Munchausen Syndrome by Proxy as a Cause of Child Abuse

Munchausen syndrome by proxy (MSBP) is a rare form of mental disorder and is known as a particular type of child abuse. MSBP has been described since 1977 as a severe form of abuse with illness falsification or the intentional harming by guardians, mostly mothers. The perpetrator of MSBP may inflict damage to the child directly or indirectly through medical procedures. The perpetrator’s alleged motive is to satisfy her psychological needs, and she has a history of mental illness, mostly, factitious disorder, personality disorder, and somatic disorder. The pathology is not well known; as such, it is difficult for medical personnel to detect it early. In addition, it is hard to be handled effectively by the police and child welfare agencies because of the scarcity of evidence. Therefore, the authors attempt to examine the essential information from early detection and child abuse prevention by analyzing its clinical characteristics and the perpetrator’s characteristics, including alerting signs of MSBP. For this purpose, we focus on the role of nursing staff to detect this unusual cause of child abuse.

A descriptive, retrospective case series of patients with factitious disorder imposed on self

Background Despite cases of factitious disorder imposed on self being documented in the literature for decades, it appears to remain an under-identified and under-diagnosed problem. The present study aimed to explore factitious disorder imposed on self in a series of French patients. Methods Patients 18 years old and over with factitious disorder imposed on self were retrospectively included by two independent reviewers according to DSM-5 criteria in Rennes University Hospital for the period 1995 to 2019. Patients were identified from a clinical data warehouse. Results 49 patients with factitious disorder imposed on self were included. Among them, 36 (73.5%) were female. The average age at diagnosis was 38.4 years. The 16 patients with a health-related profession were all female. Direct evidence of falsification was found in 20.4% of cases. Falsification was mainly diagnosed on the basis of indirect arguments: history of factitious disorder diagnosed in another hospital (12.2%), extensive use of healthcare services (22.4%), investigations that were normal or inconclusive (69.4%), inconsistent or incomplete anamnesis and/or patient refusal to allow access to outside information sources (20.4%), atypical presentation (59.2%), evocative patient behaviour or comments (32.7%), and/or treatment failure (28.6%). Dermatology and neurology were the most frequently involved specialities (24.5%). Nine patients were hospitalized in intensive care. Some of them received invasive treatments, such as intubations, because of problems that were only reported or feigned. The diagnosis of factitious disorder imposed on self was discussed with the patient in 28 cases (57.1%). None of them admitted to making up the disorder intentionally. Two suicide attempts occurred within 3 months after the discussion of the diagnosis. No deaths were recorded. 44.9% of the patients returned to the same hospital at least once in relation to factitious disorder imposed on self. Conclusions The present study reinforces data in favour of a predominance of females among patients with factitious disorder imposed on self. This diagnosis is difficult and is based on a range of arguments. While induced cases can be of low severity, cases that are only feigned can lead to extreme medical interventions, such as intubation.

