Dissertations / Theses on the topic 'Munchausen by proxy'

Syftet med studien var att undersöka hur litteraturen samt personer som arbetar med barn beskriver ärenden som innehåller en problembild som anknyter till Munchausen by proxy (MBP). MBP är en form av barnmisshandel där förövaren hittar på, framkallar eller överdriver symtom hos barnet. Materialet består av data från en litteraturstudie samt intervjuer med två personer. Metoden som använts för analys av materialet är meningskategorisering. Resultaten kopplades till de teoretiska begreppen anknytning och projektion. Studien visade att vissa beteenden hos föräldern är karaktäristiska då MBP förekommer. Det vanligast förekommande verkar vara förälderns benägenhet att söka vård för barnet samt den ihärdighet med vilken vården krävs. Vidare visar resultatet att samspelet mellan förälder och barn påverkas av att MBP förekommer. Förövaren kan agera som hon gör pga. bristande empati eller ilska. Barnets självuppfattning påverkas av samspelet mellan förälder och barn. Vissa orsaker till MBP kan relateras till föräldrarollen. Resultatet visar att framgångsrik behandling av förövare kräver ett erkännande av misshandeln. Resultatet visar på de starka känslor MBP väcker hos personer som arbetar med det. Det kan bero på föreställningar om förövarna som personalen har. Förövarna framställer sig som engagerade föräldrar och personalen känner sig lurad när MBP upptäcks.

Munchausen By Proxy Syndrome is a form of child abuse whereby parents induce symptoms of real illness, or falsely report symptoms, to initiate medical treatment for their children. Following a review of the literature with respect to case management, the author presents for study a case followed from initial suspicion to resolution two years later. The management of this case is compared to what the literature would suggest is the ideal practice. Areas of weakness are found to be the average social worker's lack of knowledge about the syndrome, due to its rarity, agency unpreparedness to deal with a case, over-reliance upon medical opinion and a lack of advice as to the long term likelihood of family reunification. Recommendations are made for the field of social work, child protection in particular.

This thesis will demonstrate how Munchausen Syndrome and, by derivation Munchausen Syndrome by Proxy, grew out of historical themes of assigning disease labels to anomalous or problematic behaviour, replicating issues of gender, particularly in respect of illness and madness and power biases, in society. The literature review will demonstrate how the early case notifications provided 'a Munchausen narrative', which came both to construct and to pathologise, first patients and later women, as mothers. It is argued that psychiatric models account for few cases of child abuse. A more coherent theory allows child abuse and, therefore, Msbp to be understood within a framework, which takes account of past and present ecological influences on the development of individual experience, characteristics and competency, and importantly, the meaning of a child within the life-cycle of that individual. The research, in this thesis, was designed to provide an estimate of the incidence of Msbp in Scotland. While it confirmed die findings of earlier studies diat illness induction and fabrication are rare events, it demonstrated a range of manifestations of abnormal behaviour among parents, in presenting their children to doctors, which were recognisable as being abusive and which often overlapped other forms of child maltreatment and neglect. It became apparent that the connotations of the title Msbp, particularly in relation to its psychodynamic formulations and evidencing actual or a risk ofsignificant harm, makes this a professionally fraught and ill-defined area of child protection work for Paediatricians, irrespective of recent Guidance (RCPCH 2002). The concluding sections of the thesis will consider inherent difficulties in working in this difficult area of child abuse and will provide recommendations for facilitating professional and child protection practices.

Thesis (M.S.)--Boston University
Munchausen Syndrome by Proxy (MSBP) is a term given to a situation which presents criteria for both Pediatric Condition Falsification (PCF) and factitious disorder by proxy (FDP). According to the Diagnostic and Statistical Manual of Mental Disorders-IV text revision (DSM-IV-TR), in child abuse cases where FDP is a result of PCF, then the nomenclature, MSBP, can be used interchangeably to describe such an event. Currently, in a situation that is diagnosed as Factitious Disorder by Proxy, the perpetrator of such an event is diagnosed as having Factitious Disorder Not Otherwise Specified (FD-NOS). An obvious issue stemming from this is the confusion over what should be diagnosed and remedied, i.e., the situation, the perpetrator, and/or the victim. Due to the convoluted and often controversial definition of such an event, as well as the criteria for diagnosis, it is proposed here that a new definition be adopted to explain this form of child abuse. With this novel definition, the symptoms of this psychological disorder of the perpetrator are observed in the victim. Under this new definition, the psychiatric term "Factitious Disorder by Proxy" would be used as a mental diagnosis of the caregiver, wherein the symptoms manifest in that of the victim. Additionally, an addendum to the type of symptoms exhibited in the child is proposed to include that of the exacerbation of symptoms in children with valid pre-existing conditions. An extensive literature review was performed to support the proposal for changing the criteria and diagnosis of FDP in the DSM. The implications of this change would greatly benefit not only the psychiatric, medical, and legal realm, but the forensic community as well.

