Münchausen syndrome by proxy: the strange form of child abuse 21-11-2019
Author: BBC MUNDO
When the medical team of pediatrics and otolaryngology of the Chilean hospital Carlos Van Buren, in Valparaiso, confirmed their suspicions, the boy, about three and a half years old, had already accumulated 5 hospitalizations and numerous antibiotic treatments in just nine months.
The little one, whom we will call Mario in this article, always returned with his mother to the hospital for the same problem: a mysterious secretion of both ears accompanied by granulomas, small points of inflammation in the tissue of the ear canals, which prevented doctors from seeing the eardrums.
The official diagnosis was chronic otitis media, but no one could explain the cause. The child responded well to cures and antibiotic treatments but the problem recurred once he was discharged.
In addition, he presented a delay in the development of an unexplained cause: "At about three years of age he walked with difficulty and spoke very little," surgeon Cristian Papuzinski, of the Otolaryngology Service of that hospital, who was part of the team that treated him, told BBC Mundo.
3 suspicious items
Mario's is a real clinical case, whose details were published in 2016 in the Journal of otolaryngology and head and neck surgery, of Chile. Papuzinski and the rest of the medical team that treated the child began to suspect due to several incongruous elements: the main one was the absence of a clear cause that explained the recurrence of the disease.
But also the rare clinical features of the case: rare pathogens in ear infections and unexplained injuries.
Finally, the fact that Mario clearly improved when he was separated from his usual environment.
Papuzinski said that two months after being treated in his hospital, they began to suspect that perhaps the mother put some irritant substance in the child's ear. It was after the first biopsy, when doctors saw that “while the boy was hospitalized, he got better,” Papuzinski says. “So we figured maybe there was a familiar factor that maybe we weren't considering. And one of them could be some kind of mistreatment by family members, ”added the surgeon, who admits that he had never encountered such a case in his specialty.
But after an evaluation of the child with social assistance and child psychiatric staff, this hypothesis was dismissed. According to Papuzinski, the mother denied any situation of ill-treatment at home. And she kept doing it to the end.
A “very worried” mother
Actually Mario's mother seemed to be very involved in her son's health
“She was very worried. She was always there with him, she arrived early and spent practically 24 hours a day in the hospital, ”recalls the Chilean surgeon. In total, in the nine months he was treated at the Carlos Van Buren, Mario spent more than 80 nights admitted. Seven months after his first consultation, a coincidence caused the truth to be discovered.
The mother of another child admitted to the hospital who shared a ward with Mario surprised his mother injecting him some medication without medical authorization.
That's how the doctors first saw the baby's eardrums and were able to confirm, fortunately, that they were healthy. According to the doctors, they even perceived “a substantial improvement in the child's interaction with other people.”
An “underdiagnosed” syndrome
It was not the child who was really ill, but the mother: she had Münchausen syndrome by proxy (SMPP), as diagnosed by the psychiatric team of the Carlos Van Buren Hospital itself.
This recognized mental disorder, also called factitious disorder imposed on another, was first identified in 1977 by British pediatrician Roy Meadow.
This syndrome involves a twist on Münchausen Syndrome, which consists in the manufacture of symptoms and signs of a disease by the patient to generate help, compassion, admiration and medical attention.
This syndrome involves a twist on Münchausen Syndrome, which consists in the manufacture of symptoms and signs of a disease by the patient to generate help, compassion, admiration and medical attention. Se considera, de hecho, una forma de maltrato infantil, que a menudo pasa desapercibida para médicos y autoridades durante meses o años.
In the case of SMPP, known in English as "Münchausen Syndrome by proxy", it is the person in charge of a patient, usually the mother or caregiver of a minor, who manufactures these symptoms or diseases.
It is considered, in fact, a form of child abuse, which often goes unnoticed by doctors and authorities for months or years.
However, it has a causal mortality rate of about 7%, according to the team of Chilean doctors. The international press has collected several notorious cases in which the minors died and the parents were sentenced to prison terms.
Adults suffering from this psychiatric disorder may reach unsuspected limits in their pathological search for medical care: they may inject the minor with blood, urine or feces to generate disease, give them drugs that generate symptoms such as vomiting or diarrhea, and subject them to invasive tests such as biopsies or surgeries.
According to the authors of the report on the Chilean clinical case, the true incidence of MSP cases is unknown, but they believe that it is "underdiagnosed" because health personnel do not usually suspect the parents of minor patients.
However, several studies show that the mother is the abuser in the vast majority of cases, 75% according to Chilean doctors.
Why do they do this?
In reality little is known about the causes of Münchausen Syndrome and Münchausen Syndrome by proxy.
Experts believe that people who suffered abuse, mistreatment, or neglect during their childhood are at greater risk of it.
They theorize that the patient self-inflicts an injury or causes it on someone in their care in an attempt to seek empathy, gain attention, or generate admiration for their ability to cope with their problem.
On the other hand, even when there are suspicions, it is difficult for medical staff to confront patients for an alleged Münchausen syndrome. There are several risks: if they feel interrogated, patients can become defensive and even disappear, only to seek help in another hospital where they are not known. In fact Mario arrived at the hospital in Valparaiso referred from another medical center that he had already visited on numerous occasions without achieving a diagnosis.
The other danger is the possibility of accusing someone wrongly, with all the repercussions that this can generate.
“It's a very complex situation,” says the Chilean otorhinolaryngologist.
Indeed, the British paediatrician who coined the end of the syndrome was embroiled in controversy after having participated as a witness in several trials in which parents were wrongly convicted of the murder of their children.
