What Is Munchausen Syndrome by Proxy?

Munchausen syndrome is a mental disorder that causes a person with a deep-seated need for attention to fake sickness or injury. Munchausen syndrome by proxy (MSP) is a disorder in which an adult acts as though someone in his or her care—usually a child—is injured or ill. The term “by proxy” means “through a substitute.”

A person with MSP may directly cause or lie about an illness in order to get attention. Some people with MSP will even have a child undergo painful or risky tests and procedures in an effort to gain sympathy from family or community.

MSP is a mental illness, but it is also considered a form of child abuse.

According to the Cleveland Clinic, anyone can have MSP, but it is most often seen in mothers of children under the age of six. People who have MSP have an overwhelming need for attention and go to great lengths to achieve it, even if it means risking a child’s life. Approximately 1,000 out of 2.5 million cases of child abuse reported each year may be MSP-related. (Cleveland Clinic, 2012)

In many cases, MSP goes undetected. Doctors usually begin to suspect child abuse when a child experiences frequent illnesses and injuries. The child’s symptoms are usually exacerbated when home alone with the parent, and decrease when under a doctor’s care. The parent with MSP will appear to be highly devoted, self-sacrificing, and overly involved with medical personnel.

Treatment for the child usually involves removing the child from the care of the abuser. The parent may face criminal charges, and long-term psychiatric counseling is recommended.

Recognizing the Signs of MSP

People who have MSP exaggerate or lie about a child’s symptoms, and may even tamper with medical records. They often create symptoms by poisoning food, withholding food, suffocating, or causing an infection. In many cases, the parent may also work in a healthcare-related field.

Look for warning signs in both the child being abused and the parent suffering from MSP. Signs of a child whose parent has MSP include:

  • a history of repeated injuries, illnesses, or hospitalizations
  • symptoms that don’t quite fit together
  • symptoms that seem to improve under medical care and worsen when at home

Health care personnel may discover blood samples that do not match the child’s blood type. Chemicals or drugs may be found in the child’s urine and blood samples, but cannot be explained based on the clinical findings in the child.

In the parent, signs of MSP include:

  • attention-seeking behavior
  • striving to appear self-sacrificing and devoted
  • becoming overly involved with doctors and medical staff
  • refusing to leave the child’s side
  • exaggerating the child’s symptoms or speaking for the child
  • having had another child who suffered a mysterious illness or death

Long-Term Complications of MSP

A child of someone with MSP can suffer from multiple illnesses or injuries and be subjected to painful and frightening medical procedures, even at the risk of death. The death rate for victims of MSP is thought to be about 10 percent, according to the Cleveland Clinic. (Cleveland Clinic, 2012)

Survivors of child abuse often experience depression and anxiety that can last for years. Victims of MSP are at increased risk for developing Munchausen syndrome themselves.

Causes of MSP

MSP is a rare condition, and its exact cause is unknown. Doctors theorize that both psychological and biological factors are involved. Many people diagnosed with MSP were either victims of child abuse themselves or suffered serious illness as a child. It is thought that heightened stress may trigger MSP. This stress could be due to a previous traumatic event, marital problems, or perhaps abuse during their own childhoods.

Diagnosing MSP

In order for a parent to be diagnosed with MSP, he or she will need to admit to the abuse and submit to psychiatric treatment. As such, diagnosing MSP can be extremely difficult. A person with MSP is prone to dishonesty in matters of health.

Additionally, with attention focused on a sick child, it is easy for doctors and family members to overlook the possibility of MSP.

If you experience a desire to harm your child, seek medical or psychiatric help immediately. Child abuse, regardless of the reason, is a criminal offense.

It is likely that a doctor will first try to diagnose the child with a specific illness. If a child repeatedly presents with unexplained illness or injury, the doctor may begin to suspect child abuse or MSP. The doctor’s first duty is to protect the child from abuse by reporting these suspicions to the proper authorities. While under a doctor’s care, the child will be diagnosed and treated for specific illness, injury, and emotional trauma.

Treatment Options for MSP

Treatment must involve both the child and the adult, and often the entire family.

Treatment for the Child

Once it is determined that the child is a victim of abuse, he or she must be protected. This usually means involving child protective services and removing all children from the care of the parent abuser. Physical illness and injury must be treated accordingly. Psychological counseling may be necessary.

Treatment for the Parent

The parent accused of child abuse will likely face criminal charges. If MSP is suspected, psychiatric counseling will be recommended. Treatment may be difficult if the parent will not admit there is a problem.

Individual or family therapy may help all parties cope with the situation.

Long-Term Outlook

For the parent being treated for MSP, there may be years—or a lifetime—of psychiatric counseling. It is a very difficult condition to treat effectively.

For the child, the long-term outlook will depend on the extent of their physical and psychological injuries. Victims of child abuse are prone to depression and anxiety throughout their lives.

Preventing MSP

There is no way to predict who will develop MSP, and no known form of prevention. However, if MSP is suspected, there are ways to prevent it from escalating. If you have symptoms of MSP, seek psychiatric counseling immediately—before you hurt your child. Report suspected cases of child abuse to the proper authorities.