Who is the Baron von Munchausen

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Who is the Baron von Munchausen

• And why did they name a syndrome after him?

Stephen Lazoritz, MD, CPE
www.lazoritz.com
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"Here is described a common syndrome which most
doctors have seen, but about which little has
been written. Like the famous Baron von
Munchausen, the persons affected have always
travelled widely and their stories, like those
attributed to him, are both dramatic and
untruthful. Accordingly the syndrome is
respectfully dedicated to the Baron, and named
after him.
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Munchausen Syndrome by Proxy
(1977, Meadow)
may be applied to anyone who persistently
fabricates symptoms on behalf of another so
causing that person to be regarded as ill
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Care Seeking Behavior
Normal Range
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Non-compliance
Exaggerate symptoms
Classical neglect
Rather lackadaisical about symptoms or treatment
Invent symptoms
Anxious about trivial symptoms
Jeopardize health through carelessness
Classical Munchausen syndrome by proxy procure
symptoms
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Two Parts to the Munchausen Puzzle
Factitious Disorder by Proxy a diagnostic
label for the psychiatric disorder of a
perpetrator who deliberately feigns or induces
illness in a child for the purpose of fulfilling
psychological needs
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Two Parts to the Munchausen Puzzle
Pediatric Condition Falsification abuse of a
child by falsification of an illness
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Two Parts to the Munchausen Puzzle
Factitious Disorder by Proxy

Pediatric Condition Falsification
To diagnose Munchausen Syndrome by Proxy, both
must be present
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Two Parts to the Munchausen Puzzle
Pediatric Condition Falsification
Is considered abuse of the child May be caused
by FDP or by seeking secondary gain
psychosis or mental disorder
overwhelmed parent seeking help
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Two Parts to the Munchausen Puzzle
Not quite Pediatric Condition Falsification
Doctor shopping Overanxious parents Hysteria by
proxy Delusional mothers
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Presentation

• Simulation
• FALSE REPORTING OF SYMPTOMS, CHART
  FALSIFICATION, LAB SPECIMEN CONTAMINATION
• Production of Symptoms
• ANY ACTION THAT AFFECTS THE CHILDS BODY

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Common Presentations

• Apnea
• Seizures
• Vomiting
• Fever
• Bleeding
• Allergies

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Perpetrators

• Women (93-95)
• Work in healthcare or childcare( 80)
• History of factitious disorder or somatiform
  disorder (70)
• Very knowledgeable about treatment options
• May be pathologic liars

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Warning Signals

• Mother constantly at bedside
• Mother thriving on Pediatric ward
• Alleged apnea with multiple resuscitations
• Unexplained, prolonged extraordinary illness
• Symptoms appear only after contact with mother

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Warning Signals

• Large number of alleged allergies
• Mother not as worried as doctors
• Family history of SIDS
• Suffocation may be cause of SIDS may be
  smothering (.3-10)
• Apnea presenting symptom in 15-57

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Risks to Victim

• Iatrogenic Complications of tests, drugs or
  surgery
• Risk of developing factitious disorder
• Emotional and behavioral problems
• PTSD

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Management

• Carefully review the history
• Check all family and social history details
• Try to establish motive for mother
• Assure security of medical records
• Obtain toxicology
• Verify source of all specimens
• Total surveillance or separation

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Have a Plan!
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SIDS and PCF

• Higher suspicion if
• Multiple episodes of apnea
• Older than 6 months
• A sibling with a major illness
• A sibling who has died
• Blood in nose or mouth
• Episodes only when suspected caretaker is present

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• We may teach, and I believe that we should
  teach, that mothers are always right. But at the
  same time we must recognize that when mothers are
  wrong, they can be terribly wrong
• -Roy Meadow