Griffith J L
Department of Psychiatry, University of Mississippi Medical Center, Jackson 39216.
Fam Process. 1988 Dec;27(4):423-37. doi: 10.1111/j.1545-5300.1988.00423.x.
Munchausen Syndrome by Proxy describes a parent who fabricates the appearance of physical illness in a child. Previous descriptions of the syndrome have focused exclusively upon medical or psychiatric assessments of the involved child and perpetrating parent. The family evaluations of two cases presented here suggest that Munchausen Syndrome by Proxy may be a systemic syndrome generated when a mother already possessing a somatoform or factitious disorder joins an enmeshed, authoritarian family system possessing a systemic history of exploitation of children. We suggest that measures instituted to protect the abused child must take into account the systemic function of the Munchausen by Proxy behavior in maintaining family stability, lest such measures be rendered ineffective by family members. When there is ongoing victimization of perpetrating parents in a similar pattern of dominance/submission within their own family of origin, disruption of these intergenerational patterns of exploitation may be a necessary component of treatment.
代理型孟乔森综合征描述的是父母编造孩子身体疾病表象的情况。此前对该综合征的描述完全集中在对涉案儿童和施虐父母的医学或精神病学评估上。这里呈现的两个案例的家庭评估表明，代理型孟乔森综合征可能是一种系统性综合征，当已经患有躯体形式障碍或做作性障碍的母亲加入一个存在对儿童进行系统性剥削历史的纠结、专制的家庭系统时就会产生。我们建议，为保护受虐儿童而采取的措施必须考虑到代理型孟乔森行为在维持家庭稳定方面的系统功能，以免这些措施被家庭成员破坏而失效。当施虐父母在自己的原生家庭中以类似的支配/服从模式持续成为受害者时，打破这些代际剥削模式可能是治疗的必要组成部分。
