麻豆传媒

HONOLULU -- Although most reported cases of Munchausen-by-proxy syndrome involve children, adults can also be victims, a researcher said here.

A search of Mayo Clinic patient records turned up six cases of Munchausen by proxy with victims in their late teens and 20s, said George Deimel, MD, of the clinic's headquarters in Rochester, Minn.

In three of the cases, the victims appeared to be willing participants by giving false history information or helping to induce real symptoms, Deimel said at the American Psychiatric Association meeting here.

The syndrome involves one person artificially producing or faking symptoms in another person so as to attract attention of medical personnel. Typically, the proxy is a parent and the victim is his or her child.

The six cases presented by Deimel followed that pattern except the victims were fully grown. He said isolated cases had been reported previously but this is the first series to be identified at a single institution.

He told 麻豆传媒 that he and colleagues had seen two cases within a year. That raised their suspicion that others had presented similarly, so they reviewed records going back to 1994, looking for references to Munchausen or factitious disorder diagnoses.

Out of about 150 results of the search, the researchers found four others with adult victims in addition to the initial two.

Victims ranged in age from 18 to 28 and five of them were women. Three had attended college; one had just finished high school; and two were considered mentally retarded or developmentally delayed.

All of the proxies included the victims' mothers, with fathers also participating in two cases.

In one case, the victim died of sepsis resulting from the Munchausen scheme. Deimel explained that the victim, a 21-year-old female, had presented repeatedly with bacteremia. Her physicians, including Deimel, eventually discovered a syringe under her hospital mattress.

They determined that the victim and both parents had collaborated in deliberately producing the bacteremia from which she soon died.

In another case, the victim had presented with a mysterious rash that, her mother claimed, had baffled physicians at other institutions. Deimel and colleagues checked with her previous doctors, one of whom tipped them to the likelihood of Munchausen by proxy, specifically involving the mother.

When they barred the mother from visiting the daughter, the rash cleared up, Deimel said.

He said it was common for the patients and parents to visit several increasingly prestigious institutions with their complaints, very much like a game in which the goal was to keep the treating physicians baffled. He noted that one case had been seen at Northwestern University Medical Center in Chicago and at the Cleveland Clinic before coming to the Mayo Clinic.

Because of Mayo's reputation, having a Munchausen-by-proxy patient seen there was "like the Super Bowl" for them, Deimel told 麻豆传媒.

He added that the six cases identified as Munchausen by proxy at Mayo were probably a small fraction of the total number of cases, as most of the time the perpetrators succeed in deceiving the doctors.

Tipoffs include discrepancies between reported histories and clinical observations, odd mixes of symptoms that don't point to a unifying etiology, and an "overly involved" caregiver.

Deimel also suggested that a version of the "Stockholm syndrome," in which hostages and kidnap victims ally themselves with their captors, may come into play as the patients become active participants in the scheme.

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