What is Munchausen syndrome by proxy?

Munchausen syndrome by proxy (MSBP) is a mental health disorder in which a person falsely reports or causes symptoms in another person who is under his or her care. The caregiver almost always is a mother, and the victim, her child. Because children are the victims, Munchausen syndrome by proxy is considered a form of child abuse.

The caregiver with MSBP may:

• Falsely claim a child has experienced serious symptoms, such as seizures.
• Contaminate test results to make a child appear ill.
• Physically harm the child to produce symptoms.

Victims of MSBP, typically small children, often undergo needless and painful medical tests. They may become seriously ill or injured or may die as a result of the actions of the offending caregiver. Many children affected by MSBP develop emotional problems that can last all through life.

In Munchausen syndrome by proxy, a mother may abuse more than one of her children at different times. Children subjected to MSBP are usually younger than 6 years old but may be older. Older children may become convinced that they have an illness. They may passively or actively participate with the caregiver in deceiving health professionals.

This condition is related to Munchausen syndrome, a similar disorder in which a person causes or reports symptoms in himself or herself. Children who are victims of MSBP may later develop Munchausen syndrome as adults.

What causes Munchausen syndrome by proxy?

Medical professionals don't entirely understand what causes a caregiver to create or falsify an illness in a child. A caregiver receives attention from having a sick child. And sometimes a caregiver seeks this type of attention after having had an illness as a child or adult. Also, it appears that MSBP may be related to the abuser's childhood experience. Usually, the abuser grew up feeling unloved and unwanted. She often has poor self-esteem, is unable to manage stress or anxiety, and feels a lack of control over her life.

Also, parents may be motivated by the social rewards they feel they achieve. They may get attention from not only doctors and nurses, but others in their community. Sometimes the parents who deceive others about the health of their child are rewarded with money. People may help out in small or big ways-such as by doing chores, bringing meals, or donating money or services.

How does the caregiver typically act?

A person with Munchausen syndrome by proxy is often intelligent and may have medical training or experience. She usually appears devoted to her child. The respect, sympathy, and attention she gains from health professionals and others who are concerned about the child, including her spouse, make her feel important and in control of events. Her actions serve to maintain this sense of power and control. The caregiver gets emotional fulfillment from the close relationships she develops with the health professionals involved in her child's care. But underneath this satisfaction may be a lot of hostility, which is shown through the ongoing deception.