MUNCHAUSEN-SYNDROME BY PROXY - PROBLEMS OF DEFINITION, DIAGNOSIS AND TREATMENT

Munchausen Syndrome by Proxy (MSbP) is a form of child abuse in which the abuser, usually the mother, fabricates or induces illness in anoth er, usually a child, in order to present the child to the medical esta blishment for unnecessary examination. Since 1977, when the term was f irst used in Britain by Meadow, an extensive literature has evolved ar ound the concept, describing cases, delineating indicators and perpetr ators characteristics, and recommending strategies for management. Whi le the technicalities of diagnosis have attracted some criticism, ther e has been much less debate about the validity of the concept itself. This paper raises certain problems associated with the conceptual vali dity of MSbP, outlines some concerns of current research and puts forw ard an alternative research programme in order that the concept be und erstood from the point of view of the suspected abuser and in the wide r context of the creation of medical knowledge and sociocultural facto rs.