Munchausen Syndrome by Proxy

Overview

What is Munchausen syndrome by proxy?

Munchausen syndrome by proxy (MSP), also known as fictitious disorder by proxy, is a mental illness that affects caregivers, especially caregivers of children. Mothers of small children are most often affected by this condition, but fathers or other caregivers can have it as well. Someone suffering from MSP will act as though the person under his or her care is sick. They often will falsify medical information or lie to medical professionals about the health or condition of the person in their care. They do this to gain sympathy or for attention.

In addition to lying about or exaggerating symptoms of the child’s illness, someone who has MSP will purposely take action to make his or her child sick. They knowingly will expose the child to painful or risky medical procedures, even surgeries. Someone who has MSP may deliberately create symptoms in a child by withholding food, poisoning or suffocating, or by giving the child inappropriate medicines or withholding prescribed medicines. Creating these situations can put the child at extreme risk. About 1 in 10 victims of MSP die as a result of it.

Common illnesses or symptoms that caregivers bring MSP victims to the doctor to treat include failure to thrive, nausea and vomiting, diarrhea, seizures, breathing difficulty and asthma, infections, allergic reactions, and other illnesses that require immediate emergency care. Fevers of unknown origins are also common in these cases.

Parents and other caregivers who have MSP are not discouraged by the cost of medical treatments or how they will manage the bills. Instead, they believe driving up a large hospital bill reinforces the perception that they are doing everything they can for their child and others will see them as even better caretakers.

What are the symptoms of Munchausen syndrome by proxy?

Symptoms that can help identify someone who has MSP can be difficult to spot. There are certain personality traits and backgrounds that seem to be common in persons who have MSP. Many of them suffered mental, physical, or sexual abuse growing up, or they received love or attention only when they were sick. As adults, they are very interested in medicine and often work in the medical field. They can speak expertly about medical conditions. People who have MSP are typically very cooperative and friendly with health care professionals. They always appear to be completely devoted to the well being of their child.

In the child, symptoms of MSP include a history of being in and out of hospitals with unusual health symptoms. Many times, their health symptoms do not match any single disease. Symptoms usually get worse when they are alone with their mother or caregiver and disappear in the absence of that person.

How is Munchausen syndrome by proxy diagnosed?

The ethical issues involved in MSP make it difficult to diagnose. Accusing a mother, father, or other caretaker of intentionally creating symptoms or making a child sick is a very serious matter. Medical professionals will look for symptoms and other incriminating evidence before doing so.

One way to confirm suspicions of MSP is to separate the mother, father, or other caregiver from the child to determine if the child’s symptoms improve. Doctors also can evaluate medical records and look for patterns that suggest something is off. For example, a child who has been seen for many different illnesses during a short period of time should trigger suspicion. If MSP is suspected, health care providers are required to report it.

Can Munchausen syndrome by proxy be prevented or avoided?

Unfortunately, there is no way to prevent MSP. Prevention relies on the caregiver recognizing that his or her feelings about illness are not normal. In those situations, seeking help could prevent them from harming a child.

For the most part, it is up to others to recognize the behavior and stop it before it escalates. If you believe a child is in danger or is currently a victim of MSP, you should contact a health care professional, the police, or child protective services.

Munchausen syndrome by proxy treatment

Safety of the child is the No. 1 priority of treatment. Once MSP has been identified as the primary cause of illness, the child should be treated and protected from further abuse. Psychological treatment may also be necessary as the child recovers.

Treatment of the mother, father, or other caregiver involved is not as straightforward. Many times, this person will deny playing a role, even when evidence proves it. They often have blurred what is true and what is not. Until they are ready to recognize the truth, it will be difficult for them to get better.

Psychotherapy is recommended for persons who have MSP. During these counseling sessions, the therapist helps the caregiver identify the feelings that caused his or her harmful behavior. Over time, the caregiver can learn to change that behavior and form healthy relationships that don’t rely on someone being sick.

Living with Munchausen syndrome by proxy

Psychotherapy is recommended for persons who have MSP. During these counseling sessions, the therapist helps the caregiver identify the feelings that caused his or her harmful behavior. Over time, the caregiver can learn to change that behavior and form healthy relationships that don’t rely on someone being sick.

Questions to ask your doctor

  • What are some clues that my spouse/child’s caregiver has Munchausen syndrome by proxy?
  • What could be causing my spouse/child’s caregiver to act this way?
  • What should I do if I suspect that someone I know is showing symptoms of Munchausen syndrome by proxy?
  • Can someone fully recover from Munchausen syndrome by proxy?