Bibliography: leaves 106-112.
The primary aim of this dissertation was to gain an understanding of the psychopathology present in the perpetrator of Munchausen Syndrome by Proxy (MSP), exploring Jureidini's (1999) notion that this behaviour can be explained as the perpetrator engaging in a form of pathological play. A systematic literature review regarding MSP, with particular foci on psychopathology in perpetrators of MSP and the notion of pathological play was conducted. The notion that MSP is a form of pathological play was critically evaluated through the use of clinical case material. Two cases were selected, both of which met the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) diagnostic criteria for MSP, based on the assessment of a child psychiatrist with expertise in this area. The case material was analysed through the generation of common themes and identification of repetitive patterns which were then systematically analysed and compared with the findings cited in the literature review, with particular reference to MSP as a form of pathological play. Jureidini's (1999) theoretical statement was analysed in the light of the available evidence and the theoretical basis was then revised. Aspects explained by the theory were presented. Aspects not explained by the theory were rejected. Object Relations Theory was proposed as an alternative to understanding the psychopathology present in a perpetrator of MSP.

The Munchausen syndrome by proxy refers to a pathology characterized by physical and emotional abuse in which the simulation or production of symptoms is directed towards a child, which involves taking him or her to health treatments and unnecessary surgeries. The difficulties in the diagnosis of this form of abuse and the emotional aspects involved highlight the destructive effects in the infancy subjectivity due to the lack of loving capacity protecting and prioritizing the child demands. Psychoanalysis offers a differentiated view, comprehending that the mother attempts to elaborate her own psychic conflicts by the repetition of traumatic experience. There is a necessity of comprehension of the instinct destructivity presented in the maternal unconscious dynamics revealed in the modality of caring which is reflected in violence.
El Síndrome de Munchausen by proxy se refiere a una patología caracterizada por el abuso físico o emocional, en donde la simulación o producción de síntomas es direccionada al hijo, llevando a tratamientos de salud y cirugías innecesarios. Las dificultades diagnósticas de este tipo de abuso y los aspectos emocionales implicados llaman atención por los efectos destructivos en la subjetividad infantil, fruto de una falla en la capacidad de amar, proteger y priorizar las demandas del hijo. El Psicoanálisis ofrece una mirada que retrata un intento de elaboración de los propios conflictos psíquicos por la vía de la repetición de vivencias traumáticas. Así, se percibe la necesidad de una comprensión de la destrucción pulsional presente en la dinámica inconsciente materna revelada por esta modalidad de cuidado que se traduce en violencia.

Bakgrund: Tusentals barn utsätts varje år för misshandel, år 2009 anmäldes 11000 misshandelsbrott mot barn i Sverige. Misshandeln yttrar sig fysiskt och psykiskt på dessa barn. Orsaker till misshandel kan vara aggressivitet hos föräldern, ”fel” kön av barnen, ekonomiska och karriärmässiga problem etc. Barnen berättar inte om misshandeln som pågår hemma bland annat på grund av hot om straff om barnen erkänner misshandeln. Syfte: Att beskriva signaler som förekommer vid barnmisshandel, samt utsatta barns upplevelser, för att synliggöra kunskap som sjuksköterskan behöver för att uppmärksamma misshandeln. Metod: En autobiografisk studie som baseras på sex självbiografier. Studien är av kvalitativ ansats. Kunskap inhämtades från barnens egna upplevelser, handlande och tankar. Biografierna kvalitetsgranskades enligt Fribergs (2006) kvalitetsgranskning. Resultat: De tre teman som framkom var: den vuxnes beteende, barnens beteende och rop på hjälp. Resultatet visade att barnen upplevde att de inte hade makt över sitt eget liv, att de nonchalerades av vårdpersonal och inte fick komma till tals. Mängder av signaler om barnmisshandel förmedlades till vårdpersonal och måste tas på allvar. Slutsats: Vården måste kommunicera med barnet som är expert på sin egen situation för att upptäcka eventuell misshandel. Att kunna fråga ut den utsatte om misshandel kan locka fram ett medgivande om att detta pågår.

