Outcome of psychiatric intervention in factitious illness by proxy (Munchausen's syndrome by proxy)

Abstract

OBJECTIVE To determine the outcome for children after psychiatric intervention in cases of factitious illness by proxy.

METHODS All 17 children from 16 families, selected for admission to the Park Hospital Oxford family unit 1992–96 were followed up after a mean of 27 months. Information was obtained on the children and their carers from general practitioners, social workers or both; 13 of the children and carers were interviewed.

RESULTS All patients were at the severe end of the abuse spectrum; 12 involving direct induction of illness, 1 tampering with samples to mimic illness, and 4 fabrication of symptoms. The biological mother was the abuser in all cases. Four children and their parents had been initially admitted for assessment, and 13 for treatment to decide whether family reunification was viable. The 4 assessments clarified diagnosis, enabling improved care plans to be made. Of the 13 treatment cases, 10 were reunited with parents after a mean of 7½ weeks' admission, whereas 3 were discharged to out of home care. There was a further episode of induced illness in 1 of the reunited children. Although some mothers had continuing mental health difficulties, only 1 of the other reunited cases had appreciable parent–child relationship difficulties (not requiring referral to psychiatric services). The children did well in their development, growth, and adjustment.

CONCLUSION Family reunification is feasible for certain cases, but long term follow up is necessary to ensure the child's safety and to identify deterioration in parent's mental health. The outcome for reunited children compared well with reported untreated cases.