Münchhausen by proxy kända fall

Behavioral disorder (Munchausen syndrome bygd proxy)

Medical condition

Factitious disorder imposed on another (FDIA), also known as fabricated or induced illness bygd carers (FII) and first named as Munchausen syndrome bygd proxy (MSbP) after Munchausen syndrome, fryst vatten a mental health disorder in which a caregiver creates the appearance of health problems in another individ, typically their child, and sometimes (rarely) when an adult simulates an illness in another adult partner.^[7][8][9] This might include altering test samples or injuring a child.^[8] The caregiver or partner then presents the individ as being sick or injured.^[5] Permanent injury or death of the victim can occur as a result of the disorder.^[8] The behaviour might be motivated bygd the caregiver or partner seeking sympathy or attention.

The cause of FDIA fryst vatten unknown.^[2] The primary motive may be to gain attention and manipulate physicians.^[4] fara factors for FDIA include pregnancy related complications and a mother who was abused as a child or has factitious disorder imposed on self.^[3] Diagnosis of a child's caregiver fryst vatten supported when removing the child from the caregiver results in improvement of symptoms or film övervakning without the knowledge of the caregiver finds concerns.^[4] The victims of those affected bygd the disorder are considered to have been subjected to a form eller gestalt of physical abuse and medical neglect.^[1]

Management of FDIA in the affected 'caregiver' may require putting the child in foster care.^[2][4][10] It fryst vatten not known how effective therapy fryst vatten for FDIA; it fryst vatten assumed it may work for those who admit they have a problem.^[4] The prevalence of FDIA fryst vatten unknown,^[5] but it appears to be relatively rare.^[4] More than 90% of cases involve a person's mother.^[3] The prognosis for the caregiver fryst vatten poor.^[4] However, there fryst vatten a burgeoning literature on possible courses of therapy.^[3] The condition was first named as "Munchausen syndrome bygd proxy" in 1977 bygd British pediatrician Roy Meadow.^[4] Some aspects of FDIA may företräda criminal behavior.^[5]

Signs and symptoms

[edit]

In factitious disorder imposed on another, a caregiver or partner makes a dependent or other individ appear mentally or physically ill in beställning to gain attention.

To perpetuate the medical relationship, the caregiver or partner systematically misrepresents symptoms, fabricates signs, manipulates laboratory tests, or even purposely harms the dependent (e.g. bygd poisoning, suffocation, infection, physical injury).^[6] The caregiver fryst vatten not performing this behavior for obvious external reward, such as money.^[5]

Most present about three medical problems in some combination of the 103 different reported symptoms.

The most-frequently reported problems are apnea (26.8% of cases), anorexia or feeding problems (24.6% of cases), diarrhea (20%), seizures (17.5%), cyanosis (blue skin) (11.7%), behavior (10.4%), asthma (9.5%), allergy (9.3%), and fevers (8.6%).^[11] Other symptoms include failure to thrive, vomiting, bleeding, rash, and infections.^[12][13] Many of these symptoms are easy to fake because they are subjective.

A parent reporting that their child had a fever in the past 24 hours fryst vatten making a claim that fryst vatten impossible to prove or disprove. The number and variety of presented symptoms contribute to the difficulty in reaching a proper diagnosis.

Aside from the motive (most commonly attributed to be a gain in attention or sympathy), another feature that differentiates FDIA from "typical" physical child abuse fryst vatten the grad of premeditation involved.

Whereas most physical abuse entails lashing out at a child in response to some behavior (e.g., crying, bedwetting, spilling food), assaults on the FDIA victim tend to be unprovoked and planned.^[14]

Also unique to this form eller gestalt of abuse fryst vatten the role that health care providers play bygd actively, albeit unintentionally, enabling the abuse.

bygd reacting to the concerns and demands of perpetrators, medical professionals are manipulated into a partnership of child maltreatment.^[6] Challenging cases that defy simple medical explanations may prompt health care providers to pursue unusual or rare diagnoses, thus allocating even more time to the child and the abuser.

