Myalgic encephalomyelitis by proxy

Myalgic Encephalomyelitis by proxy

Sir,—The letter by Drs F Harris and L S Taitz describing the damaging effects of the diagnoses of myalgic encephalomyelitis in children¹ prompts us to report a case that we believe shows myalgic encephalomyelitis by proxy. (The name of the general practitioner has not been cited as a co-author to protect patient confidentiality.)

A 12 year old boy presented with his mother to the general practitioner with complaints of recurrent nasal congestion, runny nose, sore throat, muscle aches, headaches, and lethargy. Clinical examination revealed no abnormalities apart from mild obesity. At the insistence of his mother, who was convinced her child was suffering from myalgic encephalomyelitis (M.E.), the child was referred to a general medical clinic to reassure her that he had no actual illness.

When the mother was questioned on the child’s symptoms the criteria for myalgic encephalomyelitis or the postviral fatigue syndrome² were sufficiently fulfilled to be diagnostic, but when the child was questioned the symptoms were not sufficiently diagnostic. Because of the overbearing nature of the mother it was necessary to interview the child separately to obtain an unbiased history. There were no supporting clinical or laboratory features of the syndrome or other illness.

The mother had presented to the same practice in March 1988 with headaches, painful muscles and joints, periorbital oedema, and swelling of fingers and feet. These symptoms persisted and were investigated. In April she diagnosed herself as having myalgic encephalomyelitis after watching a television programme on the subject. She joined the ME Association and became an active member. One month later a diagnosis of hypothyroidism was confirmed biochemically, the thyroid stimulating hormone being >50 IU/l. She was referred to an endocrinology clinic and was treated with thyroxine. Her muscle aches persisted but other symptoms abated. Her symptoms and investigations were not diagnostic of the postviral fatigue syndrome, but she clung to the belief that she had myalgic encephalomyelitis despite being told the opposite. In May 1989 she was once again told that her symptoms were not typical of the condition. In the same month she brought her child to the practice for the first time with the symptoms she attributed to myalgic encephalomyelitis.

When interviewed in the general medical clinic the mother seemed crestfallen when admitting that her other doctors did not think she had myalgic encephalomyelitis. She frequently prompted her son on points of history, and he reluctantly agreed with her on these points.

Meadow described Münchausen syndrome by proxy as a syndrome in which anyone, but usually a mother, fabricates symptoms in another person.³ We believe that our case is an example of myalgic encephalomyelitis by proxy, possibly a variant of the Münchausen syndrome by proxy. We support the views of Drs Harris and Taitz on the part that the ME Association could play in preventing the referral of children to hospital clinics. When doctors are confronted with parents insisting on the diagnosis of myalgic encephalomyelitis in their children myalgic encephalomyelitis by proxy should be considered.

T M MacDONALD

Raigmore Hospital,

Inverness IV2 3UJ

References

1 Harris F, Taitz LS. Damaging diagnoses of myalgic encephalitis in children. Br Med J 1989;299:790. (23 September.)

2 Ho-Yen DO. A different ME. Communicable Diseases Scotland Weekly Report 1988;48:4–5.

3 Meadow R. Münchausen syndrome by proxy—the hinterland of child abuse. Lancet 1977;ii:343–5.