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   Medpage Today    
      
   MEETING COVERAGE 05.15.2011   
      
      
   APA: Munchausen by Proxy Victims Not All Kids   
      
      
   HONOLULU -- Although most reported cases of Munchausen-by-proxy syndrome   
   involve children, adults can also be victims, a researcher said here.   
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   by John Gever    
   Senior Editor, MedPage Today   
      
   Action Points   
      
      
   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.   
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   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.   
   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   
   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.   
      
      
      
   http://www.medpagetoday.com/MeetingCoverage/APA/26480   
      
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