Yapay bozukluk/bakım verenin yapay bozukluğu olgularına psikodinamik bakış ve klinik yaklaşım: Bir gözden geçirme

Yapay Bozukluk fiziksel veya psikolojik belirtilerin taklit edilmesi, yaralamanın veya hastalığın indüklenmesinin aldatma niyetiyle oluşturulması ile karakterize bir bozukluktur. Bakım verenin Yapay Bozukluğu bir başkasında fiziksel veya psikolojik belirtileri taklit etme, aldatma amaçlı belirtiler üretme, yaralama veya hastalığa neden olmadır. Bu bozuklukta, dışsal bir ödül olmaksızın aldatmaca davranışları belirgindir. Yüksek mortalite ve morbiditeye neden olan ciddi bir çocuk istismarı türüdür. Literatürde, hekimin hastalık hakkında farkındalığının arttırılmasının morbidite ve mortaliteyi azaltacağı veya önleyebileceği belirtilmektedir. Bu bozukluğun belirlenmesi ve sürecin doğru yürütülmesi için multidisipliner yaklaşım hayati öneme sahiptir. Ülkemizde bu hastalarla çalışabilecek multidisipliner ekipler oldukça sınırlı sayıdadır. Hukuk sisteminin bu davalara çok yabancı olduğu, genellikle yasal süreci başlatmadığı ve çocuk istismarını önleyemediği görülmektedir. Bu makalede hastanemizin Çocuk İstismarı Değerlendirme Araştırma ve Tedavi komisyonunun multidisipliner ekip çalışması, klinik deneyimleri ve yazında yer alan olgu serileri göz önüne alınarak Yapay Bozukluk/Bakım verenin Yapay Bozukluğu olgularının biyopsikososyal ve psikodinamik özelliklerini çok boyutlu olarak tartışmak, alan yazın eşliğinde, son bilgiler ışığında bu olgulara yaklaşımla ilgili bir yol haritası sunmak amaçlanmıştır.

Psychodynamic aspects and clinical approach to the concepts of factitious disorder/factitious disorder imposed on another: A review

Factitious Disorder is characterized by fabricating physical or psychological symptoms, injuring or inducing the illness with the intent of deception. Factitious Disorder Imposed on Another is mimicking physical or mental, misleading symptoms, injuring or causing the disease on another. In this disorder, behaviors of deception are obvious, even without any extrinsic reward. It is a severe form of child abuse which leads to high levels of mortality and morbidity. It is stated in the literature that raising awareness of physicians about the disorder can reduce and even sometimes prevent the mortality and morbidity. Multidisciplinary approach is of great significance for the process to be carried out properly and for the disorder to be detected. Turkey suffers from the lack of multidisciplinary teams of physicians who can study and treat such a disorder. It is clear that the judicial system in the country is ignorant of such cases, does not usually commence legal proceedings and cannot prevent the child abuse. This article aims to extensively discuss the biopsychosocial and psychodynamic features of the concepts of factitious disorder and the factitious disorder imposed on another and undertakes to set a course for these concepts in the light of literature research and recent information on the issue, considering the multidisciplinary teamwork conducted by the Commission on Evaluation, Research and Treatment of Child Abuse, clin-ical experiences and a wide range of concept research included in the literature.

Kaynakça

1. Meadow S. Munchausen syndrome by proxy. J Clin Forensic Med 1994; 1: 121-127.

2. Scher LM, Knudsen P, Leamon M. Somatic Symptom and Related Disorders, in The American Psychiatric Publishing Textbook of Psychiatry, Chap. 16, edited by RE. Hales, SC. Yudofsky, LW Roberts with foreword by DJ Kupfer–Sixth Edition, Washington, DC, American Psychiatric Press, 2014, pp. 531-556.

3. Bursch B, Emerson ND, Sanders MJ. Evaluation and management of factitious disorder imposed on another. J Clin Psychol Med Settings 2019; 1-11.

4. Cardona L, Asnes AG. Disclosure of caregiver-fabricated illness to a child: A team-based approach to communicating with pediatric patients. Clin Child Psychol Psychiatry 2019; 24: 494–502.

5. Flaherty EG, MacMillan HL. Caregiver-fabricated illness in a child: a manifestation of child maltreatment. Pediatrics 2013; 132: 590–597.

6. Sousa Filho DD, Kanomata EY, Feldman RJ, Maluf Neto A. Munchausen syndrome and Munchausen syndrome by proxy: a narrative review. Einstein (Sao Paulo) 2017; 15(4):516-521.