Mock jurors (N = 200) read descriptions of a mock civil case involving an adult survivor of Munchausen Syndrome by Proxy who is suing his/her abuser for monetary/psychological damages. Jurors individually decided perceived percent of responsibility of defendant, award to plaintiff pre- and post-group deliberations, and as a mock jury, in groups of 5 to 10. Jurors and juries assigned greater percent of culpability to female defendants than male defendants. Individual jurors awarded more n1oney to plaintiffs abused by female defendants than male defendants. Low Modem Sexism Scale (MSS) scorers attributed greater percentage of responsibility to defendants and awarded plaintiff more money than high scorers. There was no significant difference in award to male or female plaintiffs; however, greater percent of culpability was assigned to defendants who abused plaintiff longer (i.e., 19 years vs. 10 years). Low Belief in Just World (BJW) scorers individually attributed greater percent of responsibility to defendant and awarded more money to plaintiff than high scorers. Gender of defendant, just world, and sexist attitudes appeared to play important roles in jurors' decisions in cases involving adults who were child victims.

Barnmisshandel genom sjukvårdsinsatser (BMSI) innebär att ett barn blir utsatt för onödiga sjukvårdskontakter med olika undersökningar och behandlingar. Personen som definieras som förövare är vanligtvis den biologiska modern till barnet, men det kan även vara en annan person i barnets närhet. Studiens syfte var att undersöka socialsekreterares erfarenhet av BMSI samt att undersöka hur samverkan mellan socialtjänst, polis, åklagare, barnläkare och barnpsykiatriker organiseras. Vidare undersöktes om socialsekreterare som jobbat med denna typen av fall kan urskilja specifika framgångsfaktorer i arbetet med BMSI. Frågeställningarna var: Vilka erfarenheter beskriver socialsekreterarna när det gäller BMSI? Hur organiseras samverkan mellan socialtjänst, polis, åklagare, barnläkare och barnpsykiatriker när det föreligger misstanke om BMSI? Vilka framgångsfaktorer anser socialsekreterare är viktiga i ärenden med misstanke om BMSI? För att besvara syfte och frågeställningar genomfördes en kvalitativ intervju och 73 enkäter lämnades ut till en grupp för socionomer. Systemteori användes som teoretiskt perspektiv för analysen eftersom socialarbetare behöver se på barnets situation i och mellan dess omgivning. Resultatet av studien visar att det finns en hög risk för att BMSI inte anmäls till socialtjänsten samt en risk för att ärenden inte utreds som BMSI på grund av kunskapsbrist. Annan vårdnadshavare eller anhöriga var de som i lägst grad anmälde oro för ett utsatt barn trots att det kan antas att de som är närmast bör vara de som slår larm först. Slutsatserna som kunde dras utifrån resultatet var att samverkan och ökad kunskap var två viktiga framgångsfaktorer.
Medical child abuse (MCA) means that a child is exposed to unnecessary health contacts with various examinations and treatments. The person defined as the perpetrator is usually the biological mother of the child, but it may also be another person in the child's vicinity. The aim was to investigate social secretaries’ experience of MCA and to investigate how collaboration between social services, police, prosecutors, pediatricians and pediatric psychiatrists is organized. It was also investigated whether social secretaries who have worked with these types of cases can discern specific success factors in their work with MCA. The questions were: What experiences does the Social Secretaries describe regarding MCA? How is collaboration between social services, police, prosecutors, pediatricians and child psychiatrists organized when there is a suspicion of MCA? What success factors do social secretaries consider important in cases of suspicion of MCA? A qualitative interview was conducted, and 73 questionnaires were handed out to a group for social workers. System theory was used as a theoretical perspective for the analysis as social workers need to see the child's situation in and between its surroundings. The results of the study show that there is a high risk that MCA will not be reported to the social services and a risk that cases will not be investigated as MCA due to a lack of knowledge. Other custodians or relatives were those who reported the least concern for a vulnerable child, although it may be assumed that those closest to them should be the ones who ‘sound the alarm’ first. The conclusions drawn from the results were that collaboration and increased knowledge were two important success factors.

