Munchausen by Proxy Syndrome: A Deadly Disorder 

Jessica Feurtado

May 15, 2004

Munchausen by Proxy Syndrome (MBPS) is a deadly disorder of which awareness must be increased. It is characterized by a parent, usually the mother, who intentionally causes illness in her child. The disorder was named after Baron von Munchausen. There are different intensities and manifestations of this disorder. Symptoms of the syndrome are hard to identify but are most prevalent when the child only becomes sick in the presence of his or her mother. The mother maintains a dynamic relationship with the physician, as the whole disorder is centered upon her need for attention from the doctor. It is most widely agreed that MBPS is caused by a need for attention and compassion to placate self-doubt in the sufferer. The only plausible treatment known for this disorder is extensive psychotherapy. If more research is conducted on this syndrome, it will help to protect the youth against abuse that is a by product of a psychologically sick mother.

Introduction

            When asked what Munchausen by Proxy Syndrome is, most people will draw a blank. They are unaware of this form of abuse that claims the life of nine percent of children that fall victim to it. This paper will discuss the definition of Munchausen by Proxy Syndrome (MBPS), the origin of its name, the subtypes of the disorder, the symptoms associated with it, the dynamic relationship between the sufferer of the disorder and the physicians caring for the sufferer’s child, the causes of this syndrome, and the suggested treatment for it. MBPS is extremely difficult to diagnose, which is why many children die before doctors realize what was actually happening to them. Treatment for this disorder is limited, as well as knowledge and understanding of its causes. For this reason, it is extremely important to raise awareness of Munchausen by Proxy Syndrome and to work towards ensuring that no more children fall victim to illness and death at the hands of their own parents.

Munchausen by Proxy Syndrome Defined

            Munchausen by Proxy Syndrome, also called Factitious Disorder by Proxy, is a psychological disorder characterized by a pattern of behavior in which someone, usually a mother, induces physical ailments upon another person, usually her child (“Munchausen by Proxy Syndrome,” n.d., p. 1). The mother attempts to gain attention and recognition for herself by putting on the public façade of dedicated and loving mother. However, when alone with her child she will subject them to abuse, both physical and emotional, as she tries to deliberately make them sick. The website “Munchausen by Proxy Survivors Network,” offers an extended definition for the disorder:

Children who fall victim to a parent suffering from Munchausen by Proxy Syndrome quite often require extensive emergency medical care, and undergo several unnecessary procedures such as painful surgeries and physical testing. Parents with Munchausen by Proxy Syndrome do not typically appear psychotic and, based on incidents caught on film, are calm and collected when inflicting harm on their children. Victims of Munchausen by Proxy Syndrome range greatly in age. The youngest case known was of a mother intentionally harming her fetus. The older cases involve people inducing illness in adults (Schreier & Libow, 1993, p. 6). With such a wide array of possibilities it is often too late for the victim before the disorder can be diagnosed.

The Origin of the Name

            Munchausen Syndrome, a disorder where people fabricate illness in themselves, and Munchausen by Proxy Syndrome were named after an 18^th-century German dignitary named Baron von Munchausen. Baron von Munchausen was known for telling “outlandish stories,” (“Munchausen by Proxy Syndrome,” n.d., p. 1). The name was first used in 1951 by Dr. Richard Asher to describe self-induced illness. It is told that Asher came upon the name Baron Hieronymus Karl Friedrich Freiherr von Munchausen in fictional accounts of his stories published in 1785 (Schreier & Libow, 1993, p.6-7). Because of the correlation between Baron von Munchausen’s fictional stories and the exaggerated and made up symptoms of a person with this disorder, the terms Munchausen Syndrome or Munchausen by Proxy Syndrome were adopted as clinical terms describing the two main factitious disorders.

