Munchausen Syndrome

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Classification according to ICD-10
F68 Other personality and behavioral disorders
F68.1 Artificial disorder (deliberate creation or pretense of physical or psychological symptoms or disabilities)
Munchausen syndrome
Hospital hopper syndrome (hospital jumper)
ICD-10 online (WHO version 2019)

The Munchausen syndrome (also referred to as "artificial disorder", from French artificiel 'artificial' , also luminary killer syndrome , English factitious disorder ) is a mental disorder in which those affected invent or cause physical complaints themselves and mostly plausible and present dramatically.

The name was coined in 1951 by the London psychiatrist Sir Richard Asher (1912–1969) after Baron Münchhausen , the "baron of lies". The spelling “Munchausen” is mostly used in English publications.

Clinical picture

Compared to patients with similar disorders such as conversion syndromes , somatization and hypochondria , patients with Munchausen syndrome are rare and much more difficult to detect. They are mostly middle-aged men. Recent long-term studies have shown that menopausal women also suffer from Munchausen syndrome more often. Furthermore, the syndrome occurs more frequently in people with pronounced identity disorders or self-esteem deficits in personality disorders of the borderline , narcissistic or antisocial type.

It is typical to visit numerous doctors and hospitals with varying, arbitrary, but pronounced symptoms (e.g. abdominal pain, neurological complaints such as headache, loss of consciousness and "seizures"; lung and stomach "bleeding"), a high frequency of complex apparatus Examinations and operations as well as usually quick doctor and hospital changes as soon as the treatment request is not met or a practitioner suspects (“ hospital hopper syndrome ”).

The gain in illness is the acquisition of medical attention (medical examinations, hospital admission, diagnostic and therapeutic procedures up to and including unnecessary surgical interventions). People are prone to self-harm or poisoning to prove their illness, and they often require serious medical examinations and interventions that can cause or worsen the simulated disease. Doctors run the risk of becoming “accomplices” of self-harm and being sued for damages for their negligent assistance .

The aim and motive of those affected is often to get affection and compassion from doctors, nursing staff, family members or via the Internet. Further possible motifs, see below. Patients usually switch doctors immediately as soon as the possibility of mental illness is raised; they evade psychiatric referrals and examinations. As a rule, patients also evade psychotherapeutic treatment.

Classification

Patients with Munchausen syndrome often suffer from other mental disorders such as self-harm , borderline personality disorders or aggressive personality disorder . According to the specialist literature (Eckhardt), the artificial disorder (the Münchhausen syndrome) is understood as a form of self-harming or self-harming behavior in the context of borderline personality disorder. Most patients also have pronounced identity disorders or self-esteem deficits. Munchausen syndrome is similar to the historical diagnosis of Pseudologia phantastica ( Anton Delbrück , 1891).

As with the borderline personality disorder, unfavorable psychosocial growth conditions (possibly also real trauma ) in childhood and adolescence are discussed as the cause of the disorder (detailed description by Eckhardt).

Munchausen proxy syndrome

A special form is the Munchausen syndrome by proxy , also Munchausen by Proxy Syndrome or advanced Munchausen syndrome ( English Munchausen by proxy syndrome (MbPS), factitious disorder imposed on another ). It occurs when people (predominantly women, mothers) have a close relative (= proxy), usually a child, but also e.g. B. inflict artificial symptoms of illness or physical injuries to the partner, a sick person or person in need of care, damage them medically (e.g. through incorrect or polymedication, poisoning with medication, drugs, toxic substances, withholding necessary medication or medical measures, malnutrition) , aggravate existing diseases and / or prevent their recovery in order to look after and care for the victims (" symptom carriers ") seemingly loving and self-sacrificing and avoid unnecessary, dangerous and / or harmful medical procedures (diagnostics and / or therapies (by doctors and / or the perpetrator himself)). Possible motifs include a. Attention, interpersonal and social recognition (by partners, doctors and clinic staff, social environment, media), emotional and material affection and support, appreciation in the caring role, compensation for deficits in self-esteem , helper syndrome , dependency of the victim, power and control, "symbiotic Relationship ”, emotion control, compensation of inner emptiness and states of tension and hidden acting out of anger and aggressive impulses are discussed.