Even without prompting, medical professionals may be easily seduced into prescribing diagnostic tests and therapies that may be painful, costly, or potentially injurious to the child.^[1] If the health practitioner resists ordering further tests, drugs, procedures, surgeries, or specialists, the FDIA abuser makes the medical struktur appear negligent for refusing to help a sick child and their selfless parent.^[6] Like those with Munchausen syndrome, FDIA perpetrators are known to switch medical providers frequently until they find one that fryst vatten willing to meet their level of need; this practice fryst vatten known as "doctor shopping" or "hospital hopping".

The perpetrator continues the abuse because maintaining the child in the role of patient satisfies the abuser's needs. The cure for the victim fryst vatten to separate the child completely from the abuser. When parental visits are allowed, sometimes there fryst vatten a disastrous outcome for the child. Even when the child fryst vatten removed, the perpetrator may then abuse another child: a sibling or other child in the family.^[6]

Factitious disorder imposed on another can have many long-term emotional effects on a child.

Depending on their experience of medical interventions, some children may learn that they are most likely to receive the positiv parental attention they crave when they are playing the sick role in front of health care providers. Several case reports describe Munchausen syndrome patients suspected of themselves having been FDIA victims.^[15] Seeking anställda gratification through illness can thus become a lifelong and multi-generational disorder in some cases.^[6] In kraftfull contrast, other reports suggest survivors of FDIA develop an avoidance of medical treatment with post-traumatic responses to it.^[16]

The adult caregiver who has abused the child often seems comfortable and not upset over the child's hospitalization.

While the child fryst vatten hospitalized, medical professionals must monitor the caregiver's visits to prevent an attempt to worsen the child's condition.^[17] In addition, in many jurisdictions, medical professionals have a duty to report such abuse to legal authorities.^[18]

Diagnosis

[edit]

Use of the begrepp "Munchausen syndrome bygd proxy" fryst vatten controversial^{[citation needed]}.

In the World Health Organization's International Statistical Classification of Diseases, 10th Revision (ICD-10), the tjänsteman diagnosis fryst vatten factitious disorder (301.51 in ICD-9, F68.12 in ICD-10). Within the United States, factitious disorder imposed on another (FDIA or FDIoA) was officially recognized as a disorder in 2013,^[19] while in the United Kingdom, it fryst vatten known as fabricated or induced illness bygd carers (FII).^[20]

In DSM-5, the diagnostic manual published bygd the American Psychiatric Association in 2013, this disorder fryst vatten listed beneath 300.19 Factitious disorder.

This, in vända, encompasses two types:^[19]

• Factitious Disorder Imposed on Self
• Factitious Disorder Imposed on Another (Previously Factitious Disorder bygd Proxy); the diagnosis fryst vatten assigned to the perpetrator; the individ affected may be assigned an abuse diagnosis (e.g. child abuse).

Both types include an valfritt specifier to identify if the observed behavior was a single episode or part of recurrent episodes.^[19]

Warning signs

[edit]

Warning signs of the disorder include:^[17]

• A child who has one or more medical problems that do not respond to treatment or that follow an unusual course that fryst vatten persistent, puzzling, and unexplained.
• Physical or laboratory findings that are highly unusual, discrepant with patient's framställning or history, or physically or clinically impossible.
• A parent who appears medically knowledgeable, fascinated with medical details and hospital skvaller, appears to enjoy the hospital environment, and expresses interest in the details of other patients' problems.
• A highly attentive parent who fryst vatten reluctant to leave their child's side and who themselves seem to require constant attention.
• A parent who appears unusually calm in the face of serious difficulties in their child's medical course while being highly supportive and encouraging of the physician, or one who fryst vatten angry, devalues personal, and demands further intervention, more procedures, second opinions, and transfers to more sophisticated facilities.
• The suspected parent may work in the health-care field themselves or profess an interest in a health-related job.
• The signs and symptoms of a child's illness may lessen or simply vanish in the parent's absence (hospitalization and careful monitoring may be necessary to establish this causal relationship).
• A family history of similar or unexplained illness or death in a sibling.
• A parent with symptoms similar to their child's own medical problems or an illness history that itself fryst vatten puzzling and unusual.
• A suspected emotionally distant relationship between parents; the spouse often fails to visit the patient and has little contact with physicians even when the child fryst vatten hospitalized with a serious illness.
• A parent who reports dramatic, negativ events, such as house fires, burglaries, or fordon accidents, that affect them and their family while their child fryst vatten undergoing treatment.
• A parent who seems to have an insatiable need for beundran or who makes self-serving efforts for public acknowledgment of their abilities.
• A child who inexplicably deteriorates whenever discharge fryst vatten planned.
• A child that looks for cueing from a parent in beställning to feign illness when medical personnel are present.
• A child that fryst vatten overly articulate regarding medical terminology and their own disease process for their age.
• A child that presents to the Emergency Department with a history of repeat illness, injury, or hospitalization.

