From: logical23x@gmail.com   
      
   Munchausen syndrome by proxy: the importance of behavioral artifacts.   
      
       
      
   In the 1990s, two unrelated mothers living in different parts of the United   
   States had a lot in common. Both cared for children with significantly complex   
   medical problems. One woman's daughter suffered from constant intestinal   
   problems, and the other    
   woman's two foster daughters experienced a multitude of ailments that left   
   them weak and emaciated. In addition, both women spent most of their time   
   escorting their sickly girls from doctor to doctor. The daughter of the first   
   mother was eventually    
   hospitalized 200 times, and all three children had to undergo surgery to place   
   feeding tubes into their stomachs. Furthermore, both parents received national   
   praise for their motherly care and devotion to their young girls. Prosecutors   
   maintain that both    
   women shared one more feature, a dark secret eventually exposed to television   
   and newspapers around the world. They were accused of exhibiting symptoms of a   
   bizarre psychiatric ailment called Munchausen syndrome by proxy (MSBP) that   
   led them to fabricate    
   the girls' illnesses to fulfill their own needs for attention and sympathy.   
   (1)    
      
   Doctors, emergency medical services (EMS) personnel, members of protective   
   service agencies, and law enforcement officers may unwittingly participate in   
   MSBP when they fail to recognize MSBP behavior, treat the offender, and create   
   a favorable outcome    
   for the child. Protecting America's children is immeasurably important;   
   therefore, law enforcement personnel and EMS providers need to know the   
   significance of behavioral artifacts in the recognition, investigation, and   
   prosecution of MSBP offenders.    
      
       
      
   HISTORY    
      
   Munchausen syndrome was named after an 18th century dignitary named Baron von   
   Munchausen who was known for telling exaggerated stories. Individuals who   
   exhibit the characteristics of Munchausen syndrome fabricate or exaggerate   
   illness or sickness,    
   usually for the purpose of attracting attention to themselves. Munchausen   
   syndrome by proxy is the practice of fabricating or exaggerating illness or   
   sickness onto another person, usually a child. MSBP is a form of child abuse   
   and can prove fatal.    
   Children subjected to this form of abuse may be hospitalized repeatedly and   
   undergo numerous surgeries.    
      
   Researchers first began to recognize this pattern of abuse in the 1970s.   
   Sudden infant death syndrome (SIDS) became the default judgement when no cause   
   of death could be identified. Further, several cases where multiple children   
   from the same family    
   perished were attributed to SIDS because of no apparent causes of death. As   
   research on SIDS progressed, the likelihood of a family experiencing multiple   
   infant deaths due to SIDS became unlikely. On the eve of this realization in   
   the 1970s, MSBP became    
   a routinely published topic highlighting its terrible effects on children. Law   
   enforcement personnel have become important players in the fight against MSBP   
   because their position enables them to recognize the affliction in its   
   earliest stages.    
      
   RECOGNITION    
      
   Law enforcement personnel should remember that MSBP is not a diagnosis.(2)   
   Instead, investigators should recognize it as a form of abuse. In short, MSBP   
   is not what someone has, but what someone does. The majority of people   
   associated with MSBP are women.   
    Often, investigators, along with friends, family, and neighbors, view these   
   women as very caring and loving parents who try to do everything they can for   
   children afflicted with devastating illnesses. Offenders usually exhibit   
   knowledge of diseases and    
   medical procedures beyond what most parents may know. They typically have a   
   medical background or have been around the medical profession in some   
   capacity. A family history of frequent moves and lengthy visits to multiple   
   health care professionals also    
   may exist. MSBP offenders are not associated with any specific ethnic group or   
   level of economic status. Some researchers believe that the behavior of MSBP   
   perpetrators is a character disorder; it does not follow social norms. The   
   satisfaction sought    
   from misleading caregivers at the expense of their children is thought to be   
   the sole reason for committing the abuse.    
      
       
      
   The methods that offenders use to exaggerate or fabricate illness are quite   
   extensive and designed to deceive health care professionals. MSBP perpetrators   
   convincingly fabricate and lie even when confronted with contrary information.   
   Offenders need    
   attention, and they often seek it through their actions with health care   
   professionals. To feign illness, perpetrators go to great lengths, such as   
   suffocating to mimic apnea, tainting urine with blood, poisoning to resemble   
   gastric complications,    
   inducing vomiting with ipecac to look like reflux problems, and producing   
   unexplainable rashes with chemical irritants.    
      
   INVESTIGATION    
      
   Often, the first contact with a patient/victim of MSBP occurs in the   
   prehospital arena. Law enforcement and EMS personnel need to not only   
   understand the characteristics of MSBP perpetrators and victims but also   
   realize that this determination is made    
   over time, not just a single occurrence. In the event of an infant or child   
   illness, police and EMS personnel should request information about the history   
   of the illnesses from the parents. Generally, they view parents as individuals   
   who want the best    
   for their children, an assumption that perfectly suits MSBP offenders.   
   Further, police and EMS personnel see parents as knowledgeable, caring   
   individuals extremely attentive to their children's needs and illnesses, which   
   stands in direct opposition to    
   what law enforcement personnel learn as the characteristics of child abusers.   
   As mandated reporters of child abuse, however, police and EMS personnel must   
   understand the differences in behaviors and characteristics found in MSBP as   
   opposed to other forms    
   of abuse.    
      
   Police and EMS personnel not only must remain aware of offenders'   
   characteristics but also must be observant of MSBP signs at a child abuse or   
   illness scene. MSBP often goes unrecognized because many law enforcement   
   officers have never encountered, or    
   are unfamiliar with, the disorder. Thus, when dealing with a suspected case of   
   MSBP, law enforcement personnel must alert colleagues of the abuse to ensure   
   correct management of the investigation. They also can employ certain   
   guidelines to help in    
   determining a case of MSBP, including--    
      
      
   [continued in next message]   
      
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