title: Characteristics of hospital-based Munchausen Syndrome by Proxy in Japan.
abstract: OBJECTIVE
  This article explores characteristics of Munchausen Syndrome by Proxy (MSBP) in Japan, a country which provides an egalitarian, low cost, and easy-access health care system.
  
  
  METHODS
  We sent a questionnaire survey to 11 leading doctors in the child abuse field in Japan, each located in different hospital-based sites. Child abuse doctors answered questions regarding the characteristics of MSBP cases for whom they had helped care.
  
  
  RESULTS
  Twenty-one MSBP cases (20 families) were reported. Characteristics of the victims included: no differences based on sex, 4.6 years of age on average when MSBP was confirmed, and an average of 1.9 years duration of MSBP abuse. Biological mothers were at least one of the perpetrators in 95% of cases. Among the 12 cases (57%) who remained with their families, 2 victims died. Only 5% of perpetrators had a medical background or relatives who engaged in healthcare work.
  
  
  CONCLUSIONS
  There are similar features of MSBP cases between Japan and other English-speaking countries, such as the UK or the US. However, perpetrators of MSBP in Japan did not have a medical background. Easier access to hospital resources in Japan may give greater opportunities for perpetrators to obtain medical knowledge from doctors or nurses.
  
  
  CONCLUSIONS
  The findings suggest that perpetrators of MSBP should not be assumed to possess a medical background in a country which provides universal medical care such as Japan. A contributory factor of MSBP may be the high frequency of medical consultations and equal level of accessibility of medical resources for Japanese citizens. Social welfare services that need to decide on custody for MSBP victims should recognize the relatively high risk of life-threatening danger in their family of origin. Further collaboration between hospital staff including pediatricians, nurses, medical social workers and staff at the social welfare services is needed to protect children from MSBP.
authors.affiliation: Department of Psychosocial Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Fujiwara
authors.forename: Makiko
authors.initials: M
authors.lastname: Okuyama
authors.forename: Mari
authors.initials: M
authors.lastname: Kasahara
authors.forename: Ayako
authors.initials: A
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D044466:Asian People / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007564:Japan / Q000453:epidemiology; D008297:Male; D009034:Mother-Child Relations; D016735:Munchausen Syndrome by Proxy / Q000453:epidemiology* / Q000534:rehabilitation*; D011795:Surveys and Questionnaires