Differentiation Is Useful

Child Abuse and Neglect: Diagnosis and Management by em. Prof. Dr. med. Gert Jacobi, Prof. Dr. med. Dr. jur. Reinhard Dettmeyer, Dr. med. Sibylle Banaschak, Prof. Dr. med. Burkhard Brosig, Dr. med. Bernd Herrmann in volume 13/2010

Jacobi et al in their article on child abuse and neglect rightly mention Münchhausen syndrome by proxy (MSBP). However, in the article, symptoms of children with a factitious disorder are confused with symptoms of by proxy (3), and Münchhausen syndrome by proxy (MSBP) is an important subcategory among the factitious disorders (2).

The differentiation makes for an important difference from the perspective of pediatricians and within the context of basic psychosomatic services and the work of Balint groups:

• In Münchhausen syndrome by proxy (1), the psychological or real parent (for example, the mother) presents the child under the pretext of manufactured symptoms of disease (Pseudologia phantastica); for example, a 2 year old child is reported to have had “seizures” at night.
• In factitious disorders by proxy, by contrast, manipulative measures are taken that are directly harmful for the child (for example, administration of medical drugs).

It also makes sense to differentiate between the two syndromes from a clinical perspective because it is often possible to address the dynamic in Münchhausen syndrome at the level of psychosomatic basic care as the mother’s own suffering (for example, excessive fears related to her body, which are projected on to the child). By contrast, in the factitious disorders, the disruption to the relationship between child and psychological parent is usually much more severe and unraveling the entire dynamic is a protracted process—and, additionally, the child is at immediate risk.

DOI: 10.3238/arztebl.2010.0505b

Prof. Dr. med. Gereon Heuft
Klinik und Poliklinik für
Psychosomatik und Psychotherpie
Universitätsklinikum Münster
Domagkstr. 22
48149 Münster, Germany

Conflict of interest statement

The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.

References

1. Eckhardt-Henn A, Heuft G, Hochapfel G, Hoffmann SO: Neurotische Störungen und Psychosomatische Medizin. Stuttgart: Schattauer 2009 (8. Aufl.).

2. Eckhardt-Henn A: Artifizielle Störungen und Münchhausen-Syndrom. Gegenwärtiger Stand der Forschung. Psychother Psychosom Med Psychol 1999; 49: 75–89.

3. Asher R: Munchhausen´s Syndrome. Lancet 1951; 1: 339–41.

4. Jacobi G, Dettmeyer R, Banaschak S, Brosig B, Hermann B: Child abuse and neglect: Diagnosis and management [Misshandlung und Vernachlässigung von Kindern – Diagnose und Vorgehen]. Dtsch Arztebl Int 2010; 107(13): 231–40.