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 the caretaker of a child either
makes up fake symptoms or causes real symptoms to make it appear as though the
child is injured or ill. The term “by proxy” means “through a substitute.” Though
MSP is primarily a mental illness, it’s also considered a form of child abuse.
Many people with MSP exaggerate or lie about a child’s symptoms to
get attention. They may also create symptoms by poisoning food, withholding
food, or causing an infection. Some people may even have a child undergo
painful or risky tests and procedures to try to gain sympathy from their family
members or community. It’s also believed that people with MSP may enjoy the
satisfaction of deceiving people whom they perceive to be more powerful than
themselves, particularly medical professionals.
MSP can affect anyone, but it’s most commonly seen in mothers of
children under age 6. 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. According to the Cleveland
Clinic, approximately 1,000 of the 2.5 million cases of child abuse
reported each year may be related to MSP.
Since a parent or caretaker with MSP often appears to be caring
and attentive, doctors usually don’t suspect any wrongdoing. Diagnosis can also
be difficult due to the person’s ability to manipulate doctors and induce
symptoms in the child. As a result, MSP goes undetected in many cases. Doctors may
begin to suspect child abuse when a child frequently experiences illnesses and
injuries. They may also become suspicious if a child’s symptoms worsen when
home alone with the caretaker and improve when under medical care.
Treatment for the child usually involves removing the child from
the care of the abuser. The abuser may face criminal charges, and long-term
psychiatric counseling is often recommended.
The Warning Signs of Munchausen Syndrome by Proxy
It’s important to look for warning signs in both the child and
The warning signs in a child include:
- a history of repeated injuries, illnesses, or
- symptoms that don’t quite fit any disease
- symptoms that don’t match test results
- symptoms that seem to improve under medical care
but get worse at home
The warning signs of MSP in the caretaker include:
- attention-seeking behavior
- striving to appear self-sacrificing and devoted
- becoming overly involved with doctors and
- refusing to leave the child’s side
- exaggerating the child’s symptoms or speaking
for the child
- appearing to enjoy the hospital environment and
the attention the child receives
If you experience a desire to harm your
child, seek medical help immediately. Child abuse, regardless of the
reason, is a criminal offense.
Causes of Munchausen Syndrome by Proxy
MSP is a rare condition, and its exact cause is unknown.
Researchers theorize that both psychological and biological factors are
involved. Many people diagnosed with MSP were physically, emotionally, or
sexually abused when they were children. Some grew up in families in which
being sick or injured was a way to receive love or care. It’s also believed
that stress may play a role in the development of MSP. This stress could be due
to a previous traumatic event, marital problems, or perhaps a serious illness.
Diagnosing Munchausen Syndrome by Proxy
For a caretaker to be diagnosed with MSP, they’ll need to admit
to the abuse and submit to psychiatric treatment. However, people with MSP are prone
to dishonesty, so diagnosing the condition can be extremely difficult.
Additionally, with attention focused on a sick or injured child, it’s easy for
doctors and family members to overlook the possibility of MSP.
It’s likely that the 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. They may
also become suspicious if any symptoms suddenly stop or improve when the child
isn’t with their caretaker. 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 any illness,
injury, or emotional trauma.
Treating Munchausen Syndrome by Proxy
The treatment for MSP must involve both the child and the adult.
It may also be beneficial for the entire family to participate in treatment.
Treatment for the Child
Once it’s determined that the child is being abused, they must be
protected. This usually means contacting Child Protective Services and removing
all children from the care of the abuser. Any existing physical illness or
injury must be treated accordingly. Psychological counseling may also be
Treatment for the Caretaker
The person accused of child abuse will likely face criminal
charges. If MSP is suspected, psychiatric counseling will be recommended. However,
treatment may be difficult if the caretaker doesn’t admit that there’s a
Individual or family therapy may help all parties cope with the
Potential Complications of Munchausen Syndrome by
Children who are abused by caretakers with MSP can develop
multiple illnesses or injuries, some of which may be life-threatening. They can
also be subjected to painful and frightening medical procedures. As a result,
some children may experience depression and anxiety for many years. They’re
also at an increased risk for Munchausen syndrome themselves.
Outlook for People with Munchausen Syndrome by Proxy
For the caretaker being treated for MSP, psychiatric counseling
is often required for many years. It’s a very difficult condition to treat
For the child, the long-term outlook will depend on the extent of
their physical and psychological injuries. Many victims of child abuse are
prone to depression and anxiety throughout their lives.
Preventing Munchausen Syndrome by Proxy
There’s no way to predict who will develop MSP, and there’s no
known way to prevent it. However, if MSP is suspected, there are ways to
prevent the disorder from escalating.
If you have symptoms of
MSP, seek psychiatric counseling immediately, before you hurt your child. If
you think a child is being abused, contact the police or Child Protective
Services. Call 911 if any child is in immediate danger due to abuse or neglect.
National Child Abuse Hotline is also a great resource for caretakers who
need crisis intervention and for concerned people who suspect a child is being
abused. There are crisis counselors available 24 hours a day, seven days a week
who can help you figure out the next steps. You can reach them at 800-4-A-CHILD