Munchausen Syndrome by Proxy (cont.)

Medical Author:

Roxanne Dryden-Edwards, MD

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.

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Medical Editor:

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.

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In this Article

• What is Munchausen syndrome by proxy?
• What are causes/risk factors for Munchausen syndrome by proxy?
• What are the signs and symptoms of Munchausen syndrome by proxy?
• How is Munchausen syndrome by proxy diagnosed?
• What is the treatment for Munchausen syndrome by proxy?
• What are the complications of Munchausen syndrome by proxy?
• Where can one get more information on Munchausen syndrome by proxy?
• Munchausen Syndrome by Proxy At A Glance
• Find a local Psychiatrist in your town
• Munchausen Syndrome by Proxy Index

If left untreated, this illness can result in child victims who grow up to be medically or emotionally disabled. It may even be fatal in more than 5% of cases, and more than 7% may experience either long-term or permanent injury as a result. Survivors of MSBP are unfortunately at higher risk of becoming perpetrators of this and other forms of child abuse as adults.

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American Psychiatric Association
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National Institute of Mental Health (NIMH)
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• Munchausen syndrome by proxy (MSBP) is classified as a factitious disorder and is therefore characterized by feigning or intentionally producing physical or emotional symptoms in order to assume the sick role.
• This disorder is named after Baron Karl Friedrich von Munchausen, who was known to invent fantastic stories of his adventures, including his riding cannonballs and traveling to the moon.
• MSBP specifically involves a caretaker describing nonexistent symptoms or inducing symptoms in a third person, usually a child they care for.
• How often MSBP occurs is likely very much underestimated, as evidenced by it often taking years to be discovered, even being completely missed in siblings of the victim that is eventually identified.
• Males are victims of MSBP as often as females. Women are perpetrators of this disorder the vast majority of the time, theoretically because women remain the primary caretakers of children.
• Perpetrators of MSBP are vulnerable to also suffering from depression, anxiety, and some personality disorders.
• While there is no specific cause for MSBP, perpetrators tend to have trouble forming a healthy attachment to their children, difficulty managing their anger and frustration, as well as having an ability to overcome the more natural tendency for caretakers to protect the children they care for.
• Perpetrators are also more likely to have a history of either losing a parent or being abused or neglected as a child.
• While the symptoms the victim of MSBP presents with are highly variable, they may consist of symptoms that are more easily faked or induced, like suffocation, seizure, bleeding or nausea, vomiting, or diarrhea that can be the result of poisoning.
• Theories about what perpetrators gain from assuming the sick role through their child include seeking help, inducing symptoms, and being "addicted" to interactions with medical professionals.
• MSBP is usually diagnosed through intense communication between medical, mental-health, and child-protection professionals, as well as review of all available medical records and interviewing family members, school personnel, and other pertinent community members.
• Sometimes, covertly videotaping the suspected abuser when with the child can be a useful additional diagnostic tool.
• The treatment of MSBP involves close collaboration with professionals, family, and community members, intensive psychotherapy for the victim and the perpetrator, as well protecting the child by either intensive supervision of the perpetrator, temporary or permanent removal of the child from the care of the abuser, and sometimes includes prosecution and incarceration of the perpetrator.
• If left untreated, MSBP can result in the child's death or growing up emotionally and/or medically disabled.
• Survivors of MSBP are at higher risk of becoming perpetrators themselves.

REFERENCES:

Adshead, G., Bluglass, K. "Attachment Representations in Mothers with Abnormal Illness Behavior by Proxy." The British Journal of Psychiatry 187 (2005): 328-333.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Treatment Revision. Washington, D.C.: American Psychiatric Publishing, Inc., 2000.

David, T.J. Child abuse and paediatrics. Journal of the Royal Society of Medicine 2005; 98: 229-231.

De Ridder, L., Hoekstra, J.H. Manifestations of Munchausen Syndrome by proxy in pediatric gastroenterology. Journal of Pediatric Gastroenterology and Nutrition 2000 August; 31(2): 208-211.

Ehrlich, S., Pfeiffer, E., Salbach, H., Lenz, K., Lehmkuhl, U. Factitious disorder in children and adolescents: a retrospective study. Psychosomatics 2008 September-October; 49: 392-398.

Fanu, J.L. "Wrongful diagnosis of child abuse-a master theory." Journal of the Royal Society of Medicine 2005; 98: 249-254.

Goodwin, J. Munchausen's Syndrome as a dissociative disorder. Dissociation 1988 March; 1:1.

Kamerling, L.B., Black, X.A., Fiser, R.T. Munchausen syndrome by proxy in the pediatric intensive care unit: an unusual mechanism. Pediatric Critical Care Medicine 2002 July; 3(3): 305-307.

Karlin, N.J. Munchausen syndrome by proxy. Dartmouth Medical School 1996.

Meadow, R. Mothering to death. Archives of Disease in Childhood 1999; 80: 359-362.

Rand, D., Feldman, M. An explanatory model for Munchausen by proxy abuse. International Journal of Psychiatry in Medicine 2001; 31(2): 113-126.

Sheridan, M.S. The deceit continues: an updated literature review of Munchausen Syndrome by Proxy. Child Abuse and Neglect 2003 April; 27(4): 431-451.

Stirling, J. Beyond Munchausen syndrome by proxy: Identification and treatment of child abuse in a medical setting. Pediatrics 2007 May; 119(5): 1026-1030.