Bakgrund: Denna studie uppmärksammar det komplexa fenomenet Münchhausen by proxy (MBP). MBP innebär att en förälder hittar på eller skapar sjukdomar hos sitt barn. Barnet får genomgå medicinska undersökningar, behandlingar och provtagningar. MBP har sedan början av 2000-talet inkluderats i den definition av barnmisshandel som ska vägleda arbetet med utsatta barn i Sverige. Problemformulering: Då MBP definieras som en form av fysisk barnmisshandel i SOU 2001:72, innebär detta ett delat samhällsansvar. Hälso-och sjukvården har enligt hälso- och sjukvårdslagen (HSL, 2017:30) ansvar för att utreda och behandla den fysiska vården av barnet medan socialtjänsten har ansvar för att utreda barnets skydd och behov. Socialnämnden har enligt socialtjänstlagen (SoL, 2001:453) ansvar för att barn och unga växer upp under trygga och goda förhållanden, Socialnämnden ska även verka för att barn och unga får det skydd och stöd som de behöver. Det delade ansvaret för MBP-utsatta barn mellan hälso- och sjukvård och socialtjänst kan leda till särskilda utmaningar för praktiken, då frågan ligger i skärningspunkten mellan olika politikområden, lagar och professionella verksamhetsområden. Utifrån den begränsade mängd forskning som finns i Sverige kring MBP, får policy i form av lagstiftning, föreskrifter och allmänna råd, riktlinjer och handböcker stor betydelse för hur MBP hanteras i praktiken. Syfte: Syftet med denna studie är att med Sverige som empiriskt case undersöka hur fenomenet MBP konstrueras som problem i policy inom välfärdsområdet med inriktning på utsatta barn. Vidare är syftet med studien även att undersöka konstruktionen av MBP inom nationell och internationell forskning, för att se hur nationell policy förhåller sig till forskningsläget.  Metod och teori: I denna litteraturstudie med abduktiv ansats granskades internationell och nationell forskning, offentliga dokument från statliga myndigheter, statliga offentliga utredningar och riktlinjer för det sociala arbetet och hälso-och sjukvården i Sverige. Dessa har analyserats med utgångspunkt i teori om konstruktionen av sociala problem. Resultat: MBP har konstruerats som problem i olika stor omfattning inom forskning, hälso- och sjukvård samt socialt arbete. De riktlinjer och handböcker som idag finns för socialtjänstens arbete med barnavårdsutredningar är få men omfattande, dock finns inga riktlinjer som beskriver arbetet med MBP. I befintlig svensk lagstiftning går det inte att finna lagrum som uttryckligen nämner MBP. För hälso- och sjukvården i Sverige finns nationella riktlinjer och regionala vårdprogram för arbetet med barn som far illa, som berör MBP. Det finns lagstadgat ansvar för socialt arbete och hälso- och sjukvården vid barn som far illa (SoL och HSL), de två olika verksamhetsfälten har olika arbetssätt vilket gör att det gemensamma arbetet vid barnavårdsutredningar ibland kan bli problematiskt. Diskussion och slutsats: MBP har sedan början av 2000-talet upptäckts och definierats som en form av fysisk barnmisshandel i Sverige. Ansvariga verksamhetsfält och riktlinjer har formulerats kring MBP, dock främst inom hälso- och sjukvården. Eftersom det sociala arbetet inte har några riktlinjer eller förövarbeskrivningar om MBP finns inget organisatoriskt stöd för att socialarbetare ska kunna uppmärksamma fall av MBP. I studien har vi gjort ett försök till att synliggöra konstruktionen av MBP i svensk kontext idag som har resulterat i att vi sett ett tomrum och utvecklingsmöjligheter för det sociala arbetets riktlinjer gällande hur MBP idag konstrueras i dessa.
Background: This study addresses the complex phenomenon of Münchhausen by proxy (MBP). MBP means that a parent finds or creates illnesses with his or her child. The child is allowed to undergo medical examinations, treatments and sampling. MBP has been included in the definition of child abuse since the beginning of the 2000s, a definition which is supposed to guide the work with vulnerable children in Sweden. Problem area: As MBP is defined as a form of physical child abuse in SOU 2001:72, this means shared social responsibility among societal actors. Health care is according to the Health Care Act (HSL, 2017:30) responsible for investigating and treating the physical care of the child, while the social services is responsible for investigating the child's protection and needs. According to the Social Services Act (SoL, 2001:453), the Social Services Board is responsible for securing safe and good conditions for children and young people. The Social Services Board shall also ensure that children and young people receive the protection and support they need. The fact that the health care system and the child welfare system share the responsibility for working with MBP can lead to challenges for practice, as the issue is located at the interface between different policy areas and professional fields of practice. As there is very limited research on MBP in Sweden, policy will play an important role in everyday practice regarding MBP. Aim: The aim of this study was to explore how the phenomenon of MBP is constructed in Swedish welfare policy, specifically in relation to social services and health care. Furthermore, the aim of the study was to investigate the construction of MBP in national and international research, to see how national policy relates to the research situation. Method and theory: A literature study with an abductive approach was carried out, examining national and international research, public documents from government agencies and authorities, Swedish public inquiries and guidelines for social work and health care in Sweden. The analysis is based upon the theory of the construction of social problems. Findings: MBP has been constructed as a problem in research, healthcare and social work in different extent. The guidelines and manuals that exist today for the social services work on child protection are few but extensive, although none of them mentions MBP. In existing Swedish legislation, there is no law available that explicitly mentions MBP, while there are various proposals for legislative changes that mentions MBP. For health care in Sweden there are national guidelines and regional care programs for the work of child abuse, that mentions MBP. There is statutory responsibility for the social work and health care to cooperate in the case of children at risk (SoL and HSL). The two different parts of the welfare system have different working methods, which means that the joint work in child welfare investigations can sometimes be problematic. Discussion and conclusion: Since the late 2000s, MBP has been discovered as a social problem in Sweden, defined as a form of physical child abuse, and fields of responsibility and guidelines have been developed, primarily within health care. Since social work has no guidelines about MBP, there is no organizational support for social workers to pay attention to cases of MBP. In the study we have made an effort to visualize the construction of MBP in Swedish context today, which has resulted in the founding of a gap and development opportunities for the social work guidelines on how MBP is being constructed today.

