Mental Health Center

What is Munchausen syndrome by proxy?

Munchausen syndrome by proxy (MSBP) is a mental health problem in which a caregiver makes up or causes an illness or injury in a child under his or her care. The caregiver is usually a mother, and the victim is her child. Because children are the victims, MSBP is a form of child abuse.

The caregiver with MSBP may:

• Lie about the child’s symptoms.
• Change test results to make a child appear to be ill.
• Physically harm the child to produce symptoms.

Victims are most often small children. They may get painful medical tests they don't need. They may even become seriously ill or injured or may die because of the actions of the caregiver.

Children who are victims of MSBP can have lifelong physical and emotional problems and may have Munchausen syndrome as adults. This is a disorder in which a person causes or reports his or her own symptoms.

What causes Munchausen syndrome by proxy?

Doctors aren't sure what causes it, but it may be linked to problems during the abuser's childhood. Abusers often feel like their life is out of control. They often have poor self-esteem and can't deal with stress or anxiety.

The attention that caregivers get from having a sick child may encourage their behavior. Caregivers may get attention not only from doctors and nurses but also from others in their community. For example, neighbors may try to help the family in many ways-such as by doing chores, bringing meals, or giving money.

How does someone with Munchausen syndrome by proxy act?

A person with MSBP often:

• Has medical skills or experience.
• Seems devoted to her child.
• Looks for sympathy and attention.
• Tries too hard to become close and friendly with medical staff.
• Needs to feel powerful and in control.
• Does not see her behavior as harmful.

What are the clues that a person may have Munchausen syndrome by proxy?

Checking a child's medical records for past tests, treatments, and hospital stays may help a doctor or nurse find out if a health problem is real.

Doctors or nurses may suspect a problem when:

• A child has a repeated or unusual illness, and no reason can be found.
• The child doesn't get better, even with treatments that should help. Symptoms only occur when the caregiver is with or has recently been with the child. But symptoms get better or go away when the caregiver is not there or is being closely watched.
• The other parent (usually the father) is not involved in the child’s treatment, even though the child's condition may be serious.
• A caregiver suddenly changes doctors and lies about prior testing and treatment.
• Normal test results don't reassure the caregiver. And she may be strangely calm or happy when her child’s condition is getting worse.
• The caregiver is seen (or videotaped or recorded) harming the child or causing symptoms.
• Another child in the family has had unexplained illness or death.

How is it treated?