doiSerbia

Munchausen syndrome by proxy

Jovanović Aleksandar A. (Institut za psihijatriju, Klinički centar Srbije, Beograd)
Popović Vesna R. (Institut za psihijatriju, Klinički centar Srbije, Beograd)
Savić Slobodan (Institut za sudsku medicinu, Medicinski fakultet, Beograd)
Alempijević Đorđe M. (Institut za sudsku medicinu, Medicinski fakultet, Beograd)
Janković Nada (Institut za psihijatriju, Klinički centar Srbije, Beograd)

This review deals with bibliography on Munchausen syndrome by proxy (MSbP). The name of this disorder was introduced by English psychiatrist Roy Meadow who pointed to diagnostic difficulties as well as to serious medical and legal connotations of MSbP. MSbP was classified in DSM-IV among criteria sets provided for further study as "factitious disorder by proxy", while in ICD-10, though not explicitly cited, MSbP might be classified as "factitious disorders" F68.1. MSbP is a special form of abuse where the perpetrator induces somatic or mental symptoms of illness in the victim under his/her care and then persistently presents the victims for medical examinations and care. The victim is usually a preschool child and the perpetrator is the child's mother. Motivation for such pathological behavior of perpetrator is considered to be unconscious need to assume sick role by proxy while external incentives such as economic gain are absent. Conceptualization of MSbP development is still in the domain of psychodynamic speculation, its course is chronic and the prognosis is poor considering lack of consistent, efficient and specific treatment. The authors also present the case report of thirty-three year-old mother who had been abusing her nine year-old son both emotionally and physically over the last several years forcing him to, together with her, report to the police, medical and educational institutions that he had been the victim of rape, poisoning and beating by various individuals, especially teaching and medical staff. Mother manifested psychosis and her child presented with impaired cognitive development, emotional problems and conduct disorder.

Keywords: Munchausen syndrome by proxy, factitious disorders, child abuse