The “classic” form of Munchausen proxy syndrome is “a combination of physical and emotional abuse and medical neglect in which one parent (statistically almost only mothers) harms children [and fakes disease symptoms, artificially created or exaggerated] by exposes them to unnecessary, dangerous and / or harmful medical procedures (diagnostics and / or therapy). ”It is a subtle form of child abuse that can lead to the death of the victim.

In the even rarer form of Münchhausen by Adult Proxy Syndrome , basically the same thing happens as between mother and child, only between two adults, which is considered to be even more difficult to diagnose. For example, a partner could play the role of a self-sacrificing caring woman towards the partner and the outside world and ensure that her partner does not get well, depends on her and remains dependent (in a helpless, " child-like " relationship) (for possible motives, see above ) .

This diagnosis is relatively rare and, according to ICD-10 , is currently classified under artificial disorders , subtype “unspecified simulated disorder” (F 68.1) and physical abuse (T 74.1). However, simulated disorders as such are described as " probably the most common unrecognized mental illness ". The diagnostic conceptualization of the Munchausen proxy syndrome ( Munchhausen by proxy syndrome and Munchhausen by adult proxy syndrome ) for the planned inclusion of the diagnosis in the future ICD-11 is currently still being discussed.

In some cases, pets as "are proxies " (English: proxies ) described. Thomas Mann describes such a case in his novella Tobias Mindernickel .

See also

literature

  • Henrik Uwe Peters: Dictionary of Psychiatry and Medical Psychology. 3rd, revised and expanded edition. Urban and Schwarzenberg, Munich et al. 1984, ISBN 3-541-04963-4 .
  • Ralph-Martin Schulte (Ed.): Intracorporeal foreign bodies and Münchhausen syndrome. Game types, motivation and complications of self-harm. W. Zuckschwerdt, Munich et al. 1988, ISBN 3-88603-231-0 .
  • Annegret Eckhardt: The Münchhausen Syndrome. Forms of self-manipulated disease. Urban and Schwarzenberg, Munich et al. 1989, ISBN 3-541-11821-0 (At the same time: Marburg, University, dissertation, 1987).
  • Annegret Eckhardt: Artificial disturbances. In: Deutsches Ärzteblatt . Vol. 93, No. 24, 1996, pp. 1622–1626, ( digitized version (PDF; 201.2 kB) ).
  • Reinhard Plaßmann: Artificial diseases and Münchhausen syndromes. In: Mathias Hirsch (ed.): Your own body as an object. On the psychodynamics of self-destructive body acting. Unchanged reprint. Psychosozial-Verlag, Giessen 1998, ISBN 3-932133-33-1 , pp. 118-154.
  • Marc D. Feldman: Munchausen by Internet. Detecting Factitious Illness and Crisis on the Internet. In: Southern Medical Journal. Vol. 93, No. 7, 2000, ISSN  0038-4348 , pp. 669-672, doi: 10.1097 / 00007611-200093070-00006 , PMID 10923952 .
  • Markus Reuber, Martin Zeidler, Jeremy Chataway, Martin Sadler: Munchausen syndrome by phone. In: The Lancet . Vol. 356, No. 9238, 2000, p. 1358, doi: 10.1016 / S0140-6736 (05) 74272-0 .
  • Eberhard Hildebrand, Klaus Hitzer, Klaus Püschel : Simulation and self-harm. With a special focus on insurance fraud. VVW, Karlsruhe 2001, ISBN 3-88487-906-5 .

The specialist literature describes the transition from Münchhausen syndrome to Münchhausen deputy syndrome and vice versa as flowing:

