Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Munchausen syndrome by proxy (MSBP) is classified as a factitious disorder and is therefore characterized by feigning or intentionally producing physical or emotional symptoms in order to assume the sick role.
This disorder is named after Baron Karl Friedrich von Munchausen, who was known to invent fantastic stories of his adventures, including his riding cannonballs and traveling to the moon.
MSBP specifically involves a caretaker describing nonexistent symptoms or inducing symptoms in a third person, usually a child they care for.
How often MSBP occurs is likely very much underestimated, as evidenced by it often taking years to be discovered, even being completely missed in siblings of the victim that is eventually identified.
Males are victims of MSBP as often as females. Women are perpetrators of this disorder the vast majority of the time, theoretically because women remain the primary caretakers of children.
Perpetrators of MSBP are vulnerable to also suffering from depression, anxiety, and some personality disorders.
While there is no specific cause for MSBP, perpetrators tend to have trouble forming a healthy attachment to their children, difficulty managing their anger and frustration, as well as having an ability to overcome the more natural tendency for caretakers to protect the children they care for.
Perpetrators are also more likely to have a history of either losing a parent or being abused or neglected as a child.
While the symptoms the victim of MSBP presents with are highly variable, they may consist of symptoms that are more easily faked or induced, like suffocation, seizure, bleeding or nausea, vomiting, or diarrhea that can be the result of poisoning.
Theories about what perpetrators gain from assuming the sick role through their child include seeking help, inducing symptoms, and being "addicted" to interactions with medical professionals.
MSBP is usually diagnosed through intense communication between medical, mental-health, and child-protection professionals, as well as review of all available medical records and interviewing family members, school personnel, and other pertinent community members.
Sometimes, covertly videotaping the suspected abuser when with the child can be a useful additional diagnostic tool.
The treatment of MSBP involves close collaboration with professionals, family, and community members, intensive psychotherapy for the victim and the perpetrator, as well protecting the child by either intensive supervision of the perpetrator, temporary or permanent removal of the child from the care of the abuser, and sometimes includes prosecution and incarceration of the perpetrator.
If left untreated, MSBP can result in the child's death or growing up emotionally and/or medically disabled.
Survivors of MSBP are at higher risk of becoming perpetrators themselves.
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