Silent abuse in the blind spot between medicine and law: A case series of Munchausen syndrome by proxy from Türkiye

Abstract

Munchausen syndrome by proxy is a rare but dangerous form of child abuse in which a caregiver exaggerates, fabricates, or induces medical symptoms in a dependent individual, typically a child. It is of the utmost importance to recognize and address this syndrome, which has significant legal and medical consequences. The failure to identify cases in a timely manner and to implement appropriate intervention strategies may result in irreparable harm or even fatal consequences. This study examined four cases involving 15 child victims and four perpetrators. All individuals were referred to the Turkish Council of Forensic Medicine for evaluation of criminal responsibility. The data were sourced from the National Judicial Network Project and case files spanning a decade. A comprehensive review of the clinical and forensic records was conducted. The four perpetrators, all females aged 27–34, exhibited histories of adverse childhood experiences, early marriage, limited education, and neglect. The clinical manifestations in children included apnea, immobility, bleeding, and bruising. Eleven children died before the abuse was detected, and four children were removed from their homes and placed under the protection of the state. MSBP is still frequently overlooked in clinical practice, which can result in irreparable harm and even death among affected children. The severe cases, as illustrated in this manuscript, demonstrate a recurrent pattern of abuse that persists until the cases are identified. An integrated multidisciplinary approach, involving medical and forensic services, is of paramount importance to facilitate the recognition and prevention of this form of child abuse.