« On bat un enfant » ; « on tue un enfant » : pour la plupart de nos contemporains, c’est là l’horreur même — la transgression de ce qui reste encore de sacré dans notre culture dite moderne. Pour quelques autres, c’est une réalité clinique : celle que l’on saisit à travers ce que l’on appelle d’ordinaire « maltraitance infantile » et « infanticides ». Et pour tous (pour tout sujet), il s’agit également de la présentification d’un fantasme — le plus fondamental qui soit, encela qu’il convoque d’un côté le rapport au père et le masochisme primordial, d’un autre le rapport à l’idéal et le narcissisme primaire. Le plus fondamental des fantasmes, au point de pouvoir être considéré comme une écriture de sa « formule », le texte en exprimant au mieux la logique.C’est à nouer ces registres — structure du fantasme et réel clinique de la maltraitance infantile — et à en explorer les tenants et aboutissants, que se consacre cette thèse. Qui s’emploie à montrer d’abord comment la féminité peut porter à la maternité, et ce qui se joue dans le « désir d’enfant », voire dans le désir de mort de l’enfant (c’est-à-dire dans le ravage quand il aboutit à l’acte). Puis quels extrêmes peut atteindre la clinique avec le « syndrome de Münchhausen par procuration », d’une part, et les « néonaticides » avec conservation des corps des nouveau-nés, d’autre part (c’est-à-direavec ces situations où l’horreur se montre pour mieux se dissimuler, et se cache pour mieux s’exhiber).Ce qui permet donc, en dépliant ainsi ces figures de la mère, de l’enfant, et du mal, d’éclairer la logique du fantasme par le réel clinique — et réciproquement. C’est-à-dire d’éclairer la structure subjective, saisie au « coeur de l’être »
« A child is being beaten » ; « a child is being killed » : for most of our contemporaries, this is an epitome of horror — a transgression of what is still considered as sacred in our socalled modern culture.For some others, it is a clinical reality : the one we observe through what is usually called « child abuse » and infanticides.And for everybody (for every subject), it is also the presentification of a phantasy — the most basic of all, as it concerns on one hand the relationship with the father and the primordial masochism, and on the other one the relation with the ideal and the primary narcissism. It is the most fondamental of phantasies so much that it can be considered as an account of its « formula », the text expressing its logic at best.Intertwining these two matrixes — structure of the phantasy and clinical reality of child abuse — and exploring the ins and outs ; this is the issue analyzed in the thesis. First, what is shown here is how feminity can lead to maternity and what is at stake in « desiring a child », even in the desire for the child’s death (i.e. in the « ravage » when it leads to the acting out). Then which extreme can the clinical approach get close to with « The Munchausen syndrom by proxy » on one hand, and « neonaticides » with the keeping of the bodies of the new borns on the other one (i.e. where horror can be shown to hide all the better and to hide to be better exhibited).Hence the possibility, by unfolding the figures of the mother, of the child, and of the evil, to shed light on the logic of the phantasy thanks to the clinical reality — and vice versa.In other words, to throw light on the subjective structure, seized in the « heart of being »

