Munchausen's Syndrome by Proxy
The term Munchausen's Syndrome by Proxy was first coined by paediatrician Professor Sir Roy Meadow, whose evidence has been challenged in several high profile cot death cases.
It is a highly controversial condition, which some doubt even exists.
What is Munchausen's Syndrome by Proxy (MSbP)?
MSbP is parenting disorder that comes in two forms. The children of people with MSbP will either have a fabricated illness or an induced illness.
In fact, both the Royal College of Paediatrics and Child Health and the Department of Health now use the term FII for the condition rather than MSbP.
Fabricated illness involves a parent claiming that their child is ill, when they have actually made up the symptoms.
This can involve a high degree of deception. For instance, a parent may claim that their child has passed blood in its urine, and will present samples suggesting this is the case.
However, following tests, it will become apparent that the parent has actually pricked their own finger and dropped blood into the sample.
Another example would be a parent claiming their child is having frequent epileptic fits - even when simultaneous observation by video and by EEG (a measure of brainwave activity) shows no such events are occurring.
Induced illness is the more sinister form of the condition. This involves the parent inflicting damage on their child.
For instance, this may include injecting unsterile fluids such as dishwater into a child, or putting a caustic solution into a child's eyes to make them sore.
What causes it?
The exact psychological basis for MSbP is not known. Some people believe it is a complex way of seeking attention, but this only remains a theory.
Some experts believe that there is such a wide variation in symptoms that it is unlikely that everybody diagnosed as having MSbP is actually suffering from the same condition.
Currently, it covers cases as severe as parents who kill their children and cover up the fact, and as mild as those who knowingly exaggerate real symptoms simply to get medical care.
Does it really exist at all?
It has been suggested that MSbP is only a theory. However, a spokesman for the Royal College of Paediatrics and Child Health told BBC News Online: "There have been too many documented cases were illness has been fabricated.
"However, nobody quite knows how common or rare it is."
Is it more common among certain groups?
An analysis of 300 cases has shown that the condition is more common among mothers.
Suffers often have a history of mental health problems, and may have been abused as children.
There is also some evidence to suggest many people who fabricate or induce illness in their child - although still a minority - have some basic paramedical training.
Do doctors face difficulties in diagnosing it?
Yes. Paediatricians rely heavily on history taken from parent of what happened to a child.
If the parent is lying, it makes hard for doctors to get to the truth.
Doctors also have to bear in mind that concerned parents have a tendency to over-dramatise or exaggerate symptoms - and in the over-whelming majority of cases this in no way means that their child has FII.
How common is MSbP?
It is pretty rare. However, data is fairly sketchy. There has only been one national survey into MSbP, which was carried out in the mid-1990s.
It was very thorough, every paediatrician in the UK being asked every month for 18 months if they had diagnosed a new case.
The results suggested that there are only about 50 new cases of MSbP each year, about 20 of which involve children under one year.
This means the average paediatrician will either never see a case, or only see one very rarely.
There has been no repeat survey so any claim that the rate is going up or going down is spurious.
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/medical_notes/3528517.stm
Published: 2004/03/03 10:10:02 GMT
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