مدل های تشخیص، توضیح و تبیین مونش هاوزن با پروکسی: برون یابی تمارض و فریب

Objective: The overriding objective is a critical examination of Munchausen syndrome by proxy (MSBP) and its closely-related alternative, factitious disorder by proxy (FDBP). Beyond issues of diagnostic validity, assessment methods and potential detection strategies are explored. Methods: A painstaking analysis was conducted of the MSBP and FDBP literature as it relates diagnostic and assessment issues. Given the limitations of this literature, extrapolations were provided from the extensive theory and research on malingering as a related response style. Results: Diagnostic formulations for both MSBP and FDBP de-emphasize the clinical characteristics of the perpetrator. In the case of FDBP, inferential judgments about motivation (e.g., adoption of a sick role) are challenging on conceptual and clinical grounds. When explanatory models from malingering are applied, most research has focused pathogenic models, often allied with psychodynamic thought. Finally, clinical methods for the assessment of MSBP and FDBP are not well developed. Conclusions: Refinements in the conceptualization of MSBP and FDBP can be provided through prototypical analysis. Drawing from malingering research, explanatory models should be expanded to include adaptational and criminological models. Finally, detection strategies for MSBP and FDBP must be formally operationalized and rigorously validated.

The accuracy of symptom presentation is an integral facet of effective evaluations for medical and mental disorders. As noted in a comprehensive review by Cunnien (1997), dissimulation among patient populations covers an array of presentations that vary in the magnitude of distortion, underlying motivations, and detectability. Among these distortions, Munchausen syndrome by proxy (MSBP) is a complex variant of feigning that extends beyond the individual to the fabrication/induction of symptoms in others. To understand MSBP better, the boundaries of this syndrome will be critically examined with a discussion of its place within the broader framework of feigning. This paper is organized into three major sections that progress from theory to practice. First, the conceptualization of MSBP as a syndrome and possible diagnosis is critically examined. Given the imprecision in establishing MSBP as a clinical entity, prototypical analysis is proposed as a systematic method of assessing its representative criteria. Second, the primary motivations for MSBP are explored. For this purpose, explanatory models are borrowed from the malingering literature which has extensively evaluated the likely motivations of feigners. Third, existing detection methods for MSBP are reviewed and found wanting. Extrapolating from malingering research, possible detection strategies are proposed for empirical validation.