Munchausen syndrome by proxy effort toward psychopathological understanding

After defining and describing the Munchausen, syndrome by proxy (MSBP) in a review of the international literature, the authors summarize the parental characteristics which organize this form of abuse which involves medical s taff members. Their descriptions and phenomenological analysis of mother/ch ild interactions give a certain orientation to the investigation as concern s underlying psychodynamic stakes. In four detailed and annotated observations, they try to identify and elabo rate narcissistic and perverse parental problem configurations. The importa nce of the denied or foreclosed losses, the splitting processes and the sym bolization limitations involved are evidenced in transgenerational repetiti ons. Precocious intervention for this abnormality in the very first moments of parenting enables simultaneous treatment of morbid parental projections on the child and of projections to which the parents have themselves been exposed during childhood.