Abstract â–¡ 125

At the conclusion of this presentation the participants should be able to:-

1) recognise the factors associated with these disorders, 2) to evaluate the contribution of factitious or other illness behaviour in the parent, 3) be able to recognise the part which unconscious mechanisms may play, 4) to demonstrate to Child Protection agencies, Social Workers, legal advisors and the Courts the distinction between understanding the possible behaviours on the one hand, and on the need to evaluate risk on the other and finally, 5) be able to recognise where possible treatment/intervention may be indicated and where it is unlikely to be of benefit.

Factitious Disorder imposed on children (Factitious Disorder by Proxy, Munchausen Syndrome by Proxy, Meadow's Syndrome) like other forms of child abuse is increasingly recognised. Often there is severe illness behaviour in the parent or other help-seeking behaviour. Risk to the child or children can range from mild to potentially dangerous, or to serious life threatening episodes.

General psychiatrists may have little experience of the imposed (by proxy) form until asked to provide a report for the court on the parent's mental state. Knowledge of the existense of the syndrome sometimes leads defense attorneys to assume that a "diagnosis" of MSBP will be a mitigating factor to their client. It is becoming increasingly important to evaluate the parent(s) fully with a view to describing the behaviours and potentials risks to the child rather than to categories as MSBP or not. Child Protections issues are paramount. Consultation liaison issues, helping paediatric teams to manage and in some cases confirm the existence of such behaviour in a parent will be included. The issues in some centres (for example in the UK and Australia) of collaborating in procedures such as CVS (covert video surveillance) will be debated. The management of the family, social intervention whilst investigation is proceedings, and in the long term, will be addressed.

Understanding of the various possible motivations, manipulative behaviours unconscious mechanisms (eg dissociation, denial) in persons of apparently good previous personality and their capacity to split and divide paediatric / consultation liaison / family practice teams will be explained and highlighted.