MUNCHHAUSEN SYNDROME BY PROXY - A CHALLEN GE FOR MEDICINE

In Munchhausen syndrome by proxy, a subject, usually a mother, pretend s her disorder. After simulating ficticious symptoms, or even producin g clinical signs such as convulsions, fever, bleeding, vomiting, diarr hea or skin eruptions, the mother repeatedly takes her child to differ ent hospitals for care. During hospitalization, the mother shows great concern for the child and is highly cooperative with the health care team. The consequences may be unwarrented, often invasive, investigati ons and therapy with a very high risk of morbidity and mortality. The underlying psychopathological structure is difficult to apprehend. Nar cissic fragility and borderline personality are the must frequent, but passive-dependent hysteric personality or sadomasochist behavior can be found and depression is often associated. The main, if not the sole , benefit for the mother lies in the leading role she plays during the repeated hospitalizations in front of the admizing medical staff. Rar e cases of adult-adult Munchhausen syndrome by proxy have also been re ported. Physicians should be aware of this syndrome in order to avoid unintentional participating in this morbid scenario by performing usel ess invasive examinations or by prescribing dangerous medication. Psyc hiatric treatment and sometimes legal action are required to avoid thi s particular kind of child abuse.