Jovita Anikinaite1, Asta Dervinyte-Bongarzoni1, Monika Misevice2
1Vilnius University Medical Faculty Psychiatric Clinic, Vilnius, Lithuania
2Republican Vilnius Psychiatric Hospital, Vilnius, Lithuania
Keywords: Pathological child care, abnormal illness behavior, Munchausen syndrome by proxy, hyper-protection, symbiotic relationship, parentectomy.
Pathological care for the child is a psychosocial risk factor, which can lead to various temporary or permanent mental health disorders for the child. It includes a wide spectrum of caregiver’s behavior forms: from hyper-protection to child abuse. More specific forms are those with abnormal illness behavior. Here we present two cases illustrating two different types of it. The first case is Munchausen syndrome by proxy, also known as factitious disorder imposed on other (DSM-V). It is a form of a child abuse, in which a caregiver, typically a mother, fabricates, exaggerates, or induces health problems in her own child. The second case is a milder form of pathological care, which includes hyper-protection and hyper-control, related to symbiotic mother – daughter relationship and complex family anamnesis with schizophrenia spectrum disorder. Cases above represent differential diagnosis and management challenges of abnormal illness behavior. This demonstrates, that in order to give a better care for the child, it is significant to evaluate mother – child relationship, as well as caregiver’s attachment style together with family anamnesis. Team work with adult psychiatrists would be beneficial and of great importance. In cases of hyper-protection and mother’s mental disease, it is recommended to provide a multidisciplinary help in mother – child unit. Advantages of this kind of approach include treatment of mother’s psychiatric disorder, direct observation of mother – child interaction, promotion of a healthy maternal habits and provision of social support. In such environment it would be possible to create appropriate conditions for the development of child’s autonomy. If child abuse is detected during the treatment, child protection service should be included and a possibility of parentectomy might be considered as an extreme mean of child defense.