title: 'Munchausen's syndrome by proxy' or a 'miscarriage of justice'? An initial application of functional neuroimaging to the question of guilt versus innocence.
abstract: 'Munchausen's syndrome by proxy' characteristically describes women alleged to have fabricated or induced illnesses in children under their care, purportedly to attract attention. Where conclusive evidence exists the condition's aetiology remains speculative, where such evidence is lacking diagnosis hinges upon denial of wrong-doing (conduct also compatible with innocence). How might investigators obtain objective evidence of guilt or innocence? Here, we examine the case of a woman convicted of poisoning a child. She served a prison sentence but continues to profess her innocence. Using a modified fMRI protocol (previously published in 2001) we scanned the subject while she affirmed her account of events and that of her accusers. We hypothesized that she would exhibit longer response times in association with greater activation of ventrolateral prefrontal and anterior cingulate cortices when endorsing those statements she believed to be false (i.e., when she 'lied'). The subject was scanned 4 times at 3 Tesla. Results revealed significantly longer response times and relatively greater activation of ventrolateral prefrontal and anterior cingulate cortices when she endorsed her accusers' version of events. Hence, while we have not 'proven' that this subject is innocent, we demonstrate that her behavioural and functional anatomical parameters behave as if she were.
authors.affiliation: Academic Clinical Psychiatry, University of Sheffield, The Longley Centre, Norwood Grange Drive, Sheffield, UK. s.a.spence@sheffield.ac.uk
authors.forename: Sean A
authors.initials: SA
authors.lastname: Spence
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Kaylor-Hughes
authors.forename: Martin L
authors.initials: ML
authors.lastname: Brook
authors.forename: Sudheer T
authors.initials: ST
authors.lastname: Lankappa
authors.forename: Iain D
authors.initials: ID
authors.lastname: Wilkinson
mesh_terms: D000328:Adult; D001931:Brain Mapping; D002648:Child; D002649:Child Abuse / Q000331:legislation & jurisprudence*; D005104:Expert Testimony / Q000331:legislation & jurisprudence; D005260:Female; D006167:Guilt; D006179:Gyrus Cinguli / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008014:Lie Detection / Q000523:psychology*; D008279:Magnetic Resonance Imaging; D016735:Munchausen Syndrome by Proxy / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D010100:Oxygen / Q000097:blood; D017397:Prefrontal Cortex / Q000503:physiopathology*; D011930:Reaction Time / Q000502:physiology; D012680:Sensitivity and Specificity
chemical_list: D010100:Oxygen