Münchhausen Syndrome by Proxy can be difficult to diagnose because the perpetrators appear to be someone above suspicion. The following describes the profile of a typical MSBP perpetrator:
- Often upper class, well-educated persons;
- Appears to be very knowledgeable about the victim's illness;
- Shelters the victim from participating in activities outside of the home;
- In cases involving children, the perpetrator is the mother with the father being uninvolved in the case;
- A history of marital discord;
- Lonely and isolated;
- Unusual involvement in the patient's care, to the point of trying to exclude medical staff;
- A history of Münchhausen Syndrome and/or suicide attempts;
- Socially adept and friendly around medical staff.
Most MSBP perpetrators fall into one of three types: Help Seekers, Active Inducers, and Doctor Addicts.
Help Seekers are mothers who seek medical attention for their children in order to communicate their own anxiety or inability to care for the child. They can also be suffering from depression. Help Seekers tend to come from homes studded with domestic violence, marital discord, or single parenthood. Help Seekers also tend to be open to active intervention. They acknowledge that they need help and are willing to undergo therapy in order to improve their lives.
Active Inducers induce illness in their children by dramatic methods. These mothers are anxious and depressed, and employ extreme degrees of denial and paranoid projection. They also seek acknowledgment from medical staff of their ability to be an outstanding caretaker.
Doctor Addicts are obsessed with obtaining medical treatment for nonexistent illnesses in their children. Mothers believe their children are ill, refuse to accept medical evidence to the contrary, and then develop their own treatment for their children. These mothers also tend to be distrustful, angry, and paranoid.
It is important to note that while mothers are the main inducers of MSBP, there have been cases of baby-sitters inflicting harm on the children they supervise, and even cases of fathers causing the illnesses in their children.
Experts say any of the following warning signs may point to the possibility that Münchhausen Syndrome by Proxy is a factor in a child's apparent illness:
- Illness that persists in spite of traditionally effective treatments;
- Signs and symptoms that are inappropriate or do not relate to each other;
- A child with a very poor tolerance to treatments;
- A child who has been to many doctors without a clear diagnosis;
- A parent (usually the mother) who seems eager for the child to undergo additional tests, treatments, or surgeries;
- A parent who is very reluctant to have the child out of her sight;
- Another child in the same family who has had an unexplained illness or has died;
- A Parent who has a background in health care and is articulate;
- One parent (usually the father) who is absent during hospitalization;
- Symptoms that appear only when the parent is present.
If MSBP is suspected to be behind a child's illnesses, a thorough examination of the child's medical history needs to be performed before confronting the suspect. The examination should include discussions with other relatives about the child's medical history and the history of older siblings.
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