Unfortunately, there are many minors abused every day in our society. There are several forms of child abuse and multiple classifications. In general terms, we can specify the following types of abuse: physical, psychological, sexual and neglect.
In 2002, an epidemiological study was carried out in Spain that confirmed the existence of 11,148 minor victims of abuse in the family. 86.37% of these minors suffered neglect, 35.38% psychological abuse, 19.91% physical abuse and 3.55% sexual abuse
However, as in almost any epidemiological study, there are “submerged” data and only the tip of the iceberg is visible. In this article we are going to talk about a type of child abuse that is very difficult to diagnose, we could even call it “hidden child abuse”: Munchausen Syndrome by Proxy
Munchausen Syndrome by Proxy (MPS), or according to the DSM-5 Factitious Disorder applied to another, constitutes a particular form of high-risk child abuse, difficult to diagnose, since it often goes unnoticed for a long time, even years. It is a syndrome that has seen its incidence increase due to greater knowledge of it and professional awareness.
Following the DSM-5, it is a disorder characterized by the falsification of physical or psychological signs or symptoms, or induction of injury or illness, in another, associated with deception. It is a mental disorder that typically It is seen in adults who are caring for others dependent on them (generally defenseless, which makes sense). It is common for the victims of this disorder to be minors, and it is considered a form of child abuse.
The child’s parents (generally, according to epidemiological studies on the subject, the mother) simulate the existence of diseases or cause symptoms in the minor with the aim of receiving medical assistance, some of it high risk and cost. It appears that one of the parent’s goals is to deceptively present her child to others as a sick, vulnerable, dysfunctional and/or troubled person.
Experts in the study of this disorder affirm that the parent continues with the deception even without receiving any visible benefit or reward in return The most serious consequences of this syndrome are serious physical and psychological complications for the child and, ultimately, her death.
Symptoms and signs
The symptoms or signs are usually incoherent, often unexplained, and resistant to all treatment, since the parent executes them deliberately and recurrently. Some examples are:
As we have commented previously, The diagnosis of this syndrome is a challenge for the clinician: It is difficult to detect it when the mother tends to go to various hospitals, since for health professionals the events observed will be isolated. Although pediatricians are trained to evaluate the credibility of certain stories, they do not tend to raise as an initial hypothesis that it is such an elaborate lie.
History of Munchausen Syndrome by Proxy
PMS is a variant of Munchausen Syndrome, a term first introduced in 1977 by the English pediatrician Roy Meadow. At that time, this professional described patients who had this syndrome as people who had spectacular, strange medical histories, with fabrications and lies, with the aim of obtaining medical attention.
Curiously, in that same year two authors, Burman and Stevens, described a case in which a mother who suffered from Munchausen Syndrome (nowadays Factitious Disorder) was displacing it in her two young children. They called this phenomenon “Polle Syndrome.” synonymous in its day with Munchausen Syndrome by Proxy.
Causes and motivations
The causes of Munchausen Syndrome by proxy are still unknown Studies on the subject that have interviewed perpetrators suggest that they suffered abuse in childhood, or suffer from Factitious Disorder.
The causes are not known, but progress has been made in the study of the motivations of the parents involved First of all, the person who suffers from this syndrome does not act with the aim of achieving material or economic benefits. Paradoxically, they can invest large amounts of their money, effort and sacrifice in the “care” of their victim, even though they are inflicting great harm on them.
In short, their motivations lie in an excessive need for attention, care, compassion, pity and/or recognition by the medical staff and others for their great dedication to the victim. Furthermore, it seems that a relationship of pathological ambivalence towards the victim is produced (care vs. possible hidden rejection).
Treatment
What should be done in these situations? How should professionals who detect such a case proceed? Can the father or mother who has this syndrome continue to care for her child?
There is no single appropriate way to act, and even less when there may be a judicialization of the problem. Ultimately, the one who can receive the most collateral damage is the minor (You must also evaluate the other children of the family, if they exist).
In these cases, The most important thing will always be the best interests of the minor Clinicians must ensure the certainty of the diagnosis and keep the minor safe in the most serious cases (prudentially separating them from the family, for example), by contacting social services. It is very important to collaborate with other professionals and carry out a multidisciplinary intervention.
Confession by the perpetrator is usually not frequent That is why the treatment is usually complex due to the father’s difficulties in recognizing her problems and trying to give them a coherent explanation. Necessarily, the father who suffers from Munchausen Syndrome by Proxy must commit to psychotherapy, family therapy and/or taking psychotropic drugs.
