Munchausen by Proxy Syndrome

Volume 7 Issue 7 July, 2017

Consultation Liaison Psychiatry Focus: Dermatology

Case scenario: A 4-year-old female child was brought by her parents to the OPD with the sudden onset of painful skin lesions since 3 days. On enquiring the parents gave history of similar lesions occurring suddenly in the child since almost a year. However, neither of her parents or her grandparents had seen the development of the lesions. Her mother would identify the lesions first during all the episodes. Also, they gave history of some mysterious power coming and inflicting the injury.

On examination, there was large circular erosion over the thigh with the base of the erosion being red. The skin remaining over the erosion appeared burnt. Multiple healed scars in geometrical pattern were seen over the back, gluteal region and lower abdomen.

As the nature of the lesions wouldn’t match with any common dermatological conditions and the parents denied any injury or trauma, routine investigations like complete blood count and a Tzanck smear were advised. The mother agreed for the investigations without any hesitation and got the tests done. During the subsequent visit, the child was brought by her mother and paternal grandfather. Once again on enquiring into the history, the grand father gave history of occurrence of such lesions suddenly and none of them had noticed how it occurred. Most of the episodes occurred at the paternal grand parent’s house when the father was not there, usually during vacations or functions. With the findings and the above history we could assess that probably the mother was inflicting the injury. On further enquiring to find out the possible inflicting agent, the grand father mentioned about a chemical agent used in their farm as an insecticide which is very corrosive. We could conclude that it could have been the probable inflicting agent used as every time the child suffered severe burns. The child was referred to a child psychiatrist along with her mother and explained about the probable cause to their family members. With the history and clinical findings, a diagnosis of Munchausen by proxy syndrome was made.

Discussion: Munchausen by Proxy Syndrome, also called Factitious Disorder by Proxy, is a psychological disorder in which someone, usually a mother, inflicts physical ailments upon another person, usually her child. She usually tries to gain attention and recognition for herself by showing her concern as a dedicated and caring mother. However, when alone with her child she will subject them to abuse, both physical and emotional, as she tries to deliberately make them sick.

The child is a victim of maltreatment in which an adult falsifies physical and/or physiological signs and/or symptoms in the child causing this child to be regarded as ill or impaired. The perpetrator intentionally gives false history and symptoms in the child to meet their own self-serving psychological needs. Most of the times, the examination findings and history will not correlate with any proper diagnosis. Other member in the family may support and participate in the deception. Children who fall victim to a parent suffering from Munchausen by Proxy Syndrome quite often require extensive emergency medical care, and undergo several unnecessary procedures such as painful surgeries and physical testing. MINI KID assessment tool can be applied to screen for psychiatric syndromes in child Parents with Munchausen by Proxy Syndrome do not typically appear psychotic and, based on incidents caught on film, are calm and collected when inflicting harm on their children. Victims of Munchausen by Proxy Syndrome range greatly in age. With such a wide array of possibilities it is often too late for the victim before the disorder can be diagnosed.

We would like to conclude that, when there are unusual symptoms and signs in young children or even elderly patients which cannot be categorized under any of the dermatological conditions, Munchausen syndrome by proxy can be considered as a differential diagnosis and must be ruled out.

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