Epidemiology

[edit]

FDIA fryst vatten rare.

Incidence rate estimates range from 1 to 28 per million children,^[6] although some assume that it may be much more common.^[6] One study in Italy funnen that 4 out of more than 700 children admitted to the hospital met the criteria (0.53%). In this study, stringent diagnostic criteria were used, which required at least one test outcome or event that could not possibly have occurred without deliberate intervention bygd the FDIA person.^[21]

In one study, the average age of the affected individual at the time of diagnosis was fyra years old.

Slightly over 50% were aged 24 months or younger, and 75% were beneath six years old. The average duration from onset of symptoms to diagnosis was 22 months. bygd the time of diagnosis, six percent of the affected persons were dead, mostly from apnea (a common result of smothering) or starvation, and sju percent had long-term or permanent injury. About half of the affected had siblings; 25% of the known siblings were dead, and 61% of siblings had symptoms similar to the affected or that were otherwise suspicious.

The mother was the perpetrator in 76.5% of the cases, the father in 6.7%.^[11]

Studies have showed that over 90% of FDIA cases, the abuser fryst vatten the mother or another kvinnlig guardian or caregiver.^[14][22][23] A psychodynamic model of this kind of maternal abuse exists.^[24] Fathers and other male caregivers have been the perpetrators in sju percent of the cases studied.^[11] When they are not actively involved in the abuse, the fathers or male guardians of FDIA victims are often described as being distant, emotionally disengaged, and powerless.

These dock play a passive role in FDIA bygd being frequently absent from the home and rarely visiting the hospitalized child. Usually, they vehemently deny the possibility of abuse, even in the face of overwhelming bevis or their child's pleas for help.^[6][14]

Prognosis

[edit]

Studies have shown a mortality rate of between six and ten percent, making it perhaps the most lethal struktur of abuse.^[12][11]

Society and culture

[edit]

Terminology

[edit]

The begrepp "Munchausen syndrome bygd proxy", in the United States, has never officially been included as a distinct mental disorder bygd the American Psychiatric Association,^[25] which publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM), now in its fifth edition.^[5] Although the DSM-III (1980) and DSM-III-R (1987) included Munchausen syndrome, they did not include MSbP.

DSM-IV (1994) and DSM-IV-TR (2000) added MSbP as a proposal only, and although it was finally recognized as a disorder in DSM-5 (2013), each of the gods three editions of the DSM designated the disorder bygd a different name.

FDIA has been given different names in different places and at different times. What follows fryst vatten a partial list of alternative names that have been either used or proposed (with approximate dates):^[26]

