Munchausen by Proxy Essay

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Child and Adolescent Social Work Journal, Vol. 21, No. 2, April 2004 ( 2004)
Munchausen Syndrome by Proxy:
Some Practice Implications for Social Workers
Margarete Parrish, Ph.D., L.C.S.W.-C. and Jay Perman, M.D.
ABSTRACT: The medical and psychosocial complexities involved in cases of Munchausen Syndrome by Proxy typically necessitate carefully organized interdisciplinary responses. The role of social work in the effectiveness of such responses is both crucial and historically under-considered in the existing literature. This article presents the historical and specific diagnostic components of this complex and perplexing condition, along with practice guidelines for clinical responses, with information relevant to child protection issues across multiple settings.
KEY WORDS: Munchausen Syndrome; Factitious Disorder by Proxy; Child Maltreatment.
Case Scenario
Arnie, age five, has a history of unexplained episodes of nausea. Throughout his infancy and childhood, Arnie’s parents have made elaborate dietary efforts to find foods and milk products to which Arnie does not become “allergic.” He has been admitted with dehydration to a teaching hospital at which his father recently received his nursing training. Although somewhat shy, and reluctant to interact with other children, Arnie is a very pleasant, polite child. He is small for his age, but otherwise medically normal. This is his third admission this year. Arnie’s parents both exhibit intense distress and concern about Arnie’s medical condition. His mother is an attorney, whose practice is very popu-

Margarete Parrish is Assistant Professor, University of Maryland School of Social Work. Jay Perman is Chair, Department of Pediatrics, University of Maryland School of Medicine.
Address correspondence to Margarete Parrish, University of Maryland School of Social Work, 525 West Redwood St., Baltimore, MD 21201; e-mail: mparrish@ssw
.umaryland.edu
137  2004 Human Sciences Press, Inc.
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