  • Roy Meadow: Munchausen syndrome by proxy: The hinterland of child abuse. In: The Lancet . Vol. 310, No. 8033, 1977, pp. 343-345, doi: 10.1016 / S0140-6736 (77) 91497-0 .
  • JO Warner, MJ Hathaway: Allergic form of Meadow's syndrome (Munchausen by proxy). In: Archives of Disease in Childhood. Volume 59, Number 2, February 1984, pp. 151-156, PMID 6703765 , PMC 1628464 (free full text).
  • Donna A. Rosenberg: Web of deceit: A literature review of Munchausen by proxy syndrome. In: Child Abuse & Neglect. Vol. 11, No. 4, 1987, pp. 547-763, doi: 10.1016 / 0145-2134 (87) 90081-0 .
  • D. Roth: How "Mild" is Mild Munchausen Syndrome by Proxy. In: Israel Journal of Psychiatry and Related Sciences. Vol. 27, No. 3, 1990, ISSN  0333-7308 , pp. 160-167.
  • AB Prakken, L. den Hartog, JJ Waelkens: Een nieuwe variant van het syndroom van Münchhausen by proxy: de vader in een actieve rol. In: Tijdschrift voor Kindergeneeskunde. Vol. 59, No. 3, 1991, ISSN  0376-7442 , pp. 91-94.
  • Toni Single, Richard Leigh Henry: An unusual case of Munchausen syndrome by proxy. In: Australian & New Zealand Journal of Psychiatry. Vol. 25, No. 3, 1991, ISSN  0004-8674 , pp. 422-425, doi: 10.3109 / 00048679109062646 .
  • CN Bools, BA Neale, SR Meadow: Co-morbidity associated with fabricated illness (Munchausen syndrome by proxy). In: Archives of Disease in Childhood. Vol. 67, No. 1, 1992, pp. 77-79, doi: 10.1136 / adc.67.1.77 .
  • CN Bools, BA Neale, SR Meadow: Follow up of victims of fabricated illness (Munchausen syndrome by proxy). In: Archives of Disease in Childhood. Vol. 69, No. 6, 1993, pp. 625-630, doi: 10.1136 / adc.69.6.625 .
  • Abdul Kader Souid, Ken Korins, David Keith, Stephen Dubansky, P. David Sadowitz: Unexplained Menorrhagia and Hematuria: Case Report of Munchausen's Syndrome by Proxy. In: Pediatric Hematology and Oncology . Vol. 10, No. 3, 1993, ISSN  0888-0018 , pp. 245-248, doi: 10.3109 / 08880019309029491 .
  • Herbert A. Schreier, Judith A. Libow: Hurting for love. Munchausen by proxy syndrome. Guilford Press, New York NY et al. 1993, ISBN 0-89862-121-6 .
  • Herbert A. Schreier, Judith A. Libow: Munchausen by proxy Syndrom: A Modern Pediatric Challenge. In: The Journal of Pediatrics. Vol. 125, No. 6, Part 2, 1994, ISSN  0022-3476 , pp. S110-S115, doi: 10.1016 / S0022-3476 (05) 82934-8 .
  • M. Krupinski, M. Soyka, E. Tusch-Bauer, R. Frank: Muenchhausen-by-proxy syndrome: an interdisciplinary challenge. In: Neurology. Vol. 14, 1995, ISSN  0722-1541 , pp. 348-356.
  • Stephen J. Boros, Janice P. Ophoven, Robin Andersen, Lauren C. Brubaker: Munchausen syndrome by proxy: a profile for medical child abuse. In: Australian Family Physician. Vol. 24, No. 5, 1995, ISSN  0300-8495 , pp. 768-769, 772-773.
  • Judith A. Libow: Munchausen by proxy victims in adulthood: a first look. In: Child Abuse & Neglect. Vol. 19, No. 9, 1995, ISSN  0145-2134 , pp. 1131-1142, doi: 10.1016 / 0145-2134 (95) 00073-H .