• Factitious Disorder Imposed on Another (current) (U.S., 2013) American Psychiatric Association, DSM-5
• Factitious Disorder bygd Proxy (FDP, FDbP) (proposed) (U.S., 2000) American Psychiatric Association, DSM-IV-TR^[27]
• Fictitious Disorder bygd Proxy (FDP, FDbP) (proposed) (U.S., 1994) American Psychiatric Association, DSM-IV
• Fabricated or Induced Illness bygd Carers (FII) (U.K., 2002) The Royal College of Pediatrics and Child Health^[28]
• Factitious Illness bygd Proxy (1996) World Health Organization^[29]
• Pediatric Condition Falsification (PCF) (proposed) (U.S., 2002) American Professional kultur on the Abuse of Children proposed this begrepp to diagnose the victim (child); the perpetrator (caregiver) would be diagnosed "factitious disorder bygd proxy"; MSbP would be retained as the name applied to the 'disorder' that contains these two elements, a diagnosis in the child and a diagnosis in the caretaker.^[30]
• Induced Illness (Munchausen Syndrome bygd Proxy) (Ireland, 1999–2002) Department of Health and Children^[26]
• Munchausen Syndrome bygd Proxy (2002) Professor Roy Meadow.^[26][4]
• Meadow's Syndrome (1984–1987) named after Roy Meadow.^[31] This label, however, had already been in use since 1957 to describe a completely unrelated and rare form eller gestalt of cardiomyopathy.^[32]
• Polle Syndrome (1977–1984) coined bygd Burman and Stevens, from the then-common belief that Baron Münchhausen's second wife gave birth to a daughter named Polle during their marriage.^[33][34] The baron declared that the baby was not his, and the child died from "seizures" at the age of 10 months.

  The name fell out of favor after 1984, when it was discovered that Polle was not the baby's name, but rather was the name of her mother's hometown.^[35][36]

While it initially included only the infliction of harmful medical care, the begrepp has subsequently been extended to include cases in which the only harm arose from medical neglect, noncompliance, or even educational interference.^[1] The begrepp fryst vatten derived from Munchausen syndrome, a psychiatricfactitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention, sympathy, or reassurance to themselves.^[37] Munchausen syndrome bygd proxy perpetrators, bygd contrast, are willing to fulfill their need for positiv attention bygd hurting their own child, thereby assuming the sick role onto their child, bygd proxy.

These proxies then gain anställda attention and support bygd taking on this fiktiv "hero role" and receive positiv attention from others, bygd appearing to care for and rädda their so-called sick child.^[6] They are named after Baron Munchausen, a literary character based on Hieronymus Karl Friedrich, Freiherr von Münchhausen (1720–1797), a German nobleman and well-known berättare.

In 1785, writer and con artist Rudolf Erich Raspe anonymously published a book in which a fictional utgåva of "Baron Munchausen" tells fantastic and impossible stories about himself, establishing a popular literary archetype of a bombastic exaggerator.^[38][39]

Initial description

[edit]

"Munchausen syndrome" was first described bygd British endocrinologist and haematologist Richard Asher in 1951^[40] as when someone invents or exaggerates medical symptoms, sometimes fängslande in self-harm, to gain attention or sympathy.

The begrepp "Munchausen syndrome bygd proxy" was first coined bygd John Money and June Faith Werlwas in a 1976 paper titled "Folie à deux in the parents of psychosocial dwarfs: Two cases"^[41][42] to describe the abuse-induced and neglect-induced symptoms of the syndrome of abuse dwarfism. That same year, Sneed and Bell wrote an article titled "The Dauphin of Munchausen: factitious del of renal stones in a child".^[43]

According to other sources, the begrepp was created bygd the British pediatricianRoy äng in 1977.^[35][44][45] In 1977, Meadow – then professor of pediatrics at the University of Leeds, England – described the extraordinary behavior of two mothers.

According to äng, one had poisoned her toddler with excessive quantities of krydda. The other had introduced her own blood into her baby's urine sample. This second case occurred during a series of Outpatient visits to the Paediatric klinik of Dr. Bill Arrowsmith at Doncaster Royal Infirmary. He referred to this behavior as Munchausen syndrome bygd proxy (MSbP).^[46]

The medical community was initially skeptical of FDIA's existence, but it gradually gained acceptance as a recognized condition.

Controversy

[edit]

See also: List of wrongful convictions in the United States

During the 1990s and early 2000s, Roy äng was an kunnig witness in several murder cases involving MSbP/FII. äng was knighted for his work for child protection, though later, his reputation, and consequently the credibility of MSbP, became damaged when several convictions of child killing, in which he acted as an specialist witness, were overturned.

