Munchausen Syndrome by Proxy

Nurses General Nursing

Published

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!

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.

I'm just curious, how is this different from a patient who is drug seeking rather than Munchausen's syndrome? Or is it fair to say that many drug seekers are possibly Munchausen's and may need intensive psych treatment?

I hope I'm not too confusing. I'd just like to know for my own education.

Specializes in Corrections, neurology, dialysis.

Hmmm. Makes me wonder if one our patients has that.

I work in dialysis and we have a patient who is extremely difficult and demanding. She is obsessed with her disease and claims to know more about what is happening than the doctors do. She doesn't try hurting herself or anything. She just demands more one-on-one special treatment than the other patients get. For example - we can't use regular gauze on her access site. We can only use the individually sterile wrapped gauze on her. I hate it that our clinic manager caters to her demands. I would prefer she get no special treatment because the more special treatment we give her, the worse she gets.

Specializes in Nursing assistant.

What is the personality type of these people? What clues you in? I am real worried about a family I know.

MSP is one of the cruelest psych conditions there is because it is so subtle and so destructive to the innocent kids who are its victims.

It is also, despite more publicity of late, a relatively poorly understood condition.

Among the secondary victims of MSP are those parents who are falsely accused of MSP. Not every mother who is well-versed on her child's illness is a Munchhausen mom.

My second-oldest daughter's ex-husband called the hospital where her chronically-ill son had been admitted and made accusations from a thousand miles away. He didn't really want the boy or his two siblings, but he thought he would get out of child support if the kids were taken from my daughter and placed in foster care.

An eager young social worker came in and put my daughter under a microscope. This went on for a couple of days until some wiser heads prevailed. In my daughter's case it should have been obvious. Her son has spina bifida--kind of hard to manipulate--and a host of other conditions and complications that she couldn't possibly have caused or influenced. And often, when she raised a stink about something, she was right. They were in a teaching hospital where the new interns and residents often made assumptions and wanted to do tests that had already been done or subject our little guy to procedures that were, more or less, experimental. She put her foot down to protect her son.

Munchhausen's has a very specific profile, but a profile is not confirmation.

Suspicions should always be looked into, but with the attitude that everyone needs to be respected and protected. This is doubly true where there are parental custody issues. A good mom will understand the need to put the child first and cooperate with authorities, but the investigation should be done by people who know what they are doing and with as little commotion and stress for the child as possible.

After my daughter was cleared, many staff members apologized for what she'd been through and they look out for her to this day four years later. Her ex-husband has--by court order--been barred from contacting the hospital or any of his son's doctors by phone. He has no say in his son's care and is given only basic information from my daughter or her attorney.

Always take Munchhausen's possibilities seriously, but investigate. Don't jump to conclusions.

Specializes in Nursing assistant.

munchausens is narcissism at it's epitome. Netty, my Lord, child, how do you deal with this?

I have seen it in a somewhat benign form (if that is even a possibility!?) and struggle "is it that or what?" And now I am wondering about a family that is not close to me, and it breaks my heart.

wait, more than that, Munchausens by proxy is pure evil.

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

Very valid point- this is also a consideration when assessing "frequent flyers", patients who may be labeled a "hypochrondriac" and anyone with a psych diagnosis.

munchausens is narcissism at it's epitome. Netty, my Lord, child, how do you deal with this?

I have seen it in a somewhat benign form (if that is even a possibility!?) and struggle "is it that or what?" And now I am wondering about a family that is not close to me, and it breaks my heart.

wait, more than that, Munchausens by proxy is pure evil.

I have to say, I do love my mom. Some people (like my DH) have a hard time reconciling that. She was horribly abused and never taken seriously about it. When she had my sister and I (we are twins) the docs told her over and over how lucky she was that we were so healthy. I think she spent nine months expecting the worst and then when it didn't happen something snapped. She was mentally prepared for sickly babies. When reality didn't give her that, she made her own. We became the sickly babies. All my childhood memories involve hospitals. And whatever I can't recall she recreated for us through stories.

"You were so sick."

"They couldn't figure it out."

On and on. I had nine spinal taps in an 18 month period. Thats a tap every eight weeks!! Sheesh. I remember crying at night at home, and wanting my regular peds nurse to comfort me...

