Article extract:
Munchausen’s Syndrome by Proxy (MSBP) is a form of abuse in which a caregiver deliberately produces or feigns illness in a person under his or her care. A rare disorder, it most frequently consists of poisoning of an infant by an adult caregiver. A related condition is ‘factitious disorder by proxy’, also referred to as ‘pediatric condition falsification’. The Diagnostic and Statistical Manual of Mental Disorders, requires the intentional production or feigning of physical or psychological signs or symptoms for the diagnosis of factitious disorder. It also suggests that the motivation for the behavior is to assume the sick role, and that there be no external incentives for the behavior such as economic gain. “The diagnosis of FD can only be confirmed if observation of symptom-producing behavior occurs or is admitted.”
Thus the essential feature of both MSBP and factitious disorder is the intentional and
conscious imitation or production of illness. While there have been legitimate controversies concerning ME/CFS, the intentional or conscious attempt to feign the illness is close to impossible because of the complexity of the symptoms. Very few medical providers are even aware of the ME/CFS symptoms involving sleep, orthostatic intolerance, post-exertional malaise and sensory sensitivities. If pediatricians were better aware of ME/CFS, MSBP or factitious disorder would not enter the conversation…
One important question remains however: can an overly sympathetic parent cause activity limitation in an adolescent? While this has never been answered scientifically, it is highly unlikely. Behavioral problems caused by family dysfunction usually result in hyperactivity
not hypersomnolence. An overindulged and undisciplined child is clearly not characterized by activity limitation. And in the era of rheumatic fever, where strict bed rest was prescribed as a treatment, it was invariably unsuccessful…
Conclusion: The lack of training and awareness of pediatricians in the subject of ME/CFS has led to the inappropriate diagnosis of MSBP and factitious disorder, both of which can result in placement of the child or adolescent in either psychiatric hospitalization or foster care. There is ample evidence that ME/CFS is not a psychiatric condition, and the recent IOM publication has clearly stated “Seeking and receiving a diagnosis can be a frustrating process for several reasons, including skepticism of health care providers about the serious nature of ME/CFS and the misconception that it is a psychogenic illness or even a figment of the patient’s imagination… Physicians should diagnose myalgic encephalomyelitis/ chronic fatigue syndrome if diagnostic criteria are met following an appropriate history, physical examination, and medical work-up.
Munchausen’s Syndrome by Proxy, Factitious Disorders in Children and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome by Dr David S Bell, IACFSME, Dec 2015