7. Fliege H, Grimm A, Eckhardt-Henn A, Gieler U. Martin K, Klapp BF. Frequency of ICD-10 factitious disorder: survey of senior hospital consultants and physicians in private practice. Psychosomatics 2007; 48: 60–64.

8. Bass C, Halligan P. Factitious disorders 2; Factitious disorders and malingering: challendes for clinical assessment and manage-ment. Lancet 2014; 383: 1422-1432.

9. Squires JE, Squires RH. Munchausen syndrome by proxy: ongoing clinical challenges. JPGN 2010; 51: 248–253.

10. Hamilton JC, Feldman MD, Sherwood IM. Factitious Disorder, Munchausen Syndrome, Munchausen by Proxy, and Malingering. Encyclopedia Ment Health 2016; 226-234. doi: 10.1016/B978-0-12-397045-9.00010-0

11. Pavan C, Scarpa C, Bassetto F, Azzi M, Vindigni V. Munchausen’s syndrome in plastic surgery: an interdisciplinary challenge. Plast Reconstr Surg Glob Open 2015; 3: e428

12. Caselli I, Poloni N, Ceccon F, Ielmini M, Merlo B, Callegari C. A systematic review on factitious disorders: psychopathology and diagnostic classification. Neuropsychiatry 2018; 8:281-292.

13. Libow JA. Beyond collusion: active illness falsification. Child Abuse Negl 2002; 26; 525–536

14. Bass C, Jones D. Psychopathology of perpetrators of fabricated or induced illness in children: case series. Br J Psychiatry 2011; 199(2):113-8. https://doi.org/ 10.1192 /bjp.bp.109.074088.

15. Foto-Özdemir D, Yalçın S, Akgül S, Evinç ŞG, Karhan A, Karadag F, Balseven-Odabaşı A, Tekşam Ö, Yıldız İ, Kanbur N, Özmert E, Derman O, Tümer AR, Atik H, İnce T, Yurdakök K, Gökler B, G Kale. Munchausen By Proxy: A Case Series Study From Turkey. J Fam Violence 2015; 30: 661-671. DOI 10.1007/s10896-015-9700-3.

16. Karakoç Demirkaya S, Tağcı S, Aksu H. Hipoglisemi nöbetleri ile başvuran tip-1 diyabetes mellitus tanılı ergen olguda Munchausen Sendromu. Anatolian Journal Of Psychiatry/Anadolu Psikiyatri Dergisi 2016; 17: 91-93.

17. Foto-Özdemir D, Yalçın SS, Zeki A, Yurdakök K, Özusta Ş, Köse A, Karadağ F, Yıldız İ, Balseven-Odabaşı A, Kale G. Munchausen by proxy syndrome presented as recurrent respiratory arrest and thigh abscess: A case study and overview. Turk J Pediatr 2013; 55: 337-343.

18. Yates GP, Feldman MD. Factitious disorder: a systematic review of 455 cases in the professional literature. Gen Hosp Psychiatry 2016; 41: 20–28.

19. Sheridan MS. The deceit continues: an updated literature review of munchausen syndrome by proxy. Child Abuse Negl 2003; 27: 431-451.

20. Davis P, Murtagh U, Glaser D. 40 years of fabricated or induced illness (FII): Where next for paediatricians? Paper 1: Epidemiology and definition of FII. Arch Dis Child 2019; 104: 110–114. https://doi.org/10.1136/archdischild-2017-314319

21. Eisendrath SJ. Current Overview of Factitious Physical Disorders. In The Spectrum of Factitious Disorders. Edited by MD Feldman, SJ Eisendrath, Washington, DC: AmericanPsychiatric Press, 1996, pp.21-36.

22. Sanders MJ. Symptom coaching: Factitious disorder by proxy with older children. Clin Psychol Rev 1995; 15: 423–442.

23. Day LB, Faust J, Black RA, Day DO, Alexander A. Personality profiles of factitious disorder imposed by mothers: a comparative analysis. J Child Custody 2017; 14: 191–208 Https://Doi.Org/10.1080/15379418.2017.1331780

24. Kozlowska K. Abnormal illness behaviors:a developmental perspective. Lancet 2014; 383: 1368-1369.

25. Adshead G, Bluglass K. Attachment representations in mothers with abnormal illness behaviour by proxy. Br J Psychiatry 2005; 187: 328-333.

