woman who is an official of World Health Organization who had the responsibility of caring for children displaced by war (p. 166).
She would tell stories about her work that health care providers would spend time on her bedside and openly admire her. Persons with Munchausen syndrome frequently have a poor sense of self. By portraying one’s pseudologia fantastica, falsely elaborating symptoms and histories (Murray, 1997, p.1) the patient obtains satisfaction from assuming fantastic roles of famous athlete, leading professional or a jetsetter and enjoys being the center of medical attention. A minority of the MS patients suffers from cerebral dysfunction as evidenced by pseudologia fantastica in that they have greater verbal ability than logical or organizational.
MSBP is usually diagnosed by physicians in hospitals and school settings and are usually referred to psychologists afterwards. Common symptoms include seizures, allergies, apnea, diarrhea, vomiting and combinations of factitious diseases ((Kahan & Yorker, 1990; Stern, 1980) Murray, 1997). Starvation, suffocation, inflicted vaginal/ rectal injuries in order to produce bleeding, altered laboratory reports, adding fat to stool collection, putting parent’s blood into urine and the injection of contaminated material intravenously, are some of the mechanisms employed by MSBP cases (( Mehl et al., 1990; Pearl, 1995) Murray, 1997).
Because MS is a complex disorder, often diagnosed after extensive historical investigation, the treatment is also difficult. Because of its very nature, the need to be perpetually sick and attended to, MS patients will often resist treatment. The have the ability to move from one hospital to another if the diagnosis and treatment is not favorable. Nevertheless, if the attending physician suspects MS in a patient, the immediate treatment is to manage the symptoms to avoid major, invasive operations. Handling of the patient should be objective by directly articulating diagnosis to the patient and supporting family member. Any legitimate illness must be dealt with Patients with a factitious disorder should be confronted with the diagnosis without suggesting guilt or reproach. The physician must address the legitimate illness, but at the same time tackle the psychological problem. He must gain his patient’s cooperation to the road for treatment.
The prognosis of MS patients can cause serious illness, especially if the illness will require multiple invasive procedures. Negative repercussions of prolonged and frequent hospitalizations affect one’s means of living, family responsibilities and community involvement. For victims of MSBP, the frailty of their young bodies may take a toll on multiple illnesses and may lead to eventual death. Those who survive and mature may suffer developmental problems and psychological difficulties later in life.
With the modernization of medical documentation, it is now possible to share medical records among hospitals, which allow detecting possible MS patients and preventing their disorder. Limiting admission of patients may be the immediate answer, though they should be referred to a psychologist for treatment. MSBP children should immediately be removed from the custody of the abusive parent and be provided a psychologically stable guardian.
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