Subtypes of Munchausen by Proxy Syndrome

            Though difficult categorize, Munchausen by Proxy Syndrome manifests in a plethora of different forms. This section will discuss the most commonly recognized subtypes. Factitious Disorder by Proxy can range in frequency or intensity. Chronic Munchausen by Proxy Syndrome is characterized by the constant pursuit of attention through the harming of another individual.  People suffering from this degree of the disorder are compulsive and allow the syndrome to consume most of their lives. The episodic form of the disorder occurs in bouts. There are intervals in which the sufferer experiences symptoms of Munchausen by Proxy Syndrome followed by a hiatus where he or she can conduct a normal life. More intense degrees of symptoms can cause the caregiver to put the child in immediate jeopardy of dying. These parents resort to measures such as “suffocation, inducing vomiting, poisoning, or removing the blood from a child.” In less extreme cases, the caregiver may withhold treatment for an already sick child, or simply lie about the child having symptoms that they aren’t truly exhibiting (Schreier & Libow, 1993, p. 9). In extreme cases of this disorder, a mother can induce severe symptoms in her child, but appear cooperative, compassionate, and concerned in the presence of a physician. Schreier and Libow call these sufferers “active inducers.” Milder cases have shown mothers that forge medical histories of their child and lie about the child being sick rather than actually causing sickness by active means. They do this for the emotional gratification they feel from receiving the attention of a doctor. These individuals are defined as “doctor addicts,” (1993, p. 10).

Symptoms of Munchausen by Proxy Syndrome

            Munchausen by Proxy Syndrome is quite possibly one of the most difficult disorders to diagnose. For this reason, an unfortunate nine percent of victims to this abuse die (Feldman, 1998, p. 1). Indicators that a parent may be suffering from Munchausen by Proxy Syndrome include but are not limited to a discrepancy between the child’s medical records and what actually seems logical to have happened, the child exhibiting symptoms that do not respond to treatment as they were expected to, an illness that only appears or becomes more grave in the presence of the parent,  symptoms that disappear in the absence of the perpetrating parent, sickness that resumes once the caretaker is informed that the child is recovering, or similar symptoms found in siblings or family members of the victim (Lasher, 2004, p.1). The induced illness can range anywhere from diabetes to diarrhea. The possibilities are endless, as individuals with this disorder do not conform to feigning any particular illness. Because of the seemingly infinite sicknesses people with Munchausen by Proxy Syndrome have to choose from, it is impossible for doctors to single out Munchausen Syndrome based solely on the ailment of the patient. This makes it particularly important for medical personnel to recognize the behavioral patterns that individuals with Munchausen by Proxy Syndrome display. A single child suffering from many different illnesses in a short span of time is usually an early indicator that something is not right. Unusual responses to treatment are also factors that can indicate a problem (Schreier & Libow, 1993, p. 15). It is common for victims of this syndrome to exhibit genuine symptoms of illness along with the exaggeration and fabrication of other symptoms. This furthers the difficulty in diagnosing Munchausen by Proxy Syndrome because it makes it difficult for physicians to distinguish the real ailments from the ones which were made up. Another sign that is common among parents with Factitious by Proxy Disorder is their “righteous indignation” when confronted by a doctor about their fictitious accounts of the child’s medical history, or of inducing symptoms in their child. Often the parent will threaten to file a malpractice lawsuit, or may even cause the child to become deathly ill to prove to physicians that she was right about the child’s poor health (Schreier & Libow, 1993, p. 40)

Dynamics of the Mother-Physician Relationship

            When a mother (or caregiver) suffers from Munchausen by Proxy Syndrome, she is in a constant effort to mask the life endangering child abuse she commits behind closed doors. Schreier and Libow call this process “mother imposturing.” They define it as a clinical condition that is “a form of relating (here, to a physician) in which lying is the essential mode of interaction,” (1993, p. 84-85). The mother attempts to portray an outward image of perfection. She shows compassion and devotion to her child by giving up much or all of her time to constantly take them to the hospital (Feldman, 1998, p. 1). Though the abuse on the child is the most prevalent aspect of Munchausen by Proxy Syndrome, the real focus of the disorder is on the relationship between the doctor and the parent. When the pediatrician withholds some attention from the mother and her ill child, the symptoms further escalate, as the mother tries harder to gain the attention of the doctor. It is clear that the mother thrives off of any sympathy or attention given to her, especially by a physician.

