IPT Book Reviews


Munchausen Syndrome by Proxy: Issues in Diagnosis and Treatment 

Editors: Alex V. Levin and Mary S. Sheridan
Publisher: Jossey-Bass Publishers, 1995

Lexington Books: Jossey-Bass Publishers
350 Sansome St.
San Francisco, CA 94104-1310
(800) 223-2336

Not much is known about the pattern of behavior subsumed under the label Munchausen Syndrome by Proxy, which was first identified and described by Roy Meadows in 1977.  This 479-page book is the first attempt at a systematic review of what is known about  this puzzling and highly dangerous form of child abuse.  The 32 chapters by a variety of contributors consist mostly of anecdotal accounts, summaries of clinical observations, and case studies.  This is the way science begins to collect data, understand, and generate hypotheses and information.  The book ends with an  18-page bibliography and a useful index.

The thrust of this book is to describe the pattern of  behavior in which an adult, almost always a mother,  deceives others by presenting false claims of illness in a child.  This may range from parents simply lying about symptoms the child is said to have to deliberately and repeatedly killing their children.  In between are parents who may deliberately, or as the result of an environmental pressure, make false claims of abuse, physical or sexual, by the other parent or another adult.  It is clear that the behavior of an adult causing illness, injury, or emotional harm to a child is a form of child abuse.  It is also likely that the pathology of the adult is the principal etiological factor, however, there is little known about the nature, extent, or origin of the adult pathology.

The book also contains the best thinking up to this point about how to recognize and treat the problem.  Recognition of an adult creating a false illness in a child requires cooperation of all professionals who may come in contact with the parent, child, and family.  The most significant data may be generated by an observed difference in the symptomatology shown by a child when not in the care of the parent and when the parent is caring for the child.  The book addresses the full range of reported symptoms generated in recognized cases of Munchausen Syndrome by Proxy.  There are separate chapters summarizing the known symptoms according to physical systems, organs, and the psychological effects of false allegations.  The remedy proposed is decisions by multidisciplinary teams that effectively remove a child from the care of the parent.  There is not a great deal of enthusiasm for reunification of a family when there has been a child damaged by the adult's machinations.

The prevalence and incidence of Munchausen Syndrome by Proxy is not known but it is clearly frequent enough and the risks to children high enough that professionals should entertain this syndrome as a possibility when confronted by claims of illness or abuse that seem to be affected by the ability of the complaining parent to be in contact with the child.

This book should be of value to all professionals who may be in a position to encounter children whose lives may be dramatically affected by a parent's pathology.

Reviewed by Ralph Underwager, Institute for Psychological Therapies, Northfield, Minnesota 55057.

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