Cette thèse sur travaux retrace une activité clinique et rassemble des écrits (corpus de 15 articles, monographies et un livre) sur une vingtaine d’années portant sur une forme de maltraitance intrafamiliale qui instrumentalise la sphère médicale : le Syndrome de Munchausen Par Procuration. Depuis notre première rencontre avec un cas SMPP en 1996, nous avons appris à penser les traumatismes de la petite enfance avec différents modèles psychopathologiques et des approches cliniques distinctes (psychodynamique, EMDR, Intégration du Cycle de la Vie). Dans une perspective trans- et interdisciplinaire, nous nous sommes engagés au fil du temps dans une compréhension des phénomènes traumatiques se fondant sur des hypothèses psychodynamiques, cognitives ou neurophysiologiques à la recherche d’espaces de dialectisations féconds. De là l’intérêt d’étudier ce cheminement à travers ces champs épistémologiques a priori opposés, reflet d’une évolution de la clinique actuelle, en décrivant comment des patients auteurs ou victimes du SMPP ont pu bénéficier de cette dynamique. Composée en trois parties, la première partie de cette thèse est dédiée à une présentation générale de la psychopathologie du trauma et des détresses précoces en prenant en compte les développements conceptuels traités dans nos écrits. La deuxième partie centrée sur le SMPP porte sur sa sémiologie et son étiologie, les terminologies médicales et psychopathologiques comme sur les conduites multidimensionnelles nécessaires à sa prise en charge. La troisième partie est consacrée aux différentes approches psychothérapiques que nous avons utilisées dans le traitement de patients, adultes ou enfants, concernés par le SMPP. Cette dernière partie est l’occasion de comprendre comment les notions de clivage et de dissociation peuvent être revisitées, intégrées dans une perspective neuropsychologique développementale. Caractérisé par une réflexion épistémologique basée sur un pluralisme théorique et thérapeutique, ce partage d’expérience souhaite permettre une approche psychopathologique laissant place à la complémentarité, à l’intersubjectivité et à la phénoménologie
This thesis based on previous publications retraces clinical interventions and brings together written materials (15 articles, monographs and a book) spanning a period of 20 years on a form of intrafamilial abuse exploiting the medical field: the Munchausen Syndrome by proxy.Since our first encounter with a case of MSbP in 1996, we have learned to think about early childhood trauma using different psychopathological models and distinct clinical approaches (psychodynamic, EMDR, Lifespan Integration) in search of a fertile dialectisation and, over time, have committed to a trans- and inter-disciplinary perspective based on psychodynamic, cognitive and neurophysiological hypotheses to understand traumatic phenomena. From there interest in studying the line of thought involving epistemological fields assumed at first glance to be opposites reflects an evolution of clinical practice in describing how patients – authors or victims of MSbP have benefited from this dynamic. Composed of three parts, the first part of this thesis is devoted to a general presentation of the psychopathology of trauma and early distress taking into consideration the conceptual developments treated throughout our writings. The second part, centered on MSbP focuses on its semiology and etiology, medical and psychopathological terminology as well as the multidimensional interventions necessary for its treatment. The third part is dedicated to different psychotherapeutic approaches that we have used in treating patients, adults or children involved with MSbP. This last part gives rise to an understanding of how the concepts of splitting and dissociation can be revisited and integrated into a neuropsychological developmental perspective. Characterized by an epistemological framework based on a theoretic and therapeutic pluralism, this experience is shared with the desire of encouraging a psychopathological approach including complementarity, intersubjectivity and phenomenology