  • Paul DiBiase, Hilary Tirnmis, Jose A. Bonilla, Wasyl Szeremeta, J. Christopher Post: Munchausen syndrome proxy complicating ear surgery. In: Archives of Otolaryngology - Head & Neck Surgery. Vol. 122, No. 12, 1996, ISSN  0003-9977 , pp. 1377-1380, doi: 10.1001 / archotol.1996.01890240083018 .
  • Jenny Gray, Arnon Bentovim: Illness Induction Syndrome. In: Child Abuse & Neglect. Vol. 20, No. 8, 1996, pp. 655-673, doi: 10.1016 / 0145-2134 (96) 00055-5 .
  • Roy Meadow: Munchausen Syndrome by Proxy. In: Roy Meadow (Ed.): ABC of Child Abuse. 3. Edition. BMJ, London 1997, ISBN 0-7279-1106-6 , pp. 47-50.
  • Michelle Bryk, Pamela T. Siegel: My mother caused my illness: The story of a survivor of Münchausen by proxy syndrome. In: Pediatrics . Vol. 100, No. 1, 1997, pp. 1-7, doi: 10.1542 / peds.100.1.1 .
  • Klaus M. Keller, Meinolf Noeker, C. Hilliges, Hans-Gerd Lenard, Michael J. Lentze: Münchhausen-by-proxy-Syndrom. In: Monthly Pediatrics . Vol. 145, No. 11, 1997, pp. 1156-1162, doi: 10.1007 / s001120050211 .
  • Kenneth W. Feldman, Robert O. Hickman: The Central Venous Catheter as a Source of Medical Chaos in Munchausen Syndrome by Proxy. In: Journal of Pediatric Surgery. Vol. 33, No. 4, 1998, ISSN  0022-3468 , pp. 623-627, doi: 10.1016 / S0022-3468 (98) 90329-3 .
  • R. Meadow: Munchausen syndrome by proxy abuse perpetrated by men. In: Archives of Disease in Childhood. Volume 78, Number 3, March 1998, pp. 210-216, PMID 9613349 , PMC 1717505 (free full text).
  • R. Meadow: Unnatural sudden infant death. In: Archives of Disease in Childhood. Volume 80, Number 1, January 1999, pp. 7-14, PMID 10325752 , PMC 1717785 (free full text).
  • David E. Hall, Laura Eubanks, Swarnalatha Meyyazhagan, Richard D. Kenney, Sherry Cochran Johnson: Evaluation of Covert Video Surveillance in the Diagnosis of Munchausen Syndrome by Proxy: Lessons From 41 Cases. In: Pediatrics. Vol. 105, No. 6, 2000, pp. 1305-1312, doi: 10.1542 / peds.105.6.1305 .
  • SJ Denny, CC Grant, R. Pinnock: Epidemiology of Munchausen syndrome by proxy in New Zealand. In: Journal of Paediatrics and Child Health. Vol. 37, No. 3, 2001, pp. 240-243, doi: 10.1046 / j.1440-1754.2001.00651.x .
  • HMC Munro, MV Thrusfield: 'Battered Pets': Munchausen syndrome by proxy (factitious illness by proxy). In: Journal of Small Animal Practice. Vol. 42, No. 8, 2001, ISSN  0022-4510 , pp. 385-389, doi: 10.1111 / j.1748-5827.2001.tb02486.x .
  • HS Tucker, F. Finlay, S. Guiton: Munchausen syndrome involving pets by proxies. In: Archives of Disease in Childhood. Vol. 87, No. 3, 2002, pp. 263-265, doi: 10.1136 / adc.87.3.263 .
  • Herbert Schreier: On the importance of motivation in Munchausen by Proxy: the case of Kathy Bush. In: Child Abuse & Neglect. Vol. 26, No 5, 2002, pp. 537-549, doi: 10.1016 / S0145-2134 (02) 00329-0 .
  • Julie Gregory: You made me sick. My mother made me suffer. Ehrenwirth, Bergisch Gladbach 2004, ISBN 3-431-03602-3 .
  • Sabine Nowara: The Münchhausen-by-proxy-Syndrome. In: Günther Deegener, Wilhelm Körner (Hrsg.): Child abuse and neglect. A manual. Hogrefe, Göttingen et al. 2005, ISBN 3-8017-1746-1 , pp. 128-140.

