Munchausen by proxy defined.

Abstract

Roy Meadow first described Munchausen by proxy (MBP) in 1977 in England. Since then, there have been over 400 reports in the world’s pediatric and child psychiatry literature. Although it is often described as a rare disorder, when the results of a very carefully conceived, total population study done in England are transposed to the United States, some 1200 new cases of suffocation and poisoning alone would be expected to occur each year.1 As the condition became more known through professional as well as popular media (some 20 television news-magazine programs), there was a loosening of definitions so that even some workers in the field came to regard medical falsification of a condition in a child sufficient for the diagnosis.2 Through brief examples, this article will illustrate the essentials of definitional guidelines compiled by a multidisciplinary group convened by the American Professional Society on the Abuse of Children (APSAC),3 which were reviewed and modified with the input from several professional societies.4 These definitions create a specific term to be used for the medical diagnosis in the child, to wit “pediatric condition falsification” (PCF). But this approach recognizes that there are many serious forms of illness exaggeration or fabrication that pediatricians and others encounter that involve motivations other than those found in MBP. Factitious disorder by proxy (FDP) is the diagnostic category for the caretaker who harms her child though PCF for particular self-serving psychological needs. MBP then is retained as the name applied to the disorder that contains these 2 elements, a diagnosis in the child and a diagnosis in the caretaker. The APSAC group’s definition recognized that the usual clinical presentation, motivation, and prognosis in MBP is such that distinguishing it from other forms involving PCF is essential for the protection of the child. The …