The Case of Kilian Jornet: Factitious Heroism

| None of the hundreds of millions of people, from May 2017 to the present, who were presented reports that Kilian Jornet reached the summit of Mt. Everest twice in May 2017, uncovered the intricate, multifaceted fraud of his. This is a case of Factitious Heroism, a condition which is discussed by Dr. Marc Feldman. Kilian's factitious presentation was done in order to motivate others to conceive of him as being a sports hero, and concurrently, in order to receive immense and enduring gratification via innumerable worldwide media-reports, and in order to obtain financial improvement.| This case is akin to my Factitious Disorder By Proxy and Factitious Heroism autism cases, and aspects of my physics and mathematics case.| Kilian Jornet reported reaching the summit of Mt. Everest, via the North Route, solo, without oxygen, and without fixed-ropes, on May 22 at 12:00am, and again on May 27 at 9:30pm. For both of his climbs, he has no summit photos, no summit video, and no summit witnesses. His GPS tracking for the 27th begins at 8650m and descends from there. His GPS tracking for the 22nd gives a highpoint elevation reading of just over 8500m. For both of his climbs, he was a multitude of hours from the summit when he turned back. For both of his climbs, he did not call anyone via his satellite-smartphone from the summit, nor near the summit. 4 climbers, of 2 separate climbing groups (of 2 climbers each), 2 from the USA and 2 from India, and who were separated from one another by several hours, and who climbed to the summit from Camp 4 on May 21-22 on the same route as Kilian, would have each been passed by Kilian during his descent, and within inches or feet of each other, and would have each seen his headlamp a multitude of times as he ascended and descended. The 2 Indian climbers came forward to the media to report that it is impossible that Kilian summitted at 12:00am on May 22 because they would have seen him as described above. The 2 USA climbers indicated to me that they hold this opinion as well. Over 1 year later, Kilian submitted claimed summit-photos and claimed summit-video, for both of his claimed summits, all of which are 100% dark except for minimal illumination of his face and upper torso, as he did not use his headlamp nor GoPro light to illuminate any of the surface of the mountain, which could have easily been done to show that he was at the summit – he could have illuminated the highly recognizable summit surface (its general shape), and the abundant summit-flags and other summit-objects. For all of Kilian's other mountain climbs and mountain runs, for his several year Summits of My Life project, he has abundant summit-photos, summit-video, summit-witnesses, and complete and accurate GPS tracking. For both of Kilian's Everest attempts, he began his ascents during hours of the day that are the opposite to what all other climbers do, namely in the late afternoon and early evening. Climbers do not climb during these times because the increase of temperature, the presence of sunlight, and the increase of wind, cause changes to the mountain surface such that chance of rock-fall, ice-fall, and opening-crevasses increases dramatically, and become extreme dangers to one's life. Kilian claimed to not climb with fixed-ropes for either climb. However, his self-taken GoPro video on May 27 shows that he used fixed-ropes. Despite that it is the highest elevation video of himself on Everest, he did not provide the video to any media, nor on his website. Apparently it was inadvertently provided to a French media who did a YouTube video about Kilian, which was never linked to nor mentioned by any other media. Kilian stated that his Suunto watch battery failed for his May 22 climb shortly below the summit (several hours below the summit). However, Suunto watch batteries last for many years. Over 1 year after my case-report began to be disseminated and discussed in many countries and by minor-media and major-media, Kilian reported to a forum-user of LetsRun.com, Andy Tavin, that he has GoPro GPS tracking for both of his climbs. Kilian took about 2 months to provide the data to the Andy. Andy wrote his own case-report on the matter in early 2019, using much of my case-report for his own report. Unlike Kilian's above Suunto GPS data, which was auto-uploaded to his Suunto Movescount.com account-webage, Kilian has never provided his claimed GoPro data to any media, nor published it. It was likely manually contrived post-controversy. Of Kilian's claimed summit-video, he likely went back to the rock-band that he videoed himself at previously (mentioned above), at night, and took the video, as all aspects of the video are essentially identical to his above video, except that it is dark. There are other aspects of my case-report that are not summarized above.| All of my other references are listed within the below case-report.

