Munchausen By Proxy Essay

The Impact of Munchausen's by Proxy on the Short-term Physiological State and the Psychological Welfare of the Child

Munchausen syndrome by proxy is a mental illness in which a perpetrator, usually a caregiver or guardian, induces or fabricates symptoms on a proxy. In the situation where the proxy is a child, it is classified as child abuse due to the high risk present. In most cases, short term morbidity occurs due to either the perpetrator’s maltreatment, prescription of unnecessary medications or the subsequent invasive treatments by medical staff. This form of abuse impairs child development and damages the psychological welfare of the proxy and can lead to anxiety, emotional issues and depression. It also predisposes the proxy to developing
Munchausen’s or becoming a perpetrator of Munchausen by proxy themselves.
Keywords: Factitious disorder, child abuse, neglect, trauma, caregiver-fabricated illness

Introduction
Munchausen syndrome is a mental disorder where the individual imitates factitious symptoms intentionally in order to adopt the sick role (Krahn et al. 2003) It is characterised by a strong desire to be hospitalised or to receive treatment. Usually a cycle of treatments with dramatic improvement followed by the reappearance of the same or other medical issues are noted. Regardless that the individual’s claims misalign with the testing done, people affected by Munchausen’s insist on receiving medication or hospitalisation. There are other variations of Factitious disorder including Munchausen’s by proxy, Munchausen by internet and Malingering. Munchausen Syndrome by proxy (MSbP) involves a perpetrator that intentionally fabricates or induces an illness or disease on a
proxy. The perpetrator can either produce these symptoms through means such as poisoning or fabricating inaccurate medical history (Koetting 2015; Lawlor and Kirakowski 2014). The general motivation of MSbP is usually to seek attention and affection through medical staff (Lawlor and Kirakowski 2014). Being a proxy is considered a form of child abuse and neglect as it involves high risk to the child who doesn’t have the resources or the power to stop the maltreatment. The aim of this review is to explore the short-term and long-term impacts of being a proxy in MSbP on the physiological and psychological state of the child. Firstly, the possible methods of maltreatment following the immediate physiological impact on the proxy will be discussed. Subsequently, the possible long term impacts on the psychological welfare and development of the child alongside the possibility of the child developing Munchausen themselves will be explored.

Short-term Physiological Effects on the Proxy
In order to receive medical care and therefore a sense of satisfaction, the perpetrator induces pain on the proxy either directly or through subsequent invasive treatment (Gomila et al. 2016). The most common way of inducing pain was smothering which deprived the proxy of oxygen leading to abnormal breathing and using poisons like common salt, phenytoin and imipramine. Perpetrators were also found to claim stories of seizures in order to obtain a prescription for epilepsy medication for the proxy (Bools et al.1994).The manifestation of this syndrome varied from symptoms ranging from allergies to life threatening respiratory conditions in the proxy, which was usually induced by the mothers. (Flaherty and MacMillan 2013)
In a specific case of Munchausen by proxy, a three-year-old boy was brought into the Emergency Department with various neurological symptoms. Upon testing, Alimemazine was detected in high levels in his serum, urine, gastric and cerebral spinal fluid. Repetitively, the 3-year-old was hospitalised for Alimemazine poisoning. Alimemazine, an antihistaminic drug, prevents itching from eczema and acts as a sedative (Singh et al. 2013). The overuse of antihistaminic drugs can lead to skin eruptions, headaches, seizures and in an extreme case, it lead to the formation of neuroleptic malignant syndrome (Vries and Hunsel 2016). Only once separated from his mother, signs of improvement for his neurological symptoms appeared (Gomila et al. 2016). Without removal of the child from the perpetrator’s care, these symptoms can unnecessarily last for months, thus causing further damage.
In another case in 2011, a 16-month old girl was brought into Hacettepe University Children’s hospital for repeated apnoea attacks and thigh abscess.
The mother repeatedly complained of spasms and was given ceftriaxone to reduce the amount of seizures. At 8 months the child was hospitalised for swelling on her thigh at the injection site for antibiotics for a respiratory tract infection. Despite antibiotic treatment for the swelling, her symptoms did not improve and a thigh abscess formed. Following her two week stay at the Paediatric Intensive Care unit her condition improved rapidly and she had no seizure-like episodes. Once discharged, reports of apnoea attacks and spasm reappeared. (Foto-Ozdemir et al.
2013)
These cases show the proxy being severely injured by either the perpetrator or the medical staff as a result of invasive treatments. Rosenberg’s (1987) study showed that from 117 children, 100% suffered short term morbidity, which involved pain or illness with no permanent harm. Out of this 75% of harm were caused by the perpetrator and medical staff and 25% due to medical staff alone. The presence of unnecessary poisons, prescription of medications and hospitalisations leading to invasive operations has side effects that harm the child’s body in unnecessary ways. Anda et al. (2006) found that childhood abuse can lead to cardiovascular disease, hypertension, asthma, infections, sleep disturbances, severe obesity and other somatic symptoms. Furthermore, from Rosenberg’s experiment, of the 117 children studied, 10 of the children died and 8% had long term morbidity causing a permeant impairment of functioning. These ranged from oesophageal surgeries to gastrointestinal function impairment. These physiological effects and maltreatment at an early age can lead to psychological and developmental issues.