Munchausen by Proxy Syndrome (MBPS)

Written for KidsHealth educator's site and reposted at DrMomma.org with permission.
Reviewed by Leslie A. Gavin-Devitt, Ph.D., and David V. Sheslow, Ph.D.

Munchausen by proxy syndrome (MBPS) is a relatively uncommon condition that involves the exaggeration or fabrication of illnesses or symptoms by a primary caretaker. One of the most harmful forms of child abuse, MBPS was named after Baron von Munchausen, an 18th-century German dignitary known for telling outlandish stories.

About MBPS

In MBPS, an individual — usually a mother — deliberately makes another person (most often his or her own preschool child) sick or convinces others that the person is sick. The parent or caregiver misleads others into thinking that the child has medical problems by lying and reporting fictitious episodes. He or she may exaggerate, fabricate, or induce symptoms. As a result, doctors usually order tests, try different types of medications, and may even hospitalize the child or perform surgery to determine the cause.

Typically, the perpetrator feels satisfied by gaining the attention and sympathy of doctors, nurses, and others who come into contact with him or her and the child. Some experts believe that it isn't just the attention that's gained from the "illness" of the child that drives this behavior, but also the satisfaction in being able to deceive individuals that they consider to be more important and powerful than themselves.

Because the parent or caregiver appears to be so caring and attentive, often no one suspects any wrongdoing. A perplexing aspect of the syndrome is the ability of the parent or caregiver to fool and manipulate doctors. Frequently, the perpetrator is familiar with the medical profession and is very good at fooling the doctors. Even the most experienced doctors can miss the meaning of the inconsistencies in the child's symptoms. It's not unusual for medical personnel to overlook the possibility of MBPS because it goes against the belief that a parent or caregiver would never deliberately hurt his or her child.

Children who are subject to MBPS are typically preschool age, although there have been reported cases in kids up to 16 years old, and there are equal numbers of boys and girls. About 98% of the perpetrators are female.

Diagnosing MBPS

Diagnosis is very difficult, but would involve some of the following:

• a child who has multiple medical problems that don't respond to treatment or that follow a persistent and puzzling course
• physical or laboratory findings that are highly unusual, don't correspond with the child's medical history, or are physically or clinically impossible
• short-term symptoms that tend to stop when the perpetrator isn't around
• a parent or caregiver who isn't reassured by "good news" when test results find no medical problems, but continues to believe that the child is ill
• a parent or caregiver who appears to be medically knowledgeable or fascinated with medical details or appears to enjoy the hospital environment
• a parent or caregiver who's unusually calm in the face of serious difficulties with the child's health
• a parent or caregiver who's highly supportive and encouraging of the doctor, or one who is angry and demands further intervention, more procedures, second opinions, or transfers to more sophisticated facilities

Causes of MBPS

In some cases, the parents or caregivers themselves were abused, both physically and sexually, as children. They may have come from families in which being sick was a way to get love. The parent's or caregiver's own personal needs overcome his or her ability to see the child as a person with feelings and rights, possibly because the parent or caregiver may have grown up being treated like he or she wasn't a person with rights or feelings.

Other theories say that Munchausen by proxy syndrome is a cry for help on the part of the parent or caregiver, who may be experiencing anxiety or depression or have feelings of inadequacy as a parent or caregiver of a young child. Some may feel a sense of acknowledgement when the doctor confirms their caregiving skills. Or, the parent or caregiver may just enjoy the attention that the sick child — and, therefore, he or she — gets.

The suspected person may also have symptoms similar to the child's own medical problems or an illness history that's puzzling and unusual. He or she frequently has an emotionally distant relationship with a spouse, who often fails to visit the seriously ill child or have contact with doctors.

What Happens to the Child?

In the most severe instances, parents or caregivers with MBPS may go to great lengths to make their children sick. When cameras were placed in some children's hospital rooms, some perpetrators were filmed switching medications, injecting kids with urine to cause an infection, or placing drops of blood in urine specimens.

Some perpetrators aggravate an existing problem, such as manipulating a wound so that it doesn't heal. One parent discovered that scrubbing the child's skin with oven cleaner would cause a baffling, long-lasting rash.

Whatever the course, the child's symptoms — whether created or faked — don't happen when the parent isn't present, and they usually go away during periods of separation from the parent. When confronted, the parent usually denies knowing how the illness occurred.

According to experts, common conditions and symptoms that are created or faked by parents or caregivers with MBPS include: failure to thrive, allergies, asthma, vomiting, diarrhea, seizures, and infections.

The long-term prognosis for these children depends on the degree of damage created by the perpetrator and the amount of time it takes to recognize and diagnose MBPS. Some extreme cases have been reported in which children developed destructive skeletal changes, limps, mental retardation, brain damage, and blindness from symptoms caused by the parent or caregiver. Often, these children require multiple surgeries, each with the risk for future medical problems.

If the child lives to be old enough to comprehend what's happening, the psychological damage can be significant. The child may come to feel that he or she will only be loved when ill and may, therefore, help the parent try to deceive doctors, using self-abuse to avoid being abandoned. And so, some victims of MBPS later become perpetrators themselves.

Getting Help for the Child

If Munchausen by proxy syndrome is suspected, health care providers are required by law to report their concerns. However, after a parent or caregiver is charged, the child's symptoms may increase as the person who is accused attempts to prove the presence of the illness. If the parent or caregiver repeatedly denies the charges, the child should be removed from the home and legal action should be taken on the child's behalf.

In some cases, the parent or caregiver may deny the charges and move to another location, only to continue the behavior. Even if the child is returned to the perpetrator's custody while protective services are still involved, the child may continue to be a victim of abuse. For these reasons, it's always advised that these cases be resolved quickly.

Getting Help for the Parent or Caregiver

Most often, abusive Munchausen by proxy syndrome cases are resolved in one of three ways:

• the perpetrator is apprehended
• the perpetrator moves on to a younger child when the original victim gets old enough to "tell"
• the child dies  

To get help, the parent or caregiver must admit to the abuse and seek psychological treatment. But if the perpetrator doesn't admit to the wrongdoing, psychological treatment has little chance of remedying the situation. Psychotherapy depends on truth, and MBPS perpetrators generally live in denial.

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