Differentiation Is Useful

Abstract

Jacobi et al in their article on child abuse and neglect rightly mention Munchhausen syndrome by proxy (MSBP). However, in the article, symptoms of children with a factitious disorder are confused with symptoms of by proxy (3), and Munchhausen syndrome by proxy (MSBP) is an important subcategory among the factitious disorders (2). The differentiation makes for an important difference from the perspective of pediatricians and within the context of basic psychosomatic services and the work of Balint groups: In Munchhausen syndrome by proxy (1), the psychological or real parent (for example, the mother) presents the child under the pretext of manufactured symptoms of disease (Pseudologia phantastica); for example, a 2 year old child is reported to have had “seizures” at night. In factitious disorders by proxy, by contrast, manipulative measures are taken that are directly harmful for the child (for example, administration of medical drugs). It also makes sense to differentiate between the two syndromes from a clinical perspective because it is often possible to address the dynamic in Munchhausen syndrome at the level of psychosomatic basic care as the mother’s own suffering (for example, excessive fears related to her body, which are projected on to the child). By contrast, in the factitious disorders, the disruption to the relationship between child and psychological parent is usually much more severe and unraveling the entire dynamic is a protracted process—and, additionally, the child is at immediate risk.