Munchausen Syndrome by Proxy

Last Updated January 2021 | This article was created by editorial staff and reviewed by Beth Oller, MD

What is Munchausen syndrome by proxy?

Munchausen syndrome by proxy (MSP) is a mental illness. It is also a form of child abuse. It affects caregivers, especially caregivers of children. It is also known as factitious disorder by proxy. Mothers of small children are most often affected by this condition. 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. They may lie to medical professionals about the health or condition of the person in their care. They do this to gain sympathy or for attention.

Someone who has MSP may purposely take action to make their child sick. They knowingly will expose the child to painful or risky medical procedures, even surgeries. They may deliberately create symptoms in a child. They can do this by withholding food, poisoning or suffocating the child, giving the child inappropriate medicines, or withholding prescribed medicines. Creating these situations can put the child at extreme risk.

Common illnesses or symptoms that caregivers take MSP victims to the doctor for include:

  • Failure to thrive
  • Nausea and vomiting
  • Diarrhea
  • Seizures
  • Breathing difficulty and asthma
  • Infections
  • Allergic reactions
  • Fevers of unknown origins
  • Other illnesses that require immediate emergency care

Those with MSP are not discouraged by the cost of medical treatments. They don’t worry about 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. They think 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 hard to spot. There are certain personality traits and backgrounds that seem to be common. Many suffered mental, physical, or sexual abuse growing up. Or they received love or attention only when they were sick.

As adults, people with MSP are very interested in medicine. They often work in the medical field. They can speak expertly about medical conditions. They are typically very cooperative and friendly with health care professionals. They always appear to be completely devoted to the well being of their child.

But to fake symptoms of illness in their child, they may do extreme things. These could include:

  • Giving the child certain medicines or substances that will make them throw up or have diarrhea
  • Heating up thermometers so it looks like the child has a fever
  • Not giving the child enough to eat so it looks like they can’t gain weight
  • Adding blood to the child’s urine or stool
  • Making up lab results

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

What causes Munchausen syndrome by proxy?

Doctors don’t know what causes this mental illness. It may be the result of being abused as a child. Some people with MSP may also have Munchausen syndrome. This is where they fake illness for themselves to gain attention.

How is Munchausen syndrome by proxy diagnosed?

The ethical issues involved in MSP make it hard to diagnose. Accusing a mother, father, or caretaker of intentionally creating symptoms or making a child sick is a 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 caregiver from the child, then see if the child’s symptoms improve. Doctors also can evaluate medical records. They can 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. The caregiver must recognize that his or her feelings about illness are not normal. In those situations, seeking help could prevent them from harming a child.

It is usually 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, 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. The child should be treated for any medical problems they are having and protected from further abuse. They may need to be removed from the care of the affected caregiver. Psychological treatment may be necessary as the child recovers.

Treatment of the mother, father, or 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. They can learn to form healthy relationships that don’t rely on someone being sick.

Because this is a form of child abuse, the syndrome must be reported to the authorities.

Living with Munchausen syndrome by proxy

Someone living with Munchausen syndrome by proxy has a serious mental illness. It is a form of child abuse. So they cannot be allowed to continue their behavior. If you suspect someone you know has this illness, it is important that you notify a health care professional, the police, or child protective services.  Call 911 if you know a child who is in immediate danger because of abuse or neglect.

You can also call the Childhelp National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453). Crisis counselors are available to help you figure out next steps. All calls are anonymous and confidential.

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 someone I know is showing symptoms of Munchausen syndrome by proxy?
  • Can someone fully recover from Munchausen syndrome by proxy?