Search

Childhood experiences and long-term psychological outcomes were investigated with 10 adults, ages 33 through 71, who were self-identified victims of illness fabrication by a parent (Munchausen by Proxy). During childhood they felt unloved and unsafe and had emotional and physical problems. As adults, problems included insecurity, reality-testing issues, avoidance of medical treatment, and posttraumatic stress. (Author/SW)

Objective: This article explores the relationship between factitious disorder by proxy victimization and the genesis of factitious disorder in young people. It is hoped that this will aid in our understanding of how some illness falsification behaviors may be learned and transmitted within the family system. Method: A discussion of the origins of adult factitious disorder and recent findings on the phenomenon on of illness falsification in children and adolescents is integrated with some of the more ambiguous or 'blended' cases which combine primary falsification by the youngster with caregiver collusion. Those less easily classified cases of factitious illness which fall in the gray areas, containing elements of both independent illness falsification by a child or adolescent with an earlier history of collusion with a parent's Munchausen by Proxy disorder, are proposed as a type of transitional case which may help us better understand the process by which illness falsification is learned. Results: The literature on illness falsification in adults supports the possibility that adult factitious disorder may have its origins in adolescence or perhaps even earlier. Several cases are identified which suggest that some youngsters independently falsifying illness may have had earlier experiences of Munchausen by Proxy victimization or perhaps experienced the modeling or encouragement of illness falsification by a caregiver. Certain elements of the child victim experience, including efforts to overcome feelings of powerlessness, chronic lack of control, and disappointment in the physician are suggested as possible dynamics in the eventual development of independent illness falsification behaviors. Conclusions: The many unanswered questions in our understanding of the development of factitious illness in children and adolescents suggest avenues for further research. It is hoped that increased understanding will eventually allow more rapid, reliable identification of these patients and more effective interventions within the family system, with positive implications for future generations. Keywords: Munchausen by Proxy; Factitious disorder; Illness falsification

Very little is known about the long-term impact of Munchausen by Proxy abuse on children, as many victims probably are never identified and most have been lost to follow-up soon after termination of protective services supervision. This exploratory study examined the childhood experiences and long-term psychological outcomes for 10 adults, ranging from 33 to 71 years of age, who were self-identified victims of illness fabrication by a parent. Subjects completed a 33-item questionnaire including demographic and open-ended questions and a checklist of PTSD symptoms, supplemented by telephone interviews. Subjects described a range of experiences from poisonings and induced bone fractures to symptom exaggeration. Subjects generally felt unloved and unsafe in childhood; a few were directly aware of their parent's deceptions. They made limited attempts to alert others, with little success. Subjects reported significant emotional and physical problems in childhood, and problems in adulthood including insecurity, reality-testing issues, avoidance of medical treatment and posttraumatic stress symptoms. Most of their siblings were also abused, physically or medically. Some subjects express considerable residual anger towards the abusing mothers, but a surprising degree of sympathy for the: fathers who passively colluded or failed to protect. Some of the MBPS parents have continued fabricating their own medical illnesses or harassing their adult children with fabricated dramas even decades later. Key Words - Munchausen Syndrome by Proxy, Child abuse, Factitious illness, Abuse outcome.

A review of the literature and a survey of pediatric neurologists and gastroenterologists yield data indicating that the prevalence of Munchausen syndrome by proxy is greater than is generally estimated. This possibility is further supported by follow-up data on siblings of victims, together with wide variability among practitioners in case identification.

Child victims of catastrophic incidents are often deluged by the news media and by the consequences of instant celebrity status but little is known about the effects of such publicity on these children. Several possible negative consequences for the children are discussed, as are some potential benefits. Suggestions are made for measures to minimize potential trauma arising from media attention.

Urges more dialog between and integration of feminist and family systems theories in order to expand clinicians' flexibility and effectiveness. Considers points of conceptual and pragmatic convergence as well as divergence between the two perspectives. Highlights issues for development of a structural/strategic family systems model. (RC)

There has been surprisingly little interchange between family systems and feminist clinicians up until this time despite the obvious overlap of concerns and clientele. The most striking theoretical differences are in the views of causality, the locus of change, the value placed on insight and strategy and the therapist's use of power. However, techniques of modeling and reframing, contextual concepts of pathology and emphasis on behavioral change are shared in common by feminist and family systems clinicians. This paper urges more dialogue and integration of the two camps in order to expand our flexibility and effectiveness with a variety of families. [ABSTRACT FROM AUTHOR]