Munchausen Syndrome by Proxy: medical diagnostic criteria
Section snippets
Background and purpose
Munchausen Syndrome by Proxy (MSBP) is persistent fabrication by one individual of illness in another. The usual victim is a child, the usual perpetrator the child’s mother. Since Meadow (1977) first described MSBP, not only new cases, but also novel diagnostic problems, have become evident. Among them are the hesitant diagnosis of MSBP despite overwhelming evidence, the incorrect exclusion of MSBP, the altogether missed diagnosis of MSBP, and, horribly, the mistaken diagnosis of MSBP when the
The characteristics of diagnostic criteria
Diagnostic criteria serve to efficiently discriminate between one particular diagnosis and all others. Collectively, the diagnostic criteria for a disorder are the smallest set of findings that must be present in order to make a diagnosis.
Each diagnostic criterion must be present in order to make a diagnosis. Each criterion must be pivotal, meaning that its presence is required for, and its absence excludes, the diagnosis. Each finding must be credibly observable by human senses. Other
Different degrees of diagnostic certainty
A doctor’s level of conviction about a diagnosis of MSBP will depend upon the known facts in a case. But what is known about a case may change over time and, thus, the degree of diagnostic certainty at the outset may not be the same as it is at the conclusion of an inquiry. When a diagnosis of MSBP is first entertained in the pediatric patient, the medical records, often extensive, are also often dispersed and not immediately available. As more information becomes available, either through
Diagnostic criteria for Munchausen Syndrome by Proxy
Below, the diagnostic criteria for MSBP are elaborated. Since there are different degrees of certainty concerning the diagnosis, there are, correspondingly, different sets of diagnostic criteria.
Discussion
It was only when the author attempted to devise diagnostic criteria for MSBP that she began to appreciate the pitfalls inherent in such an endeavor. There are many. Chief among them is the difficulty in maximizing taxonomic tidiness while, at the same time, minimizing misplaced precision. As with any taxonomic structure, one is attempting to identify only bona fide cases, and to avoid overcapture, undercapture, and logic flaws. Another difficulty has less to do with how these diagnostic
Summary
Medical diagnostic criteria for Munchausen Syndrome by Proxy are presented. They are meant to be practicable. The author hopes they will find a useful place in medical diagnosis and, when necessary, within the context of legal proceedings. It is further hoped that such challenges as will inevitably occur are helpful and logical, and are not in the service of some other sub rosa purpose or the product of simple mischief.
References (7)
Munchausen Syndrome by Proxy: The hinterland of child abuse
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Definitional issues in Munchausen Syndrome by Proxy
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(1998) Factitious illness by Proxy. Munchausen Syndrome by Proxy
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Cited by (57)
Medical child abuse: Medical history and red flags in French adolescents
2023, Child Abuse and NeglectShared Munchausen syndrome in adolescents: An in-between for a continuum from Munchausen syndrome by proxy to Munchausen syndrome
2023, Neuropsychiatrie de l'Enfance et de l'AdolescenceFabricated or induced illness: From “Munchausen by proxy” to child and family-oriented action
2020, Child Abuse and NeglectMunchausen syndrome by proxy and pediatric nephrology
2017, Nephrologie et TherapeutiqueExpert Witness: Qualifications, Testimony, and Malpractice
2015, Encyclopedia of Forensic and Legal Medicine: Second EditionThe Role of Nonperpetrating Fathers in Munchausen Syndrome by Proxy: A Review of the Literature
2012, Journal of Pediatric NursingCitation Excerpt :Rosenberg (2003) wrote of ways to diagnose MSBP by inclusion and by exclusion. This requires frequent presentations for medical care, tampering with the child or the child's medical situation that is caused by the perpetrator, and that no other explanation for the situation is present (Rosenberg, 2003). Furthermore, the child's condition improves with separation from the perpetrator (Rosenberg, 2003).