Munchausen Syndrome by Proxy: A Dilemma for Diagnosis

Abstract

Very little is yet known about the etiology, epidemiology, and long-term impact of Munchausen syndrome by proxy (MSBP). However, on reviewing the literature, there is an increasing interest in this unusual but serious pathology, which appears almost always in children and poses many clinical and forensic dilemmas for diagnosis and management. We present a MSBP case-study of a mother (54 years old) and her son (13 years old), through their Rorschach tests (Comprehensive System; Exner, 2000 ) and the Research Diagnostic Criteria Family-History interview (FH-RDC; Endicott, Andreasen & Spitzer, 1989 ). The main objectives were (1) to compare psychological evaluation data with DSM-IV-TR criteria for Personality Disorder (PD), and (2) to describe MSBP psychopathological manifestations on both records. Since it is a case-study, Rorschach variables were analyzed in two ways: (1) parametric variables were standardized with respect to the norms for each age and then zscores were used, and (2) nonparametric variables and some formulations were dichotomized in order to use the critical scores proposed by Exner (2000 ). Results confirm the presence of a PD in the mother. In the boy, they indicate that we could expect a development toward a PD or an increase of his isolation and his perceptual-cognitive disarray, with a possible long-term split of his frail psychic balance.