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Munchausen Syndrome by Proxy

Q. I'm interested in finding out if there has been any case studies or incidents of Munchausen by proxy with adults. I know there's elder abuse going on, but can't prove it because I don't live at the hospital.

However, after many trips to the hospital and what the caretaker has been saying, I knew this was a problem weeks ago and the doctors there won't listen to me. I'm wondering if she's not making him sick on purpose. Do you have any advice?

A. Just to acquaint our readers with Munchausen Syndrome: this is a condition diagnosed when an individual deliberately produces (fabricates) physical or psychological symptoms in him- or herself, without having a clear-cut incentive to do so (e.g., avoiding military service, collecting insurance payments, etc.) Such individuals seem intent on assuming the role of patient, and often make the rounds in dozens of hospitals, often to the outrage of health care professionals.

Munchausen Syndrome by Proxy (MSBP) applies when someone besides the identified patient--often a parent--deliberately causes the physical or psychological symptom. An example would be the mother or father who inflicts minor damage to the urinary tract of a young child, who is then presented to the doctor with blood in the urine. In that context, MSBP is usually considered a form of child abuse.

However, it seems likely that MSBP can occur in the elderly, too, as your question suggests. For example, Ben-Chetrit and Melmed (J Intern Med. 1998 Aug;244(2):175-8.) reported a case. A 73-year-old woman with multiple myeloma, who experienced four episodes of loss of consciousness, convulsions and profuse sweating while in the hospital. A thorough investigation in the department of medicine disclosed that the patient had a daughter who was a surgical nurse, and who was genuinely concerned whenever she was told that her mother was about to be discharged from the hospital.

The suspicion was that the daughter may have been injecting the patient with insulin, causing severe hypoglycemia (low blood sugar). The authors presented this case as an example of a "factitious disease by proxy" in an elderly patient. Certainly, if you have strong suspicions that an elderly person you know is being abused by his caretaker, contacting your local or state Department of Elder Services would be a reasonable step.

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November 2003

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