Munchausen Syndrome by Proxy (MSBP)

  • Medical Author:
    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

How do health-care professionals diagnose Munchausen syndrome by proxy? What types of specialists treat MSBP?

As MSBP involves the caretaker covertly abusing a child by faking or causing symptoms in the child victim, a pediatrician who has experience and training in assessing and treating child abuse is often consulted and may be the primary professional working with the family. That professional will usually work with other professionals to review all medical records that have been kept and to communicate regularly about parents who are thought to seek excessive care since the abusive parent involved may have visited many different practitioners, even using different names in some cases, in an attempt to avoid the scrutiny that is likely harder to avoid if working with one medical practice, since one practitioner has more of an opportunity to get to know the perpetrator and the victim of MSBP over time. Covertly videotaping the interactions of a child with the suspected caretaker/abuser can be useful even when the victim is in a highly monitored setting like an intensive-care unit. While videotaping the child in the hospital may help in confirming or refuting the suspicion that the parent is engaged in harming the child, it is appropriately not seen as a substitute for the hard work of close monitoring, collaboration between all medical professionals, child protective services, mental-health professionals, and community members (for example, teachers, school counselors, clergy, and concerned extended family members) involved.

As with other mental-health issues, there is no specific definitive test, such as a blood test, that can accurately assess that a person has MSBP. Therefore, practitioners conduct a mental-health interview that looks for the presence of the symptoms previously described. As with any mental-health assessment, the professional will usually work toward ruling out other mental and physical disorders and ensuring that the individual is not suffering from a primary medical problem or from medical issues that may have symptoms that cause emotional symptoms. He or she will therefore often inquire about when the child has most recently had a physical examination, comprehensive blood work, and any other tests that a medical professional deems necessary to ensure that he or she is not suffering from a true medical condition instead of or in addition to a caretaker potentially manufacturing symptoms in the child. Also of significant importance is the practitioner reviewing any available previous medical records and talking to other people who may be in the child's life (such as the other parent, if available, teachers, and counselors) in order to explore the possibility of a pattern of the caretaker in question making illness up before in this child or in a sibling or other child in their care.

Due to the use of a mental-health interview in making the diagnosis, the potentially dire consequences to missing the diagnosis of MSBP or falsely assigning the diagnosis, as well as the fact that this disorder can be quite resistant to treatment, it is of great importance that the practitioner know to conduct a thorough assessment. It is equally important that the medical and mental-health professionals work together very closely and do not make assumptions about how much medical knowledge a parent should have or how they should behave in a situation involving the illness of their child. As only 50% of people with MSBP ever come to the attention of a psychiatrist, the importance of vigilant assessment and insisting on treatment when possible seems all the more important.

Medically Reviewed by a Doctor on 10/19/2016

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