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   APA: Munchausen by Proxy Victims Not All Kids   
      
   Review   
      
   HONOLULU -- Although most reported cases of Munchausen-by-proxy   
   syndrome involve children, adults can also be victims, a researcher   
   said here.   
   A search of Mayo Clinic patient records turned up six cases of   
   Munchausen by proxy with victims in their late teens and 20s, said   
   George Deimel, MD, of the clinic's headquarters in Rochester, Minn.   
      
   In three of the cases, the victims appeared to be willing participants   
   by giving false history information or helping to induce real   
   symptoms, Deimel said at the American Psychiatric Association meeting   
   here.   
      
   The syndrome involves one person artificially producing or faking   
   symptoms in another person so as to attract attention of medical   
   personnel. Typically, the proxy is a parent and the victim is his or   
   her child.   
      
   The six cases presented by Deimel followed that pattern except the   
   victims were fully grown. He said isolated cases had been reported   
   previously but this is the first series to be identified at a single   
   institution.   
      
   He told MedPage Today that he and colleagues had seen two cases within   
   a year. That raised their suspicion that others had presented   
   similarly, so they reviewed records going back to 1994, looking for   
   references to Munchausen or factitious disorder diagnoses.   
      
   Out of about 150 results of the search, the researchers found four   
   others with adult victims in addition to the initial two.   
      
   Victims ranged in age from 18 to 28 and five of them were women. Three   
   had attended college; one had just finished high school; and two were   
   considered mentally retarded or developmentally delayed.   
      
   All of the proxies included the victims' mothers, with fathers also   
   participating in two cases.   
      
   In one case, the victim died of sepsis resulting from the Munchausen   
   scheme. Deimel explained that the victim, a 21-year-old female, had   
   presented repeatedly with bacteremia. Her physicians, including   
   Deimel, eventually discovered a syringe under her hospital mattress.   
      
   They determined that the victim and both parents had collaborated in   
   deliberately producing the bacteremia from which she soon died.   
      
   In another case, the victim had presented with a mysterious rash that,   
   her mother claimed, had baffled physicians at other institutions.   
   Deimel and colleagues checked with her previous doctors, one of whom   
   tipped them to the likelihood of Munchausen by proxy, specifically   
   involving the mother.   
      
   When they barred the mother from visiting the daughter, the rash   
   cleared up, Deimel said.   
      
   He said it was common for the patients and parents to visit several   
   increasingly prestigious institutions with their complaints, very much   
   like a game in which the goal was to keep the treating physicians   
   baffled. He noted that one case had been seen at Northwestern   
   University Medical Center in Chicago and at the Cleveland Clinic   
   before coming to the Mayo Clinic.   
      
   Because of Mayo's reputation, having a Munchausen-by-proxy patient   
   seen there was "like the Super Bowl" for them, Deimel told MedPage   
   Today.   
      
   He added that the six cases identified as Munchausen by proxy at Mayo   
   were probably a small fraction of the total number of cases, as most   
   of the time the perpetrators succeed in deceiving the doctors.   
      
   Tipoffs include discrepancies between reported histories and clinical   
   observations, odd mixes of symptoms that don't point to a unifying   
   etiology, and an "overly involved" caregiver.   
      
   Deimel also suggested that a version of the "Stockholm syndrome," in   
   which hostages and kidnap victims ally themselves with their captors,   
   may come into play as the patients become active participants in the   
   scheme.   
      
   The study had no external funding.   
      
   Deimel had no relevant financial interests.   
      
   Primary source: American Psychiatric Association   
   Source reference:   
   Deimel G, et al "Munchausen syndrome by proxy with an adult victim: A   
   case series" APA 2011; Abstract NR01-20.   
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   APA: Munchausen by Proxy Victims Not All Kids   
      
   By John Gever, Senior Editor, MedPage Today   
   Published: May 15, 2011   
   Reviewed by Robert Jasmer, MD; Associate Clinical Professor of   
   Medicine, University of California, San Francisco and   
   Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner   
      
   http://www.medpagetoday.com/MeetingCoverage/APA/26480   
      
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