July 2008

FORENSICS COMMITTEE REPORT

Myrna J. Glick, Ph.D.
Forensic Chair
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

What is MSP? No, it is not a gas additive, though at this point we could surely use one. Unfortunately, it is a dangerous psychological phenomenon. Rare though it may be, those of us who treat children and families should be alert to the possibility.

Munchausen’s Syndrome is named for Karl Hieronymus, Freiherr von Munchhausen (1720-1797). Although he was a remarkably honest businessman, Baron Munchhausen was also known as a remarkable bold-faced liar. He may have been implicated in the deaths of his wife and son. Because of his colorful, concocted adventures, he was the center of attention at social gatherings.

MSP stands for Munchausen’s Syndrome by Proxy, or a parent’s need to have his or her child perceived as ill. Sometimes this effect is achieved through simple lying; other times through actual harm done to the child. Most parents are telling the absolute truth about their children. Once in a while, they exaggerate, and then it is time to cool their anxieties. However, some disturbed parents have willfully hurt or even killed their children, garnering a great deal of sympathy and attention in the process.

By listening very carefully to parents and children, often a psychologist is the first party to discover that a client referred for psychological assistance is more in need of expert medical evaluation. Thus, a patient referred for treatment of supposed bulimia turned out to have a rare disorder that caused honeycombing of the lungs, liver and other organs. Several referred for panic disorder really were reacting to an overactive thyroid. Sometimes the process goes the other way. There are parents who have a pathological need to appear heroic in the face of a child’s baffling illness, hence MSP.

In this month’s The Forensic Examiner, Bruce Gross, J.D., presents an insightful discussion of this unfortunate disorder (“Caretaker Cruelty: Munchauser’s and Beyond”, pp. 54-57). In MPS, children are exploited to serve the needs of a parent. Often, the child undergoes needless or painful medical procedures, repeated hospitalizations or symptoms actually induced by a parent or other caretaker (http://my.clevelandclinic.org/disorders/factitious_disorders/hicmunchausen_syncrome_b). Current thinking holds that there is no way to prevent the disorder. If discovered, it is usually treated by putting the child under protection and exposing the parent or other caretaker to psychotherapy. In the data that were reviewed, there was little outcome data, and the cases presented appeared to have very wide variation. For example, one woman was described who had numerous pregnancies marked by very early caesarian sections, putting the fetuses in grave danger.

MSP seems to be in a no-man’s-land of sorts, in that mental disorder and criminal behavior seem to blend as one. Under DSM-IV, it is categorized under Factitious Disorders. In some cases, the victim can be an elderly parent and the perpetrator a grown child. Often, it is very difficult to confirm suspicions. According to Thomas G. Keens, M.D., of Children’s Hospital Los Angeles ( http://sids-network.org/experts/msp.htm), covert video-surveillance is sometimes used to obtain evidence, but a court order may be necessary. In one case in upstate New York, a family had five recurrent early childhood deaths that were initially attributed to Sudden Infant Death Syndrome (J.D. DeCristofaro, M.D., SUNY@Stony Brook, NY, http://sids-network.org/experts/msp.htm).

Although there is no one profile associated with this form of abuse, often the perpetrators are in the health professions. They usually present as the most caring, concerned, friendly and cooperative parents. There may be several unusual illnesses among family members, and the parent may have Munchausen’s Syndrome, or the tendency to fabricate symptoms in themselves. Often, the child’s symptoms or test results do not agree with the diagnosis. Blood in lab samples may not match the blood of the child. Perpetrators may be such accomplished liars that they themselves have difficulty distinguishing fact from fiction. Child victims may suffer developmental delays and be kept at home for long periods.

According to the Cleveland Clinic, the death rate for victims is about ten per cent. MSP is considered a form of child abuse and therefore subject to prosecution. Evaluators are advised to seek access to all parties for more accurate assessment. At the same time, they are warned of a high incidence of lawsuits against involved professionals, even when the charges are validated.