26. Ehlers W, Plassmann R. Diagnosis of narcissistic self-esteem regulation in patients with factitious illness (Munchausen syndrome). Psychother psychosom 1994; 62: 69-77.

27. Rogers R. Diagnostic, explanatory, and detection models of munchausen by proxy: extrapolations from malingering and deception. Child Abuse Negl 2004; 28:225–39.

28. Yates G, Bass C. The perpetrators of medical child abuse (Munchausen Syndrome by Proxy) – A systematic review of 796 cases. Child Abuse Negl 2017; 72: 45–53.

29. Rosenberg DA. Munchausen syndrome by proxy. Child Abuse Negl 2003; 27: 421–430. https://doi.org/ 10.1016/S1045-2134(03)00029-2.

30. Bools C, Neale B, Meadow R. Munchausen syndrome by proxy: a study of psychopathology. Child abuse negl 1994; 18: 773-788.

31. Schreier H, Libow J. Hurting for Love -Munchausen by Proxy Syndrome. New York, Guildford Press, 1993.

32. Bass C, Glaser D. Factitious disorders 1; Early recognition and management of fabricated or induced illness in children. Lancet 2014; 383: 1412-1421.

33. Schreier, H. Munchausen by Proxy defined. Pediatrics 2002; 110: 985–988.

34. Lopez-Rico M, Lopez-Ibor JJ, Crespo-Hervas D, Muñoz-Villa A, Jimenez-Hernandez JL. diagnosis and treatment of the factitious disorder on another, previously called munchausen syndrome by proxy. Compr Clin Med 2019; 1: 419–433.https://doi.org/10.1007/s42399-019-00057-6

35. Maldonado JR. When parents deceive their children's doc-tors: a review of factitious disorder by proxy . Am J Forensic Psychiatry 2002; 23: 29-58.

36. Criddle L. Monsters in the closet: munchausen syndrome by Proxy. Crit Care Nurse 2010; 30: 46-55.

37. Meadow R: Munchausen syndrome by proxy abuse perpe-trated by men. Arch Dis Child 1998; 78: 210-216

38. Stirling J. Beyond munchausen syndrome by proxy: identifi-cation and treatment of child abuse in a medical setting. Pediatrics 2007; 119: 1026-1030.

39. Roesler TA. Medical child abuse: what have we learned in 40 years? Curr Treat Options Peds 2018; 4: 363–372. DOI 10.1007/s40746-018-0136-x

40. Foto Özdemir D, Gökler B, Evinç ŞG, Balseven-Odabaşı A. Paylaşılmış Ailesel Psikoz Kapsamında Bir “Bakım Verenin Yapay Bozukluğu” Olgusu. Türk Psikiyatri Dergisi 2013; 24: 275-279. DOI: 10.5080/u6990.

41. Sharif I. Munchausen syndrome by proxy. Pediatr Rev 2004; 25: 215-216.

42. Martinovic Z. Fictitious epilepsy in munchausen syndrome by proxy: family psychodynamics. Seizure 1995; 4:129-134

43. Foto Özdemir D, Karakok B, Yalçın SS. Factitious Disorder Presented by Haematemesis / Factitious Disorder Imposed on Another (FDIA): A Case Report. Turk J Psychiatry 2020; DOI :10.5080/u24988. In press

44. Awadallah N. Munchausen by proxy: a case, chart series, and literature review of older victims. Child Abuse Negl 2005; 29:931–941

45. Marcus A, Ammermann C, Klein M, Schmidt MH. Munchausen syndrome by proxy and factitious illness: symp-tomatology, parent-child interaction, and psychopathology of the parents. Eur child adolesc psychiatry 1995; 4: 229-236.

46. Precey G. Assessment issues in working with mothers who induce illness in their children Child Fam Soc Work 1998; 3: 227-237.

47. Libow JA, Schreier HA. Three forms of factitious illness in children: when is it Munchausen syndrome by proxy? Am J Orthopsychiatry 1986; 56: 602-611.

48. Conway SP, Pond MN. Munchausen syndrome by proxy abuse: a foundation for adult munchausen syndrome. Aust N Z J Psychiatry 1995; 29: 504–507.

49. Taylor DC. Parental persuasion to sickness. Occasional Papers-Association for Child Psychology and Psychiatry 1996; 13-16.

50. Roesler T, Jenny C. Medical Child Abuse. Beyond Munchausen Syndrome by Proxy. Elk Grove Village, IL: Am Acad Pediatrics 2008.

Kaynak Göster

  • ISSN: 1302-0099
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1998

6.9b4.5b