Ms. J agreed to long-term therapy; in exchange, judicial proceedings were deferred. In most cases, the mother is referred to police and charged with child abuse/endangerment. However, the medical staff in this case felt treatment and supervision would provide ample rehabilitation.
The mother was referred to a psychiatrist trained in psychoanalysis. By making her aware of her unconscious responses, the doctor sought to improve Ms. J’s ability to cope with stress. Patients with a borderline personality disorder seldom respond in psychoanalysis, but Ms. J exhibited significant ego strengths and intelligence—and was motivated to regain custody of her daughter.
Ms. J’s transference response was predictable: She tried to please the doctor in everything she said or did. This reaction was analyzed and the insight helped Ms. J understand why she exaggerated or exacerbated normal childhood illnesses in her daughter. She discovered that she had hungered for approval since childhood and went as far as injuring her daughter to achieve this fulfillment. Early in treatment she developed a mantra: “I have behaved toward my daughter as my mother behaved toward me.”
After 8 months of therapy 3 times a week, Ms. J regained custody. She continued to receive once-weekly psychotherapy for 1 year.
Two years after regaining custody, Ms. J developed a stable, loving relationship with her daughter. She works full-time while her daughter is in high school and participates in many activities. The relative who assumed temporary custody stays in touch, as does her pediatrician.
The girl is seen by her father on alternate weekends. She tells friends she wants to become a nurse.
How can psychiatrists facilitate early diagnosis and treatment of Munchausen’s?
Dr. Messer’s observations
Although primary care physicians or general surgeons treat most patients with Munchausen’s, the disorder is psychiatric in nature.
For that reason, psychiatrists should participate when possible in the early medical workup of a patient who presents with an apparently severe illness. This way, the psychiatrist can:
- help detect Munchausen’s or another factitious disorder sooner
- establish a rapport with the patient early on. If Munchausen’s is subsequently diagnosed, the patient may be less likely to resist treatment or bolt when confronted.
When confronting someone suspected of fabricating or inducing symptoms, tell the patient that he or she might have Munchausen’s syndrome. Describe the disorder and cite cases, then challenge the patient to find a more appropriate way to cope with stress.
Related resources
- Adshead G, Brooke D (eds). Munchausen's syndrome by proxy. Current issues in assessment, treatment and research. Singapore: World Scientific Publishing, 2001.
- Munchausen’s syndrome by proxy. www.gktscientific.com