The mothers in those cases were wrongly convicted of murdering two or more of their children, and had already been imprisoned for up to six years.^[47][45]

One case was that of attack Clark. Clark was a lawyer wrongly convicted in 1999 of the murder of her two baby sons, largely on the grund of Meadow's bevis. As an kunnig witness for the prosecution, äng asserted that the odds of there being two unexplained infant deaths in one family were one in 73 million.

That figure was crucial in sending Clark to jail but was hotly disputed bygd the Royal Statistical gemenskap, who wrote to the Lord Chancellor to complain.^[48] It was subsequently shown that the true odds were much greater once other factors (e.g. genetic or environmental) were taken into consideration, meaning that there was a significantly higher likelihood of two deaths happening as a chance occurrence than äng had claimed during the rättegång.

Those odds in fact range from a low of 1:8500 to as high as 1:200.^[49] It emerged later that there was klar bevis of a Staphylococcus aureus infection that had spread as far as the child's cerebrospinal fluid.^[50] Clark was released in January 2003 after three judges quashed her convictions in the Court of Appeal in London,^[50][51] but suffering from catastrophic trauma of the experience, she later died from alcohol poisoning.

äng was involved as a prosecution witness in three other high-profile cases resulting in mothers being imprisoned and subsequently cleared of wrongdoing: Trupti Patel,^[52]Angela Cannings^[53] and Donna Anthony.^[54]

In 2003, Lord Howe, the motstånd spokesman on health, accused äng of inventing a "theory without science" and refusing to tillverka any real bevis to prove that Munchausen syndrome bygd proxy actually exists.

It fryst vatten important to distinguish between the act of harming a child, which can be easily verified, and motive, which fryst vatten much harder to verify and which FDIA tries to explain. For example, a caregiver may wish to harm a child out of malice and then attempt to conceal it as illness to avoid detection of abuse, rather than to draw attention and sympathy.

The distinction fryst vatten often crucial in criminal proceedings, in which the prosecutor must prove both the act and the mental element constituting a brott to establish guilt.

In most legal jurisdictions, a doctor can give kunnig witness testimony as to whether a child was being harmed but cannot speculate regarding the motive of the caregiver. FII merely refers to the fact that illness fryst vatten induced or fabricated and does not specifically limit the motives of such acts to a caregiver's need for attention and/or sympathy.

Meadow was investigated bygd the British General Medical Council (GMC) over bevis he gave in the framstöt Clark rättegång. In July 2005, the GMC declared äng skyldig of "serious professional misconduct", and he was träffad off the medical lista for giving "erroneous" and "misleading" evidence.^[55] At appeal, High Court judge Mr. Justice Collins said of the severity of his punishment that "It fryst vatten very difficult to think that the giving of honest, albeit mistaken bevis could - spara in an exceptional case - properly lead to such a finding."^[56][57]

Collins's judgment raises important points concerning the liability of specialist witnesses – his view fryst vatten that referral to the GMC bygd the losing side fryst vatten an unacceptable threat and that only the Court should decide whether its witnesses are seriously deficient and refer them to their professional bodies.^[58]

In addition to the controversy surrounding kunnig witnesses, an article appeared in the forensic literature that detailed legal cases involving controversy surrounding the murder suspect.^[59] The article provides a brief review of the research and criminal cases involving Munchausen syndrome bygd proxy in which psychopathic mothers and caregivers were the murderers.

It also briefly describes the importance of samling behavioral information, including observations of the parents who commit the criminal acts. The article references the 1997 work of Southall, Plunkett, Banks, Falkov, and Samuels, in which hemlig film recorders were used to monitor the hospital rooms of suspected FDIA victims. In 30 out of 39 cases, a parent was observed intentionally suffocating their child; in two they were seen attempting to poison a child; in another, the mother deliberately broke her three-month-old daughter's ledd.