The Case of Kilian Jornet: Factitious Heroism

| None of the hundreds of millions of people, from May 2017 to the present, who were presented reports that Kilian Jornet reached the summit of Mt. Everest twice in May 2017, uncovered the intricate, multifaceted fraud of his. This is a case of Factitious Heroism, a condition which is discussed by Dr. Marc Feldman. Kilian's factitious presentation was done in order to motivate others to conceive of him as being a sports hero, and concurrently, in order to receive immense and enduring gratification via innumerable worldwide media-reports, and in order to obtain financial improvement.| This case is akin to my Factitious Disorder By Proxy and Factitious Heroism autism cases, and aspects of my physics and mathematics case.| Kilian Jornet reported reaching the summit of Mt. Everest, via the North Route, solo, without oxygen, and without fixed-ropes, on May 22 at 12:00am, and again on May 27 at 9:30pm. For both of his climbs, he has no summit photos, no summit video, and no summit witnesses. His GPS tracking for the 27th begins at 8650m and descends from there. His GPS tracking for the 22nd gives a highpoint elevation reading of just over 8500m. For both of his climbs, he was a multitude of hours from the summit when he turned back. For both of his climbs, he did not call anyone via his satellite-smartphone from the summit, nor near the summit. 4 climbers, of 2 separate climbing groups (of 2 climbers each), 2 from the USA and 2 from India, and who were separated from one another by several hours, and who climbed to the summit from Camp 4 on May 21-22 on the same route as Kilian, would have each been passed by Kilian during his descent, and within inches or feet of each other, and would have each seen his headlamp a multitude of times as he ascended and descended. The 2 Indian climbers came forward to the media to report that it is impossible that Kilian summitted at 12:00am on May 22 because they would have seen him as described above. The 2 USA climbers indicated to me that they hold this opinion as well. Over 1 year later, Kilian submitted claimed summit-photos and claimed summit-video, for both of his claimed summits, all of which are 100% dark except for minimal illumination of his face and upper torso, as he did not use his headlamp nor GoPro light to illuminate any of the surface of the mountain, which could have easily been done to show that he was at the summit – he could have illuminated the highly recognizable summit surface (its general shape), and the abundant summit-flags and other summit-objects. For all of Kilian's other mountain climbs and mountain runs, for his several year Summits of My Life project, he has abundant summit-photos, summit-video, summit-witnesses, and complete and accurate GPS tracking. For both of Kilian's Everest attempts, he began his ascents during hours of the day that are the opposite to what all other climbers do, namely in the late afternoon and early evening. Climbers do not climb during these times because the increase of temperature, the presence of sunlight, and the increase of wind, cause changes to the mountain surface such that chance of rock-fall, ice-fall, and opening-crevasses increases dramatically, and become extreme dangers to one's life. Kilian claimed to not climb with fixed-ropes for either climb. However, his self-taken GoPro video on May 27 shows that he used fixed-ropes. Despite that it is the highest elevation video of himself on Everest, he did not provide the video to any media, nor on his website. Apparently it was inadvertently provided to a French media who did a YouTube video about Kilian, which was never linked to nor mentioned by any other media. Kilian stated that his Suunto watch battery failed for his May 22 climb shortly below the summit (several hours below the summit). However, Suunto watch batteries last for many years. Over 1 year after my case-report began to be disseminated and discussed in many countries and by minor-media and major-media, Kilian reported to a forum-user of LetsRun.com, Andy Tavin, that he has GoPro GPS tracking for both of his climbs. Kilian took about 2 months to provide the data to the Andy. Andy wrote his own case-report on the matter in early 2019, using much of my case-report for his own report. Unlike Kilian's above Suunto GPS data, which was auto-uploaded to his Suunto Movescount.com account-webage, Kilian has never provided his claimed GoPro data to any media, nor published it. It was likely manually contrived post-controversy. Of Kilian's claimed summit-video, he likely went back to the rock-band that he videoed himself at previously (mentioned above), at night, and took the video, as all aspects of the video are essentially identical to his above video, except that it is dark. There are other aspects of my case-report that are not summarized above.| All of my other references are listed within the below case-report.

The factitious/malingering continuum and its burden on public health costs: a review and experience in an Italian neurology setting

Factitious disorder is classified as one of the five aspects of somatic symptom disorders. The fundamental element of factitious disorder is deception, i.e., pretending to have a medical or psychiatric disorder, but the enactment of deception is considered unconscious. Indeed, volition, i.e., the perception of deliberate deception, is blurred in patients presenting with factitious disorder. In the USA and the UK, factitious disorder has received constant media attention because of its forensic implications and outrageous costs for the National Health Systems. Unfortunately, a comparable level of attention is not present in Italian National Health System or the Italian mass media. The review analyzes the classifications, disorder mechanisms, costs, and medico-legal implications in the hope of raising awareness on this disturbing issue. Moreover, the review depicts 13 exemplification cases, anonymized and fictionalized by expert writers. Finally, our paper also evaluates the National Health System’s expenditures for each patient, outlandish costs in the range between 50,000 and 1 million euros.