Munchausen Syndrome by Proxy - Topic Overview

What is Munchausen syndrome by proxy?

Munchausen syndrome by proxy (MSBP) is a mental health disorder in which a person falsely reports or causes symptoms in another person who is under his or her care. The caregiver almost always is a mother, and the victim, her child. Because children are the victims, Munchausen syndrome by proxy is considered a form of child abuse.

The caregiver with MSBP may:

• Falsely claim a child has experienced serious symptoms, such as seizures.
• Contaminate test results to make a child appear ill.
• Physically harm the child to produce symptoms.

Victims of MSBP, typically small children, often undergo needless and painful medical tests. They may become seriously ill or injured or may die as a result of the actions of the offending caregiver. Many children affected by MSBP develop emotional problems that can last all through life.

In Munchausen syndrome by proxy, a mother may abuse more than one of her children at different times. Children subjected to MSBP are usually younger than 6 years old but may be older. Older children may become convinced that they have an illness. They may passively or actively participate with the caregiver in deceiving health professionals.

This condition is related to Munchausen syndrome, a similar disorder in which a person causes or reports symptoms in himself or herself. Children who are victims of MSBP may later develop Munchausen syndrome as adults.

What causes Munchausen syndrome by proxy?

Medical professionals don't entirely understand what causes a caregiver to create or falsify an illness in a child. A caregiver receives attention from having a sick child. And sometimes a caregiver seeks this type of attention after having had an illness as a child or adult. Also, it appears that MSBP may be related to the abuser's childhood experience. Usually, the abuser grew up feeling unloved and unwanted. She often has poor self-esteem, is unable to manage stress or anxiety, and feels a lack of control over her life.

Also, parents may be motivated by the social rewards they feel they achieve. They may get attention from not only doctors and nurses, but others in their community. Sometimes the parents who deceive others about the health of their child are rewarded with money. People may help out in small or big ways—such as by doing chores, bringing meals, or donating money or services.

How does the caregiver typically act?

A person with Munchausen syndrome by proxy is often intelligent and may have medical training or experience. She usually appears devoted to her child. The respect, sympathy, and attention she gains from health professionals and others who are concerned about the child, including her spouse, make her feel important and in control of events. Her actions serve to maintain this sense of power and control. The caregiver gets emotional fulfillment from the close relationships she develops with the health professionals involved in her child's care. But underneath this satisfaction may be a lot of hostility, which is shown through the ongoing deception.

A person who has MSBP does not seem to perceive her behavior as harmful. She may lack empathy—the capacity to understand what another person is feeling. Although she may appear doting (showing extreme fondness or love), she may actually be emotionally removed from her child.

What are the clues that a person may have Munchausen syndrome by proxy?

Health professionals may suspect Munchausen symptom by proxy when:

• A child has a recurring or unusual illness for which no adequate explanation can be found. The parent makes the child have many different tests and evaluations, and the child continually fails to respond to or tolerate medical treatments that should improve symptoms.
• Symptoms occur or begin only when the caregiver is with or has recently been with the child. Symptoms improve or do not occur when the caregiver is absent or in a setting that is closely monitored. For example, symptoms usually improve when the child is in the hospital. But a caregiver sometimes can still cause her child to develop symptoms or make it appear that way.
• The other parent (usually the father) is noticeably absent. He is uninvolved even though a child's condition may be or appears to be serious.
• Evidence proves that the parent has given false information to health professionals or has contaminated lab samples. Often a caregiver abruptly switches doctors and provides misleading information about prior testing and treatment.
• Normal test results do not reassure the parent. She is inappropriately calm or euphoric when her child's condition is most severe.
• The caregiver makes an exceptional effort to become friendly and close to medical staff.
• A caregiver is seen or videotaped directly harming the child or causing symptoms.

Also, it may be discovered that the caregiver has a history of Munchausen syndrome. There is more cause for suspicion of MSBP if another child in the family has had unexplained illness or death.

How is Munchausen syndrome by proxy diagnosed?

Diagnosing MSBP is very difficult. If it is suspected, all health professionals involved in the child's care carefully observe, document, and chart all symptoms, laboratory test results, treatments, and the caregiver's behavior. This careful documentation helps ensure that the diagnosis of MSBP is widely supported and that the child does not need any further testing or treatment.

If MSBP or another form of child abuse is diagnosed by health professionals, then local children's protective services, police, and other authorities are notified. Usually, further investigation is not needed, and legal authorities and medical personnel develop a plan to confront the caregiver and ensure the child's safety.

How is Munchausen syndrome by proxy treated?

Protection of the child is the highest priority in all treatment phases. A hospitalized child may be protected by medical staff, children's protective services workers, and possibly police. If the child is currently not hospitalized, he or she is placed in safe custody away from the caregiver. Other children in the family may also be removed from parental custody. It is expected that symptoms will stop after the child is placed away from the caregiver. An individual physician is assigned as the child's primary doctor.

Treatment for the caregiver usually is coordinated through the legal system. Long-term psychotherapy is used to help the caregiver acknowledge and express her need for support, respect, and connection. Dealing with these emotional needs more directly may help prevent her from projecting them onto her child. Therapy also focuses on helping her to develop empathy, so she understands the effect her behavior has had on her child. Medications are used as treatment only if another diagnosed condition, such as anxiety disorder, exists along with MSBP.

Caregivers with MSBP very often resist treatment. Typically, they experience extreme denial about the problem and diagnosis. Also, these caregivers often try to manipulate health professionals involved in their treatment. MSBP behavior has a high recurrence rate, and close monitoring and continuous counseling are usually needed.

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