WebMD: Munchhousen's Byproxy

What Is Munchausen Syndrome by Proxy?

Munchausen syndrome by proxy is a mental illness where a caregiver makes up or exaggerates an illness in a person in their care. This disorder is now called factitious disorder imposed on another (FDIA). It usually involves a parent and child.

FDIA is a relatively rare behavioral disorder. It affects a primary caretaker, often the mother. The person with MSP gains attention by seeking medical help for exaggerated or made-up symptoms of a child in their care. As healthcare providers strive to identify what's causing the child's symptoms, the deliberate actions of the parent or caretaker can often make the symptoms worse.

The person with MSP does not seem to be motivated by a desire for any type of material gain. While healthcare providers are often unable to identify the specific cause of the child's illness, they may not suspect the parent or caretaker of doing anything to harm the child. In fact, the caregiver often appears to be very loving and caring and extremely distraught over their child's illness.

People with MSP may create or exaggerate a child's symptoms in several ways. They may simply lie about symptoms, alter tests (such as contaminating a urine sample), falsify medical records, or they may actually induce symptoms through various means, such as poisoning, suffocating, starving, and causing infection.

What Are the Symptoms of Munchausen Syndrome by Proxy?

Certain characteristics are common in a person with MSP, including:

Is a parent or caregiver, usually a mother

May be a healthcare professional

Is very friendly and cooperative with the health care providers

Appears quite concerned (some may seem overly concerned) about their child

May suffer from Munchausen syndrome (a related disorder in which a person repeatedly acts as if they have a physical or mental illness when they are not really sick)

Munchausen by proxy red flags

Other possible warning signs of MSP include:

The child has a history of many hospitalizations, often with a strange set of symptoms.

Worsening of the child's symptoms generally is reported by the parent and is not witnessed by the hospital staff.

The child's reported condition and symptoms do not agree with the results of tests.

There may be more than one unusual illness or death of children in the family.

The child's condition improves in the hospital, but symptoms recur when the child returns home.

Blood in lab samples may not match the blood of the child.

There may be signs of chemicals in the child's blood, stool, or urine.

What Causes Munchausen Syndrome by Proxy?

The exact cause of MSP is not known, but researchers are looking at the roles of biological and psychological factors in its development. Some theories suggest that a history of abuse or neglect as a child, or the early loss of a parent may be factors in its development. Some evidence suggests that major stress, such as marital problems, can trigger MSP.

Munchausen Syndrome by Proxy Diagnosis

Diagnosing MSP is very difficult because of the dishonesty that is involved. Doctors must rule out any possible physical illness as the cause of the child's symptoms before a diagnosis of MSP can be made.

If a physical cause of the symptoms is not found, a thorough review of the child's medical history, as well as a review of the family history and the parent's medical history (many have Munchausen syndrome themselves) may provide clues to suggest MSP. Remember, it is the adult, not the child, who is diagnosed with MSP.

How Is Munchausen Syndrome by Proxy Treated?

The first concern in MSP is to ensure the safety and protection of any real or potential victims. This may require that the child be placed in the care of another. In fact, managing a case involving MSP often requires a team that includes a social worker, foster care organizations, and law enforcement, as well as doctors.

Successful treatment of people with MSP is difficult because those with the disorder often deny there is a problem. In addition, treatment success is dependent on the person telling the truth, and people with MSP tend to be such accomplished liars that they begin to have trouble telling fact from fiction.

Psychotherapy (a type of counseling) generally focuses on changing the thinking and behavior of the individual with the disorder (cognitive-behavioral therapy). The goal of therapy for MSP is to help the person identify the thoughts and feelings that are contributing to the behavior, and to learn to form relationships that are not associated with being ill.

What Is the Outlook for Victims of People With Munchausen Syndrome by Proxy?

This disorder can lead to serious short- and long-term complications, including continued abuse, multiple hospitalizations, and the death of the victim. (Research suggests that the death rate for victims of MSP is about 10%.) In some situations, a child victim of MSP learns to relate getting attention to being sick and develops Munchausen syndrome themselves.

Related:

How Major Depression Affects Life: Symptoms & Solutions

What Is the Outlook for People With Munchausen Syndrome by Proxy?

In general, MSP is a very difficult disorder to treat and often requires years of therapy and support.

In addition, MSP is considered a form of child abuse, which is a criminal offense.

Can Munchausen Syndrome by Proxy Be Prevented?

There is no known way to prevent this disorder.