@article{ref1,
title="The perpetrators of medical child abuse (Munchausen Syndrome by Proxy) - a systematic review of 796 cases",
journal="Child abuse and neglect",
year="2017",
author="Yates, Gregory and Bass, Christopher",
volume="72",
number="",
pages="45-53",
abstract="INTRODUCTION: Little is known about the perpetrators of medical child abuse (MCA) which is often described as &quot;Munchausen's syndrome by proxy&quot; or &quot;factitious disorder imposed on another&quot;. The demographic and clinical characteristics of these abusers have yet to be described in a sufficiently large sample. We aimed to address this issue through a systematic review of case reports and series in the professional literature. <br><br>METHOD: A systematic search for case reports and series published since 1965 was undertaken using MEDLINE, Web of Science and EMBASE. 4100 database records were screened. A supplementary search was then conducted using GoogleScholar and reference lists of eligible studies. Our search yielded a total sample of 796 perpetrators: 309 from case reports and 487 from case series. Information extracted included demographic and clinical characteristics, in addition to methods of abuse and case outcomes. <br><br>RESULTS: Nearly all abusers were female (97.6%) and the victim's mother (95.6%). Most were married (75.8%). Mean caretaker age at the child's presentation was 27.6 years. Perpetrators were frequently reported to be in healthcare-related professions (45.6%), to have had obstetric complications (23.5%), or to have histories of childhood maltreatment (30%). The most common psychiatric diagnoses recorded were factitious disorder imposed on self (30.9%), personality disorder (18.6%), and depression (14.2%). <br><br>CONCLUSIONS: From the largest analysis of MCA perpetrators to date, we provide several clinical recommendations. In particular, we urge clinicians to consider mothers with a personal history of childhood maltreatment, obstetric complications, and/or factitious disorder at heightened risk for MCA. Longitudinal studies are required to establish the true prognostic value of these factors as our method may have been vulnerable to publication bias.<br><br>Copyright © 2017. Published by Elsevier Ltd.<p /> <p>Language: en</p>",
language="en",
issn="0145-2134",
doi="10.1016/j.chiabu.2017.07.008",
url="http://dx.doi.org/10.1016/j.chiabu.2017.07.008"
}