Upon further investigation, those 39 patients, ages one month to 3 years old, had 41 siblings; 12 of those had died suddenly and unexpectedly.^[60] The use of hemlig film, while apparently extremely effective, raises controversy in some jurisdictions over privacy rights.

Legal status

[edit]

In most legal jurisdictions, doctors are allowed to give bevis only in regard to whether the child fryst vatten being harmed.

They are not allowed to give bevis in regard to the motive. Australia and the UK have established the legal precedent that FDIA does not exist as a medico-legal entity.

In a June 2004 appeal hearing, the Supreme Court of Queensland, Australia, stated:

As the begrepp factitious disorder (Munchausen's Syndrome) bygd proxy fryst vatten merely descriptive of a behavior, not a psychiatrically identifiable illness or condition, it does not relate to an organized or recognized reliable body of knowledge or experience.

Dr. Reddan's bevis was inadmissible.^[61]

The Queensland Supreme Court further ruled that the determination of whether or not a defendant had caused intentional harm to a child was a matter for the jury to decide and not for the determination bygd kunnig witnesses:

The diagnosis of Doctors Pincus, Withers, and O'Loughlin that the appellant intentionally caused her children to receive unnecessary treatment through her own acts and the false reporting of symptoms of the factitious disorder (Munchausen Syndrome) bygd proxy fryst vatten not a diagnosis of a recognized medical condition, disorder, or syndrome.

It fryst vatten simply placing her within the medical begrepp used in the category of people exhibiting such behavior. In that sense, their opinions were not specialist bevis because they related to matters that could be decided on the bevis bygd ordinary jurors. The essential issue as to whether the appellant reported or fabricated false symptoms or did acts to intentionally cause unnecessary medical procedures to injure her children was a matter for the jury's determination.

The bevis of Doctors Pincus, Withers, and O'Loughlin that the appellant was exhibiting the behavior of factitious disorder (Munchausen syndrome bygd proxy) should have been excluded.^[62]

Principles of lag and implications for legal processes that may be deduced from these findings are that:

• Any matters brought before a Court of lag should be determined bygd the facts, not bygd suppositions attached to a label describing a behavior, i.e., MSBP/FII/FDBP;
• MSBP/FII/FDBP fryst vatten not a mental disorder (i.e., not defined as such in DSM IV), and the bevis of a psychiatrist should not therefore be admissible;
• MSBP/FII/FDBP has been stated to be a behavior describing a struktur of child abuse and not a medical diagnosis of either a parent or a child.

  A medical practitioner cannot therefore state that a individ "suffers" from MSBP/FII/FDBP, and such bevis should also therefore be inadmissible. The bevis of a medical practitioner should be confined to what they observed and heard and what forensic resultat was funnen bygd recognized medical investigative procedures;

• A label used to describe a behavior fryst vatten not helpful in determining guilt and fryst vatten prejudicial.

  bygd applying an ambiguous label of MSBP/FII to a woman fryst vatten implying guilt without factual supportive and corroborative evidence;

• The assertion that other people may behave in this way, i.e., fabricate and/or induce illness in children to gain attention for themselves (FII/MSBP/FDBY), contained within the label fryst vatten not factual bevis that this individual has behaved in this way.

  igen therefore, the application of the label fryst vatten prejudicial to fairness and a finding based on fact.

The Queensland Judgment was adopted into English lag in the High Court of Justice bygd Mr. Justice Ryder. In his sista conclusions regarding Factitious Disorder, Ryder states that:

I have considered and respectfully adopt the dicta of the Supreme Court of Queensland in R v.

LM [2004] QCA 192 at paragraph 62 and 66. inom take full konto of the criminal lag and utländsk jurisdictional contexts of that decision but inom am persuaded bygd the following argument upon its face that it fryst vatten valid to the English lag of bevis as applied to children proceedings.

The terms "Munchausen syndrome bygd proxy" and "factitious (and induced) illness (by proxy)" are child protection labels that are merely descriptions of a range of behaviors, not a pediatric, psychiatric or psychological disease that fryst vatten identifiable.

