Culture and Munchausen-by-Proxy Syndrome: The Case of an 11-Year-Old Boy Presenting with Hyperactivity

Abstract

Objectives:

To discuss some of the challenges presented to the clinician who deals with a possible Munchausen-by-proxy (MBP) syndrome.

Method:

The case of an 11-year-old boy presenting with hyperactivity is discussed. Information from the initial assessment and the 9-month follow-up period is presented. We highlight some cultural considerations as they apply to this immigrant family. A commentary by Dr H Schrier follows the presentation.

Results:

The positive outcome is discussed in relation to the validation of the diagnosis as well as to cultural issues.

Conclusion:

Cultural issues and dynamic factors may be important when we consider the diagnosis of MBP syndrome in an immigrant family with different expectations from our health care system.

Keywords

Munchausen-by-proxy syndrome culture parent-child relational problems

References

Ackerman

Strobel

. Polle syndrome: Chronic diarrhea in Munchausen's child. Gastroenterology 1981;81:1140–2.

Alexander

Smith

Stevenson

Serial Munchausen by proxy. Pediatrics 1990;86:581–5.

Bauman

Yalow

. Child abuse: Parenteral insulin administration. J Pediatr 1981;99:588–91.

Black

The extended Munchausen syndrome: A family case. Br J Psychiatry 1981;138:466–9.

Chan

Salcedo

Atkins

Ruley

. Munchausen syndrome by proxy: A review and case study. J Pediatr Psychol 1986;11:71–80.

Conway

Pond

. Munchausen syndrome by proxy abuse: A foundation for adult Munchausen syndrome. Aust N Z J Psychiatry 1995;29:504–7.

Roberts

. Munchausen-by-proxy [letter]. J Am Acad Child Adolesc Psychiatry 1997;36:578–9.

Schreier

Libow

. Hurting for love: Munchausen by proxy syndrome. Guilford Press; 1993.

Abe

Shinozima

Okuno

Abe

Ochi

Munchausen's syndrome in children: Bizarre clinical and laboratory features. Acta Paediatr Jpn 1984;26:539–43.

10.

Amegavie

Marzouk

Mullen

Sills

Gauthier-LeTendre

JBM

. Munchausen's syndrome by proxy: A warning for health professionals. BMJ 1986;293:855–6.

11.

Atoynatan

O'Reilly

Loin

Munchausen syndrome by proxy. Child Psychiatry Hum Dev 1988;19:3–13.

12.

Chadwick

. The diagnosis of inflicted injury in infants and young children. Pediatr Ann 1992;21:477–83.

13.

Mayo

Haggerty

. Long-term psychotherapy of Munchausen syndrome. Am J Psychother 1984;38:571–8.

14.

Meadow

Management of Munchausen syndrome by proxy. Arch Dis Child 1984;60:385–93.

15.

Meadow

Factitious illness: The hinterland of child abuse. In: Meadow

, editor. Recent advances in paediatrics. Edinburgh, Scotland: Churchill Livingstone; 1984.

16.

Meadow

ABC of child abuse Munchausen syndrome by proxy. BMJ 1989;299:248–50.

17.

Meadow

Neurological and developmental variants of Munchausen syndrome by proxy. Dev Med Child Neurol 1991;33:270–2.

18.

Mitchels

Munchausen syndrome by proxy: Protecting the child. J Forensic Sci 1983;23:105–11.

19.

Pope

Jonas

Jones

Factitious psychosis: Phenomenology, family history and long-term outcome of 9 patients. Am J Psychiatry 1982;139:1480–6.

20.

Reece

. Unusual manifestations of child abuse. Psychiatr Clin North Am 1990;37(1):905–21.

21.

Rosenberg

Web of deceit: A literature review of Munchausen syndrome by proxy. Child Abuse Negl 1987;11:547–63.

22.

Vaisrub

Baron Munchausen and the abused child [editorial], JAMA 1978;239:752.

23.

Waller

. Obstacles to the treatment of Munchausen by proxy syndrome. Journal of the American Academy of Child Psychiatry 1983;22:80–5.

24.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington (DC): American Psychiatric Press; 1994.

25.

Canadian Task Force on the Periodic Health Examination. The Canadian Guide to Clinical Preventive Health Care by Health Canada. Ottawa: Health Canada; 1994.