The purpose of this review of literature is to investigate the various roles of video surveillance (VS) in the hospital's intensive care unit (ICU) as well as its legal and ethical implications. Today, hospitals spend more money on the ICU than on any other unit. By 2030, the population of those 65 and over is expected to double. 80% of older adults have at least one chronic diseases (Centers for Disease Control and Prevention, 2013). As a consequence, the demand for ICU services will likely increase, which may burden hospital with additional costs. Because of increasing economic pressures, more hospitals are using video surveillance to enhance quality care and reduce ICU costs (Goran, 2012). Research shows that VS enhances positive outcomes among patients and best practice compliance among hospital staff. The results are fewer reports of patient complications and days spent in the ICU, and an increase in reported hospital savings. In addition, VS is becoming an important tool for the families of newborns in the neonatal ICU (NICU). The belief is that the VS can facilitate parent-baby bonding. In the United States of America, privacy rights impose legal restrictions on VS. These rights come from the U.S. Constitution, Statutory law, Regulatory law, and State law. HIPPA authorizes the patient to control the use and disclosure of his or her health information. Accordingly, hospitals are under obligation to inform patients on their right to protected health information. It is appropriate that hospitals use VS for diagnostic purposes as long as they have obtained patient consent. According to modern day privacy experts Charles Fried and Alan Westin, a violation of a person's privacy equates a violation on their liberty and morality. However, if a physician suspects that a third party person is causing harm to the patient, than the use of covert VS is justifiable.
B.S.N.
Bachelors
Nursing
Nursing

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
A Síndrome de Munchausen por Procuração é uma forma rara de abuso devido a falsificação de doença. É atribuído ao perpetrador o diagnóstico de Perturbação Factícia Imposta em Outra Pessoa. As vítimas são frequentemente crianças. Os perpetradores são frequentemente mulheres num papel materno, e poderão ter associados conflitos familiares, perturbações da personalidade, ou outras perturbações psiquiátricas. Este estudo pretende rever os casos clínicos publicados na literatura nos últimos 15 anos. Extraímos dados relevantes de 108 artigos, incluindo 54 artigos com 81 casos clínicos. A distribuição de sexo entre vítimas foi equitativa (51% masculino, 43% feminino, 6% não reportado), consistindo na maioria em crianças com média de idades de 5 anos. Os perpetradores foram quase sempre do sexo feminino (91% feminino, 1% feminino e masculino, 8% não reportado). Vinte e três casos (28%) tinham um perpetrador com diagnóstico psiquiátrico conhecido: Perturbação Factícia Imposta no Próprio (10%), Depressão (9%), e Perturbações da Personalidade (7%). Mais de um terço (36%) referiu conflito familiar/marital ou abuso. Catorze casos (17%) tinham perpetradores que trabalhavam na área da saúde. A forma mais comum de falsificação foi Indução (74%), contudo 15% dos casos apresentava mais do que um tipo de falsificação. Na evolução encontrámos: separação do perpetrador e vítima (37%); sem acompanhamento reportado (22%); prisão do perpetrador (14%); morte da vítima (12%); tratamento psicológico ou psiquiátrico (10%); reunificação de perpetrador com vítima (4%); suicídio do perpetrador (1%). Mais de três quartos dos casos revelaram-se recorrentes. Os resultados reiteram que o reconhecimento das formas mais comuns da Síndrome de Munchausen por Procuração permitem aos médicos identificá-las em contexto clínico.
Munchausen Syndrome by Proxy is a rare form of abuse due to illness falsification. The perpetrator of this abuse suffers from a psychiatric illness called Factitious Disorder Imposed on Another. Victims are usually children. Perpetrators are usually women in a maternal role, and may have associated family conflict, personality disorder, or other comorbid psychiatric illnesses. This study aims to determine the most common patterns of presentation in cases published in the literature in the past 15 years. We extracted relevant data from 108 articles, including 54 papers presenting 81 case-reports. There was a mostly even distribution of sex among the victims (51% male, 43% female, 6% unreported), who were mostly children (mean age of child victims was approximately 5 years). Most perpetrators were female (91% female, 1% female and male, 8% unreported). Twenty-three cases (28%) had a perpetrator with a known psychiatric diagnosis, the most common being Factitious Disorder Imposed on Self (10%), Depression (9%), and Personality Disorders (7%). More than one third (36%) stated family/marital conflict or abuse. Fourteen cases (17%) had perpetrators who worked in healthcare. The most common type of falsification was Induction (74%) however 15% of cases had more than one type of falsification. The most common outcomes were: separation of perpetrator and victim (37%); no follow-up was reported (22%); imprisonment of the perpetrator (14%); death of the victim (12%); psychological or psychiatric treatment of the perpetrator (10%); continued living together (4%); suicide of the perpetrator (1%). Recurrence was present in more than three quarters of cases. Our results reiterate that awareness of the most common findings in Munchausen Syndrome by Proxy allows physicians to identify them in a clinical context.