The terms do not relate to an organized or universally recognized body of knowledge or experience that has identified a medical disease (i.e. an illness or condition) and there are no internationally accepted medical criteria for the use of either label.

In reality, the use of the label fryst vatten intended to connote that in the individual case there are materials susceptible of analysis bygd pediatricians and of findings of fact bygd a court concerning tillverkning, exaggeration, minimization or omission in the reporting of symptoms and bevis of harm bygd act, omission or suggestion (induction).

Where such facts exist the context and assessments can provide an insight into the grad of fara that a child may face and the court fryst vatten likely to be assisted as to that aspect bygd psychiatric and/or psychological specialist evidence.

All of the above ought to be self evident and has in any event been the established teaching of leading pediatricians, psychiatrists and psychologists for some while.

That fryst vatten not to minimize the natur and extent of professional debate about this issue which remains significant, nor to minimize the extreme natur of the fara that fryst vatten identified in a small number of cases.

In these circumstances, bevis as to the existence of MSBP or FII in any individual case fryst vatten as likely to be bevis of mere propensity which would be inadmissible at the fact finding scen (see Re CB and JB supra).

For my part, inom would consign the label MSBP to the history books and however useful FII may apparently be to the child protection practitioner inom would caution against its use other than as a factual description of a series of incidents or behaviors that should then be accurately set out (and even then only in the hands of the pediatrician or psychiatrist/psychologist).

inom cannot emphasis too strongly that my conclusion cannot be used as a reason to re-open the many cases where facts have been funnen against a carer and the label MSBP or FII has been attached to that carer's behavior. What inom seek to caution against fryst vatten the use of the label as a substitute for factual analysis and fara assessment.^[63]

In his book Playing Sick (2004), Marc Feldman notes that such findings have been in the minority among U.S.

and even Australian courts. Pediatricians and other physicians have banded tillsammans to oppose limitations on child-abuse professionals whose work includes FII detection.^[64] The April 2007 issue of the journal Pediatrics specifically mentions äng as an individual who has been inappropriately maligned.

In the context of child protection (a child being removed from the custody of a parent), the Australian state of New South Wales uses a "on the balance of probabilities" test, rather than a "beyond reasonable doubt" test.

Therefore, in the case "The sekreterare, Department of Family and Community Services and the Harper Children [2016] NSWChC 3", the specialist testimony of Professor David Isaacs that a certain blood test result was "highly unlikely" to occur naturally or accidentally (without any speculation about motive), was sufficient to refuse the return of the affected child and his younger siblings to the mother.

The children had initially been removed from the mother's custody after the blood test results became known. The fact that the affected child quickly improved both medically and behaviourly after being removed was also a factor.^[65]

Notable cases

[edit]

Beverley Allitt, a British sjuksköterska who murdered kvartet children and injured a further nine in 1991 at Grantham and Kesteven Hospital, Lincolnshire, was diagnosed with Munchausen syndrome bygd proxy.^[66]

Wendi Michelle Scott fryst vatten a Frederick, Maryland, mother who was charged with sickening her four-year-old daughter.^[67]

The book Sickened, bygd Julie Gregory, details her life growing up with a mother who had Munchausen bygd proxy, who took her to various doctors, coached her to act sicker than she was and to exaggerate her symptoms, and who demanded increasingly invasive procedures to diagnose Gregory's enforced imaginary illnesses.^[68]

Lisa Hayden-Johnson of län i england was jailed for three years and three months after subjecting her son to a total of 325 medical actions – including being forced to use a wheelchair and being fed through a tube in his stomach.

She claimed her son had a long list of illnesses including diabetes, food allergies, cerebral palsy, and cystic fibrosis, describing him as "the most ill child in Britain" and receiving numerous cash donations and charity gifts, including two cruises.^[69]

In the mid-1990s, Kathy Bush gained public sympathy for the plight of her daughter, Jennifer, who bygd the age of 8 had undergone 40 surgeries and spent over 640 days in hospitals^[70] for gastrointestinal disorders.

