What is Munchausen syndrome by proxy?
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Munchausen syndrome by proxy (MSBP) is a mental health problem in which a caregiver makes up or causes an illness or injury in a person under his or her care, such as a child, an elderly adult, or a person who has a disability. Because vulnerable people are the victims, MSBP is a form of child abuse or elder abuse.
Note: Since most cases of MSBP are between a caregiver (usually a mother) and a child, the rest of this topic will describe that relationship. But it is important to remember that MSBP can involve any vulnerable person who has a caregiver.
The caregiver with MSBP may:
- Lie about the child's symptoms.
- Change test results to make a child appear to be ill.
- Physically harm the child to produce symptoms.
Victims are most often small children. They may get painful medical tests they don't need. They may even become seriously ill or injured or may die because of the actions of the caregiver.
Children who are victims of MSBP can have lifelong physical and emotional problems and may have Munchausen syndrome as adults. This is a disorder in which a person causes or falsely reports his or her own symptoms.
What causes Munchausen syndrome by proxy?
Doctors aren't sure what causes it, but it may be linked to problems during the abuser's childhood. Abusers often feel like their life is out of control. They often have poor self-esteem and can't deal with stress or anxiety.
The attention that caregivers get from having a sick child may encourage their behavior. Caregivers may get attention not only from doctors and nurses but also from others in their community. For example, neighbors may try to help the family in many ways—such as by doing chores, bringing meals, or giving money.
How does someone with Munchausen syndrome by proxy act?
A person with MSBP often:
- Has medical skills or experience.
- Seems devoted to his or her child.
- Looks for sympathy and attention.
- Tries too hard to become close and friendly with medical staff.
- Needs to feel powerful and in control.
- Does not see his or her behavior as harmful.
What are the clues that a person may have Munchausen syndrome by proxy?
Checking a child's medical records for past tests, treatments, and hospital stays may help a doctor or nurse find out if a health problem is real.
Doctors or nurses may suspect a problem when:
- A child has a repeated or unusual illness, and no reason can be found.
- The child doesn't get better, even with treatments that should help. Symptoms only occur when the caregiver is with or has recently been with the child. But symptoms get better or go away when the caregiver is not there or is being closely watched.
- The other parent (usually the father) is not involved in the child's treatment, even though the child's condition may be serious.
- A caregiver suddenly changes doctors and lies about prior testing and treatment.
- Normal test results don't reassure the caregiver. And he or she may be strangely calm or happy when the child's condition is getting worse.
- The caregiver is seen (or videotaped or recorded) harming the child or causing symptoms.
- Another child in the family has had unexplained illness or death.
How is it treated?
Child protective services, law enforcement, and doctors are all involved in treatment for Munchausen syndrome by proxy. Caregivers who have this condition need long-term counseling. They may resist treatment or deny that there is a problem. Medicines are used only when the caregiver has another health problem, such as anxiety disorder, along with MSBP.
Even after treatment, caregivers may repeat their behavior. So doctors, counselors, and family members need to closely watch how the caregiver interacts with his or her children.
For victims, the first step is to protect the child by moving him or her into safe custody. Then a doctor will monitor the child for symptoms. Most of the time, the child's symptoms stop after the child is away from the caregiver. Some children need counseling or other help.
What should you do if you think someone has Munchausen syndrome by proxy?
MSBP is child abuse. If you suspect that a child is a victim, don't confront the suspected caregiver. It might make the problem worse. Instead, think about these options:
- Keep a journal of the child's symptoms and other related events.
- Talk with your doctor about your concerns.
- Report your concerns to your local child welfare agency. You can make a report without using your name (anonymous).
Other Works Consulted
- Dubowitz H, Lane WG (2011). Factitious disorder by proxy (Munchausen syndrome by proxy). In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 146–147. Philadelphia: Saunders.
- Wang DL, et al. (2009). Factitious disorder. In BJ Sadock et al., eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1949–1964. Philadelphia: Lippincott Williams and Wilkins.
Current as of: January 31, 2020
Author: Healthwise Staff
Kathleen Romito MD - Family Medicine
Lisa S. Weinstock MD - Psychiatry