Web links

Individual evidence

  1. ↑ In: Lancet. 1951 Feb 10; 1 (6650), pp. 339-341 doi: 10.1016 / S0140-6736 (51) 92313-6 .
  2. ↑ a b c d e f g Annegret Eckhardt: Artificial disturbances. A-1622 (52) Deutsches Ärzteblatt 93, Issue 24, June 14, 1996.
  3. ↑ a b c d Birger Dulz, Sabine C. Herpertz, Otto F. Kernberg: Handbook of borderline disorders. Schattauer Verlag, 2nd edition, 2011, ISBN 3-7945-2472-1 .
  4. ^ A. Eckhardt-Henn: Artificial disturbances. Secret self-abuse. Psychotherapist (2015) 60: 18-24.
  5. ↑ a b c d e f g h i Volker Faust: Pretended health disorders. Psychiatry today, chap. 1, 2017, Working Group Psychosocial Health , accessed on February 10, 2018, (PDF 42 pages, 320 kB).
  6. ↑ a b c d e H.-P. Kapfhammer: Artificial Faults. Nervenarzt 5/2017, 88: 549-570, doi: 10.1007 / s00115-017-0337-8 , published online: April 27, 2017.
  7. ↑ a b "I was addicted to making my child sick" - What goes on in a mother who repeatedly puts her daughter in mortal danger so that she can take care of herself? The story of a woman with Munchausen Deputy Syndrome . Brigitte 26/2015, accessed: January 30, 2018.
  8. ↑ a b The caring perpetrator. Neue Zürcher Zeitung (NZZ) , No. 43, Zurich (Switzerland), October 26, 2003, accessed: January 30, 2018. (Archive) ( Memento of March 22, 2019 in the Internet Archive ).
  9. ^ Frank Heinz Diebel: Virtual Barons of Lies . In: taz . June 10, 2011, p. 18 ( online [accessed February 11, 2018]).
  10. ^ A. Pulman, J. Taylor: Munchausen by Internet: current research and future directions. J Med InternetRes (2012) 14: e115
  11. ^ MD Feldman: Munchausen by Internet: detecting factitious illness and crisis on the Internet. South. Med. J. (July 2000) 93 (7): 669-672. doi: 10.1097 / 00007611-200093070-00006 . PMID 10923952 .
  12. ↑ a b collective reference , see: Dulz et al. (2011), Faust (2017), Institute for Forensic Medicine (2017), Feldman (2004), Bools et al. (1994), Meadow (2002), Hamilton (2008), Noeker (2002), Sachsse (2005), Nowara (2005), Schreier (2004), Schreier & Libow (1993), Bools et al. (1994), Degener & Körner (2005), Sigal et al. (1991) Burton et al. (2015), Burton et al. (2015), Adams & Sutker (2001).
  13. ↑ a b Annegret Eckhardt: The Münchhausen syndrome - forms of self-manipulated disease. Urban and Schwarzenberg, Munich, 1989, ISBN 3-541-11821-0 .
  14. ↑ a b c AWMF guidelines No. 071/003 “Child abuse and neglect” , October 13, 2010 (PDF, 21 pages, 1.2 MB - archive ( Memento from March 22, 2019 in the Internet Archive )).
  15. ↑ Münchhausen Syndrome by Proxy (Münchhausen Stellvertreter Syndrom) - Institute for Forensic Medicine (2017), web.archive.org ( Memento from June 26, 2007 in the Internet Archive )
  16. ↑ a b c M. Caroline Burton, Mark B. Warren, Maria I. Lapid, J. Michael Bostwick: Munchausen Syndrome by Adult Proxy: A Review of the Literature (Review). ( Memento of January 4, 2019 in the Internet Archive ) Journal of Hospital Medicine, Vol. 10 (No. 1), January 2015, pages 32–35, doi: 10.1002 / jhm.2268 , Published in print and online in Wiley Online Library (Wileyonlinelibrary.com).
  17. ↑ B. Herrmann: Physical abuse of children. Somatic findings and clinical diagnostics. Monthly Paediatrics 2002 (150): 1324-1338, doi: 10.1007 / s00112-002-0610-0 (PDF, 16 pages, 528kb) .
  18. ^ A b Marc D. Feldman: Playing Sick: Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder. Routledge Publishing, London, June 3, 2004, ISBN 0-415-94934-3 .
  19. ↑ C. Bools., B. Neale R. Meadow: Munchausen Syndrome by Proxy: A Study of Psychopathology. Child Abuse & Neglect (1994), 18, pp. 773-788.
  20. ^ Meadow R. (2002). Different Interpretations of Munchausen Syndrome by Proxy. Child Abuse & Neglect, 26, 501-508.
  21. ↑ JC Hamilton, MD Feldman, AJ Cunnien (2008) Factitious disorder in medical and psychiatric practices. In: R. Rogers (ed.) Clinical assessment of malingering and deception, 3rd ed. Guilford Press, New York, pp. 128-144.