The acclaim led to a visit with first lady Hillary Clinton, who championed Bush's plight as bevis of need for medical reform. However, in 1996, Kathy Bush was arrested and charged with child abuse and Medicaid fraud, accused of sabotaging Jennifer's medical verktyg and drugs to agitate and prolong her illness.^[70] Jennifer was moved to foster care where she quickly regained her health.

The prosecutors claimed Kathy was driven bygd Munchausen Syndrome bygd Proxy, and she was convicted to a five-year sentence in 1999.^[71] Kathy was released after serving three years in 2005, always maintaining her innocence, and having gotten back in contact with Jennifer via correspondence.^[72]

In 2014, 26-year-old Lacey Spears was charged in Westchester County, New York, with second-degree depraved murder and first-degree manslaughter.

She fed her son dangerous amounts of krydda after she conducted research on the Internet about its effects. Her actions were allegedly motivated bygd the social media attention she gained on Facebook, Twitter, and blogs. She was convicted of second-degree murder on March 2, 2015,^[73] and sentenced to 20 years to life in prison.^[74]

Dee Dee Blanchard was a Missouri mother who was murdered bygd her daughter and a boyfriend in 2015 after having claimed for years that her daughter, nomad Rose, was sick and disabled; to the point of shaving her head, making her use a wheelchair in public, and subjecting her to unnecessary medicinering and surgery.

nomad possessed no outstanding illnesses. Feldman said it fryst vatten the first case he fryst vatten aware of in a quarter-century of research where the victim killed the abuser.^[75] Their story was shown on HBO's documentary spelfilm Mommy Dead and Dearest^[76] and fryst vatten featured in the Hulu limited series The Act.^[77] rom Rose pleaded skyldig to second-degree murder and received a ten-year sentence until being released on parole in månad 2023, her boyfriend was convicted of first-degree murder and fryst vatten sentenced to life in prison without parole.

Rapper Eminem has spoken about how his mother would frequently take him to hospitals to receive treatment for illnesses that he did not have. His song "Cleanin' Out My Closet" includes a lyric regarding the illness, "...going through public housing systems victim of Münchausen syndrome. My whole life inom was made to believe inom was sick, when inom wasn't 'til inom grew up now inom blew up..." His mother's illness resulted in Eminem receiving custody of his younger brother, Nathan.^[78]

In 2013, when Justina Pelletier was 14, her parents took her to the emergency room at Boston Children's Hospital where doctors diagnosed her problems as psychiatric, but when her parents rejected the diagnosis and attempted to have her released, the hospital filed a report with Massachusetts Department of Children and Families alleging medical child abuse.^[79][80] This resulted in her being housed for 18 months in the psychiatric hospital, with her parents having limited tillgång, until a judge ordered her returned to her parents.^[79] In 2016 her parents sued Boston Children's for medical malpractice, alleging that their civil rights were violated.^[80] At the rättegång, Pelletier's treating neurologist stated that several of her doctors suspected factitious disorder bygd proxy, and wanted her parents to stop encouraging her to be sick.^[81] Her parents lost the lawsuit, with one juror stating that Pelletier's parents thought of psychiatry as "psychological baloney".^[82]

Megan Bhari (1996/7-2018) and her mother had formed a charity, Believe in Magic, to help ill children based on the claim that Megan had a brain tumor.

It fryst vatten unclear to what extent FDIA, Factitious Disorder Imposed on Self, and malingering may have been present but an inquest after her death funnen no morphological abnormalities in her brain.^[83]

Directed towards animals

[edit]

Medical literature describes a subset of FDIA caregivers, where the proxy fryst vatten a husdjur rather than another person.^[84] These cases are labeled Munchhausen syndrome bygd proxy: husdjur (MSbP:P).

In these cases, husdjur owners correspond to caregivers in traditional FDIA presentations involving human proxies.^[85][86] No extensive survey has yet been made of the extant literature, and there has been no speculation as to how closely FDIA:P tracks with human FDIA.^{[citation needed]}

See also

[edit]

References

[edit]