Causes of Munchausen by Proxy Syndrome

            There are various theories regarding the cause of Munchausen Syndrome. Dowdell and Foster theorize that a mother may feel that a sick child can bring her closer to her spouse. It is more likely, however, that mothers suffering from this disorder “have had an emotionally deprived childhood with a high probability of a history of physical abuse,” (n.d., p. 1). The women are most likely depressed and insecure, and channel their personal inadequacies into abusive behavior, which in turn produces gratifying attention for themselves. The environment of a hospital also gives the mother a chance to rid herself of parental responsibility while medical personnel tend to her child. It is common for mothers with this disorder to wander the hospital and speak with other parents. Their sick child helps them establish a common bond with other mothers in the hospital and thus makes the mother feel as if she fits in. According to Schreier and Libow, “longed-for but absent” fathers appear quite often in clinical data (1993, p. 98). If a mother realizes an increasing detachment from the family in the father of her child, she may resort to hurting her child in order to restore cohesiveness in the family. An absent spouse also leaves the mother plenty of time alone with her child to inflict injuries and sickness that she otherwise may not be able to inflict in the presence of her husband. 

Treatment of Munchausen by Proxy Syndrome

            Knowledge of how to treat Munchausen by Proxy Syndrome is limited. Feldman relays about mothers with MBPS that “virtually all have personality disorders that lead them to behave in odd and even destructive ways, especially when they feel under stress,” (1998, p. 1). It is even more important, then, for these mothers to undergo extensive psychotherapy. In most cases, the mother is fully aware of her behavior but reluctant to openly acknowledge it. She is unaware of the its cause and feels she has no control over her own actions. “The therapist’s task was described as ‘uncover[ing] and interpret[ing] these fantasies and behaviors to the patient’,” (Schreier & Libow, 1993, p. 153). Parents suffering from Munchausen by Proxy Syndrome are highly unlikely to voluntarily attend psychotherapy. It is important for the court system to mandate visits for the sufferer, or the problem will not be assessed and treated. Unfortunately, “very little encouraging data is y available on successful therapeutic work with MBPS mothers,” (Schreier & Libow, 1993, p. 162).

Conclusion

            Munchausen by Proxy Syndrome is extremely difficult to characterize and diagnose. It manifests in so many different forms that it often goes undetected. It is often difficult for physicians to believe that a mother would intentionally hurt or even kill her own offspring, as it is a mother’s job to protect and ensure that her children are protected from all harm. Symptoms of this disorder are often near impossible to distinguish, however, with raised awareness among doctors and nurses, it can be spotted and treated before a child is put in life-threatening jeopardy. There is not nearly enough research on the syndrome to completely understand or pinpoint why some parents suffer from it. It is crucial that in the future some measures for prevention of Munchausen by Proxy syndrome, and more effective ways of treating it are developed. The medical and psychological community must become more aware of the problem and help children to be set free of the abusive hands of their own mothers. 

References

Dowdell, RN, PhD, E.B., & Foster, RN, K. L. (n.d.). Munchausen Syndrome by Proxy:  Recognizing a Form of Child Abuse. Retrieved April 6, 2004 from http://nsweb.nursingspectrum.com/ce/ce209.htm.

Feldman, M.D., Mark D. (1998). Parenthood Betrayed:  The Dilemma of Munchausen Syndrome by Proxy. Retrieved April 1, 2004 from http://www.selfhelpmagazine.com/articles/parenting/hsmun.html.

Lasher, Louisa J. (2004). MBP Basics. Retrieved March 29, 2004 from http://www.mbpexpert.com/definition.html.

Munchausen by Proxy Survivors Network. (n.d.). Retrieved April 3, 2004 from http://www.mbpsnetwork.com.

Munchausen by Proxy Syndrome. (n.d.). Retrieved April 3, 2004 from http://www.kidshealth.org/parent/system/ill/munchausen.html.

Schreier, H.A., & Libow, J.A. (1993). Hurting for Love:  Munchausen by Proxy Syndrome. New York:  The Guilford Press.