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Os maus tratos infantis assumem dimensão de epidemia global na saúde pública. No caso particular de vitimização infantil de Munchaunsen’s by proxy Syndrome (MbPS), o agressor – geralmente, a mãe - induz o aparecimento de sintomas compatíveis com patologias noutro indivíduo, neste caso o próprio filho, a fim de que seja alvo de procedimentos médicos injustificados. Estima-se que atinja cerca de 2,5 em 100 000 crianças no primeiro ano de vida. O epónimo Munchausen foi utilizado por Richard Asher (1951) para descrever pacientes que se submetiam a procedimentos médicos desnecessários. Roy Meadow (1977) ampliou o conceito ao reportar casos de mães que simulavam doença nos filhos. No MbPS a tipologia do agressor difere da de outros casos de mau trato: são sobretudo mulheres, cuidadoras das vítimas, e com conhecimentos médicos. A literatura aponta no sentido da evolução da vítima para um diagnóstico de Perturbação Factícia na idade adulta e, nalguns casos, para uma replicação do padrão de abuso. A gratificação obtida através do «papel de doente» (o próprio ou «by proxy») parece estar na base de uma perturbação crónica e transgeracional. Concluímos ser a detecção precoce e a articulação de equipas multidisciplinares fundamentais na tentativa de cessar a dinâmica vítima-agressor e interromper ciclo de violência.
Child abuse has become a global public health epidemic. In the particular case of Child Victimization caused by Munchausen’s by Proxy Syndrome (MbPS), the aggressor, usually the mother, fabricates symptoms consistent with different pathologies on another person, her own son, resulting in unnecessary medical procedures. MbPS is estimated to afflict 2.5 children for each 100 000 children in their first year of life. The eponymous Munchausen was first used by Richard Asher (1951) to describe patients who underwent unnecessary medical procedures. Roy Meadow (1977) introduced the concept "by proxy", when he reported cases of mothers simulating disease in their children. In MbPS cases, the perpetrator does not follow the usual profile: mainly female guardians with medical knowledge. Studies show that MbPS victims may suffer, as adults, from Factitious Disorder or continue the pattern of MbPS abuse. The gratification obtained through the "sick role" (one's own or "by proxy") appears to be the basis of a transgenerational and chronic disturbance. We conclude that early detection and the work of a multidisciplinary team are critical in the attempt to stop the victim-aggressor dynamics and therefore to end the violence cycle.

O Síndrome de Munchausen por Procuração é uma forma relativamente rara, mas grave, de maus-tratos infantis causados pelo(a) cuidador(a) que induz sinais e sintomas de doença numa criança. Consequentemente, os esforços dos profissionais de saúde para realizar o diagnóstico leva a que as intervenções realizadas sejam desnecessárias e potencialmente prejudiciais para a criança. Assim, é necessário que exista por parte dos profissionais de saúde um alto índice de alerta para a possibilidade de estarem presentes sinais e sintomas que não se enquadram numa doença em particular, quando estes são resistentes ao tratamento ou quando evoluem para outra(s) doença(s). Assim, na formulação diagnóstica é fundamental a integração dos vários registos médicos do(s) menor(es) envolvido(s), uma comunicação consistente entre os profissionais de saúde bem como, uma abordagem multidisciplinar com as várias instâncias de proteção à criança, uma vez que o diagnóstico poderá ser controverso, difícil e acarretar repercussões legais e familiares. Neste sentido, o presente estudo pretende aceder à perspetiva dos profissionais de saúde, nomeadamente acerca de que critérios é que os mesmos avaliam como sendo determinantes para a sinalização num caso em que existe a suspeita de Síndrome de Munchausen por Procuração.
The Munchausen Syndrome by Proxy (MPBS) is one of the most serious, yet relatively rare, forms of child abuse, where the caretaker of a child fakes or induces real symptoms to make it look like the child is sick. Consequently, the efforts for Healthcare Providers to diagnose and provide treatment for a nonexistent condition often lead to unnecessary and potentially harmful interventions to the child. It is therefore essential that Healthcare Providers have a high degree of clinical suspicion and awareness for possible signs and symptoms that do not fit into a specific illness, when these signs or symptoms resist treatment or when they escalate into other diseases. When making a diagnosis, the combination of the different clinical data on the child is of the essence, as it is also crucial a consistent communication among Healthcare Providers, as well as a multidisciplinary approach with the various entities of child protection and safeguarding, since the final diagnosis may be not only controversial, but also difficult and lead to legal or family consequences. In this sense, this study intends to look into the Healthcare Providers' approach, namely to understand which are the key factors in the diagnosis of a potential condition of Munchausen Syndrome by Proxy.