  22. ^ André Scholer, Cedric Wernli, Désirée Krebs, Geneviève Faffa, Dominic Grienenberger: Poisoning with unknown substance, “Munchhausen by proxy”? ( Memento of January 4, 2019 in the Internet Archive ) Toxichem. Krimtech. 2013; 80 (1): pages 38–42 (ISSN 2190-3441), Ed .: Society for Toxicological and Forensic Chemistry (GTFCh).
  23. ↑ TF Parnell, DO Day: Munchausen by proxy syndrome: Misunderstood Child Abuse. SAGE Publications (1997). H. Schreier, J. Libow: Hurting for Love: Munchausen by Proxy Syndrome. New York: Guilford Press (1993).
  24. ^ H. Schreier, J. Libow: Hurting for Love: Munchausen by Proxy Syndrome. New York: Guilford Press (1993).
  25. ↑ M. Noeker & KM Keller: Münchhausen-by-proxy syndrome as child abuse. Monthly Pediatric Medicine, 150 (2002), 1357-1369.
  26. ↑ Gunther Degener, Wilhelm Körner: Child abuse and neglect - a manual. Hogrefe-Verlag, Göttingen - Bern - Toronto 2005 - Edition: 1 (March 1, 2005) ISBN 3-8017-1746-1 .
  27. ↑ Gert Jakobi: Child abuse and neglect. Epidemiology, Diagnostics and Procedure. Huber Verlag, Bern; Edition: 1 (September 5, 2008) ISBN 3-456-84543-X .
  28. ↑ Ulrich Sachsse: Proxy - dark side of motherhood , Schattauer Verlag, September 1, 2015. ISBN 3-7945-3153-1 . About the book presentation: Ulrich Sachsse: Proxy mothers - perpetrators and rescuers at the same time. Special print Psychology Today, at: www.ulrich-sachsse.de/monitor/Dokumente (PDF; 2 p., 151 kB, archived ( memento of March 22, 2019 in the Internet Archive )).
  29. ^ Mary J. Sanders: Symptom coaching: Factitious disorder by proxy with older children. Clinical Psychology Review, Volume 15, Issue 5, 1995, pp. 423-442.
  30. ↑ Gert Jacobi, Reinhard Dettmeyer, Sibylle Banaschak, Burkhard Brosig, Bernd Herrmann: abuse and neglect of children - Diagnosis and Management. ( Memento from March 18, 2019 in the Internet Archive ) Deutsches Ärzteblatt, vol. 107, issue 13, April 2, 2010.
  31. ↑ Verena Mertens: The Münchhausen-by-proxy-Syndrome and its civil and criminal meaning. In: NJOZ. 2009, 1665, 1665.
  32. ↑ Bernd Brinkmann, Burkhard Madea: Handbook of forensic medicine. Volume I. Springer-Verlag, Berlin - Heideberg - New York (September 25, 2003) ISBN 3-540-00259-6 .
  33. ^ A b Marc D. Feldman: Playing Sick: Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder. Routledge Publishing, London, June 3, 2004, ISBN 0-415-94934-3 .
  34. ↑ Lydia Benecke: Psychopathinnen: The psychology of female evil. Lübbe Ehrenwirth Verlag, 2018, ISBN 978-3-431-03996-2 . Also: Lydia Benecke: Criminal women: That's why perpetrators are often played down. ( Memento from January 19, 2019 in the Internet Archive ) Brigitte 22/2018.
  35. ^ MD Sigal, D. Altmark, M. Gelkopf .: Munchausen syndrome revisited by adult proxy. Isr. J. Psychiatry Relat. Sci. 1991; 28 (1): 33-36.
  36. ^ Henry E. Adams, Patricia B. Sutker: Comprehensive Handbook of Psychopathology. Jumper; 3rd edition, June 30, 2001, ISBN 0-306-46490-X .
  37. ^ GP Yates, MD Feldman (2016) Factitious disorder: a systematic review of 455 cases in the professional literature. Gen Hosp Psychiatry 41: 20-28.
  38. ↑ Michael Zaudig, Hans-Ulrich Wittchen, Henning Saß: Case exercises for differential diagnosis according to DSM-IV and ICD-10. Hogrefe Verlag, Göttingen / Bern / Toronto / Seattle 2000, ISBN 978-3-8017-0916-7 .
  39. ↑ ICD-11: 6D71 Factitious disorder imposed on another: ICD-11 Beta Draft - Mortality and Morbidity Statistics. icd.who.int, accessed January 30, 2018 (English).
  40. ↑ HMC Munro, MV Thrusfield: Battered Pets . In: Journal of Small Animal Practice. 42 (8) 2001, pp. 385-389.
  41. ^ HS Tucker, F. Finlay, S. Guiton: Munchausen syndrome involving pets by proxies. In: Archive of Disease in Childhood. 2002; 87 (3), p. 263.