I do feel for those who are wrongly accused, though. I just kinda wish someone had the balls or knowledge to figure my mom out. It wasn't until my sister and I were old enough to peice it together and stand up for ourselves that it stopped. And now, I look at my amazing 3 year old...and I just cannot fathom causing her pain. Thats how I can forgive my mom, I think. No mother would do what she did unless there was a real mental problem at play.

Netty

Specializes in Nursing assistant.
I have to say, I do love my mom. Some people (like my DH) have a hard time reconciling that. She was horribly abused and never taken seriously about it. When she had my sister and I (we are twins) the docs told her over and over how lucky she was that we were so healthy. I think she spent nine months expecting the worst and then when it didn't happen something snapped. She was mentally prepared for sickly babies. When reality didn't give her that, she made her own. We became the sickly babies. All my childhood memories involve hospitals. And whatever I can't recall she recreated for us through stories.

"You were so sick."

"They couldn't figure it out."

On and on. I had nine spinal taps in an 18 month period. Thats a tap every eight weeks!! Sheesh. I remember crying at night at home, and wanting my regular peds nurse to comfort me...

I do feel for those who are wrongly accused, though. I just kinda wish someone had the balls or knowledge to figure my mom out. It wasn't until my sister and I were old enough to peice it together and stand up for ourselves that it stopped. And now, I look at my amazing 3 year old...and I just cannot fathom causing her pain. Thats how I can forgive my mom, I think. No mother would do what she did unless there was a real mental problem at play.

Netty

Oh Netty! How did you stop it?

I have to say, I do love my mom. Some people (like my DH) have a hard time reconciling that. She was horribly abused and never taken seriously about it. When she had my sister and I (we are twins) the docs told her over and over how lucky she was that we were so healthy. I think she spent nine months expecting the worst and then when it didn't happen something snapped. She was mentally prepared for sickly babies. When reality didn't give her that, she made her own. We became the sickly babies. All my childhood memories involve hospitals. And whatever I can't recall she recreated for us through stories.

"You were so sick."

"They couldn't figure it out."

On and on. I had nine spinal taps in an 18 month period. Thats a tap every eight weeks!! Sheesh. I remember crying at night at home, and wanting my regular peds nurse to comfort me...

I do feel for those who are wrongly accused, though. I just kinda wish someone had the balls or knowledge to figure my mom out. It wasn't until my sister and I were old enough to peice it together and stand up for ourselves that it stopped. And now, I look at my amazing 3 year old...and I just cannot fathom causing her pain. Thats how I can forgive my mom, I think. No mother would do what she did unless there was a real mental problem at play.

Netty

You are amazing to forgive her and move on. How truly sad for you, for both of you...in different ways. I hope you don't remember too much of it? :(

~J

I have to say, I do love my mom. Some people (like my DH) have a hard time reconciling that. She was horribly abused and never taken seriously about it. When she had my sister and I (we are twins) the docs told her over and over how lucky she was that we were so healthy. I think she spent nine months expecting the worst and then when it didn't happen something snapped. She was mentally prepared for sickly babies. When reality didn't give her that, she made her own. We became the sickly babies. All my childhood memories involve hospitals. And whatever I can't recall she recreated for us through stories.

"You were so sick."

"They couldn't figure it out."

On and on. I had nine spinal taps in an 18 month period. Thats a tap every eight weeks!! Sheesh. I remember crying at night at home, and wanting my regular peds nurse to comfort me...

I do feel for those who are wrongly accused, though. I just kinda wish someone had the balls or knowledge to figure my mom out. It wasn't until my sister and I were old enough to peice it together and stand up for ourselves that it stopped. And now, I look at my amazing 3 year old...and I just cannot fathom causing her pain. Thats how I can forgive my mom, I think. No mother would do what she did unless there was a real mental problem at play.

Netty

:crying2: :crying2: :crying2:

You are amazing to forgive her and move on. How truly sad for you, for both of you...in different ways. I hope you don't remember too much of it? :(

~J

I'm sure I don't remember it al, but there is a lot there. It comes a lot in little flashes and I have to call my sister to confirm.

As far as stopping it, when we got big enough to simply physically resist going to the ER when we knew we were fine, she slowed down. Then we sarted to question some things and she freaked out, attempted suicide, and while on a 90 day hold, started confessing.

But, life goes on! I live a blessed life with family I love and I'm on my way to a career I know I'll love and hate, depending on the day ;) !

Netty

Specializes in Med/Surge, Psych, LTC, Home Health.

How wonderful for you! :icon_hug:

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