Munchausen Syndrome by Proxy

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Specializes in Psych, Peds, LTC, Corrections.

I was just curious if any of you out there have cared for a patient with this diagnoses. If so, what kind of treatment was provided for them?

Please share!

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munchausen syndrome by proxy (msp) is extremely difficult to diagnose, extremely difficult to treat. treatment typically consists of long term psychotherapy. here's a link: http://www.clevelandclinic.org/health/health-info/docs/2800/2822.asp?

if you google this syndrome, you'll find a wealth of information.

leslie

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Specializes in Psych, Peds, LTC, Corrections.

Thanks for the link. I think this is such an interesting topic. One of the more fascinating psych illnesses. I have never seen it firsthand, so I don't know anything about the treatment process.

Have a great day!!

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My mother had/has MSP...:o

She underwent intensive therapy for a long time. But I still haven't gotten over my childhood spent in the hospital.....:angryfire

Netty

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Specializes in MICU, SICU.

We recently had a patient on our unit that the Dr's had diagnosed with Munchasen syndrome (not the by proxy part, because she did stuff to herself!) Not sure if it actually was, normally in its diagnosis, the patient hides the abuse they do to themselves.

Anyway, this patient had a trach and peg tube, young, like 34 years old, has been in and out of our MICU a lot in the last 6 months. History of a ton of strokes, etc. Well, the last time she came in, it was because....she had chewed her lips off. :uhoh21: Was that nasty or what! Yes, she did it on purpose and yes, you'd go in there and there are chunks of flesh and blood everyone, dripping from her face. Psych was definitely involved in her case. That's the closest thing I've seen to Munchausen. I did some massive papers on it during nursing school, a good story of Munchausen by proxy is in David Pelzer's books, the first one is called "A boy named it", I think.

Very interesting psych disease/disorder.

Nurse Kern

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Specializes in Case Management.

I had a patient who had Munchausen Syndrome (not by proxy). She injured herself many times and was caught with her hands in sharps containers, taking caustic substances, etc. Whatever she could do to get herself sick. She used to shop ER's all over the area where she lived. Her bottom line was she liked narcotics and would do anything to herself to get the meds. I followed her telephonically, but it still was a very difficult case. I worked for her insurance company and she was the only patient I knew who was dropped by her insurance company due to her liability to herself.

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Specializes in Psych, Peds, LTC, Corrections.

Thanks for the replies. I love the stories behind the illness (I don't like the outcome, however).

I have read most of David Pelzer's books...the Boy Called It...and the books that followed. They were very good, but very heartbreaking.

I have never seen this first hand. Thanks for sharing!

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Specializes in Peds - playing with the kids.

Hi,

The childrens hospital I work at had a very famous case. It was a little before my time, but I think it kind of makes us aware. We don't have the parents as the patient, but we see if from the perspective of the child. I know that some of the things that we look for are "excessive" medical knowledge of their childs illness, stating that things are happening in the room of the child, but never with a witness present. We may be a little more paranoid, but we are the childs advocate (especially if they are very young).

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My mother had/has MSP...:o

She underwent intensive therapy for a long time. But I still haven't gotten over my childhood spent in the hospital.....:angryfire

Netty

how tragic for you.

i'm very sorry netty.

leslie

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Hi,

The childrens hospital I work at had a very famous case. We may be a little more paranoid, but we are the childs advocate (especially if they are very young).

As a victim, I say BE paranoid. Twenty years ago no one really thought anything other than that she was a super concerned mom. She tried it all...from the fairly benign "Act sicker, dear" to the fecal matter in the IV site. To this day I downplay my illnesses to the extent that I've gottne gravely ill a few times b/c I wouldn't seek help.

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Specializes in NICU.

Another good book about Munchausen by Proxy is "Devil's Waltz" by Jonathan Kellerman.

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Hi!

How fun! I don't often think of this anymore but it was sure an exciting experience in my nursing life and one of the big challenges.

I had a Munchausen patient when I was working in a Pulmonary Acute Unit in my home country. I have to say, it took a lot of intense teamwork to care for her. This patient was very ill in her disorder and as many of these patients also educated as an LPN so she knew of all the symptoms she needed to display in order to convincingly "fake" a disease. This patient had like many severe Munchausen had also had her children taken from her care since she hurt them in order to get medical attention for herself indirectly. She was as I later learned the most severe Munchausen patient in my part of the country.

She was transferred to us from ICU where she had been on a respirator, I kid you not, for no precise disease. And she had the tentative diagnosis "asthma". I immediately read through her charts and called the head of the acute psychiatry department who managed some CF patients with me. She came and had a education session, not with the patient, but with ALL staff that would care for her, physicians included, to help us get her discharged without incidents. Boy, I liked that woman.

This patient was extremely manipulative. Nobody was allowed to talk to her about her medical conditions or her treatment outside almost word for word statements that had been decided upon. On the rounds there were always two or more of us so we all knew what had been said and only a limited number of staff cared for her at all. Absolutely no unplanned diagnostic procedures were allowed to take place, not even a BP or a temp or an O2 sat. She would frequently request them.

Of course it didn't go all that smooth, the day before discharge she went to the bathroom, fell to the floor and said she has left-sided weakness and it must be a stroke. So we sent her to the CT which showed that she was fine and then followed the one KEY POINT that the psych doctor had taught us: Always give the Munchausen patient an opening to back out of her symptoms without being called a liar.

So we told her: Sometimes these thing happen and all you need to do is wait, it can subside all by itself. Of course my doctor almost bit her nails off doing nothing, but I encouraged her to hold her horses and lo and behold, the next morning the weakness was all gone and patient subsequently discharged.

I had her as a patient one more time, straight from the ER, with some diffuse lung symptoms. That time I knew how to deal with her and she only stayed with us a day since there was no clinical evidence of any disease. She never came back. In my mind, I think she sought help at specialities that were easier to manipulate.

I might sound rough in the way we treated her but it seemed to me the only way to be fair and patient and respectful. It seems to me that many mentally ill people are looking for boundaries and that the more you back away the more they will push to find them.

It is of course worth to note that Munchausen patients often die when they actually get a real disease and nobody believes them anymore.

Thanks for letting tell my story,

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