What Is Munchausen by Proxy?
DESIGN BY HEALTH
Medically reviewed by Dakari Quimby, PhD
Munchausen syndrome is a mental health condition in which someone seeks medical care for symptoms they don't actually have. A related but distinct condition, munchausen by proxy (MBP), also known as factitious disorder by proxy or factitious disorder imposed on another (FDIA), occurs when a child or elderly person’s caretaker makes it seem as if their dependent is ill by faking symptoms or causing real symptoms. It is considered both a mental health condition and a type of abuse.
MBP was first reported by a British pediatrician named Roy Meadow in 1977 and is one of the most mysterious and often undetected mental health conditions. Reports of MBP are rare, and cases are often undiagnosed, so there is no reliable estimate of its prevalence. However, some estimates state that 0.5 to 2 children under 16 per 100,000 in the United States experience MBP (approximately 160-660 children).
Symptoms
In order to identify cases of Munchausen by proxy, it is important to recognize symptoms of both the perpetrator (the caretaker) and victim (the dependent).
Caretaker’s Symptoms
In cases of MBP, the caretaker goes to extreme lengths to fake or cause symptoms of illness in their dependent child or parent. This may include:
Faking lab results
Warming up thermometers to fake a fever
Keeping food from the dependent
Putting blood in their stool or urine
Forcing the dependent to vomit or have diarrhea by providing drugs
Infecting a dependent’s IV line
When questioned about the dependent’s symptoms, their explanations may initially seem dramatic until pushed further, after which they may become vague or inconsistent.
Dependent’s Symptoms
Dependents, such as children or older adults, may experience MBP without anyone noticing. Symptoms of MBP in dependents may include:
Frequent hospitalizations and medical procedures
Many medical appointments
Unusual symptoms that don’t match test results or consistent diagnoses
Symptoms that are only reported by the caretaker and not seen by healthcare providers
Blood samples provided by the caretaker that don’t match the dependent’s blood type
Their blood, urine, or stool contains drugs or chemicals
What Causes Munchausen by Proxy?
The causes of MBP are still unknown. Most caretakers with MBP are mothers of small children, but some are adults taking care of their elderly parent. Caretakers who are healthcare workers are more likely to be perpetrators of MBP; caretakers are deeply invested and involved in their dependent’s medical care and seem to be doting loved ones. Because of these characteristics, many cases of MBP go undetected.
Risk Factors
Some predisposing factors may make someone more likely to be a perpetrator of MBP. These include:
History of childhood abuse
Diagnosis of Munchausen syndrome
History of pathological lying
Extensive medical knowledge
Coexisting mental health conditions, including personality disorders, self-destructive behaviors, post-traumatic stress disorder (PTSD), and substance use disorders
Coexisting learning difficulty
History of long-term hospitalizations during childhood
Diagnosis
Diagnosis of MBP generally occurs after a healthcare provider begins to notice signs. If someone suspects MBP, they can look into the child’s medical history to observe any inconsistencies. It’s common for MBP to go undiagnosed.
A diagnosis of MBP must include the following:
The caretaker pretends their dependent is experiencing false psychological and physical symptoms
The dependent makes it seem as though they themselves are sick or injured
The behavior continues without external rewards
Another condition does not better explain caretaker’s behavior
Treatments for Munchausen by Proxy
The main priority of treatment for MBP is to protect the dependent by removing them from the caretaker’s custody and reporting abuse to the appropriate authorities.
It is critical to provide the dependent with medical care to treat complications from illnesses, injuries, or medical procedures they experienced, as well as psychiatric or psychological care for depression, anxiety, PTSD, or other resulting mental health conditions. Treatment may include both individual and family talk therapy. It is also important to begin rebuilding typical routines for the child or adult dependent, such as going to school regularly.
Research is still inconclusive regarding treatment for the perpetrator of MBP. Because the condition is not widely studied, neither are treatment methods. In addition, most people who receive treatment for MBP are following court orders, rather than seeking treatment voluntarily. This makes it much more likely for perpetrators to be willing to participate in research on effective treatment strategies.
Mental health providers may use a combination of medication, talk therapy, and more methods, but there is no set standard practice of care at this point for MBP specifically. If the perpetrator has existing comorbidities, it can be useful to treat them using therapy such as dialectical behavioral therapy or trauma-focused cognitive behavioral therapy. In addition, narrative therapy can be used to support them in reframing their life path while acknowledging the harm they caused in the past.
Prevention
It is important for healthcare providers to recognize MBP as early as possible to prevent ongoing abuse and potentially dangerous medical testing and procedures. Because perpetrators of MBP rely on seeing new healthcare providers and telling their narrative about the patient’s medical history, it’s possible to prevent or catch cases early through careful practice.
Healthcare settings can implement policies to ensure effective communication and documentation of cases. When switching shifts in a hospital, for example, providers who can appropriately communicate with the next team may be more likely to point out a warning sign of MBP.
By working together across teams through communication and documentation, signs of worsening symptoms or frequent hospitalizations can be detected.
Related: What Is Munchausen Syndrome?
Complications
At its most extreme, MBP can be fatal. In less severe cases, MBP can still have devastating consequences for the survivors in a range of ways—physically, psychologically, and socially.
For example:
Physical complications: Because some perpetrators create symptoms in their dependent, they can create severe resulting infections and other injuries. For example, a perpetrator may put fecal matter into a dependent’s IV while at the hospital to create a bacterial infection in the blood.
Psychological consequences: Survivors may experience mental and emotional outcomes due to abuse, including anxiety, PTSD, or eating disorders.
Social consequences: Survivors may struggle to form appropriate and healthy attachments, resulting in challenges with forming friendships and relationships.
Survivors of MBP may have lifelong physical and psychological challenges. Treatment and early detection are critical for improving their quality of life.
A Quick Review
Munchausen by proxy, or MBP, is a dangerous form of abuse in which a caretaker fakes illness in their dependent, such as a child or older adult. They may go to extreme lengths to cause or fabricate symptoms, leading to dangerous medical testing and treatment. Many of the perpetrators of MBP are women, mostly mothers with experience in healthcare and existing mental health conditions and trauma. Early detection by healthcare providers is critical for improved outcomes for survivors.
Frequently Asked Questions
What is Munchausen by proxy called now?
Many people still refer to this condition as Munchausen by proxy, but some medical providers and researchers use the term “factitious disorder imposed on another (FDIA),” which is the official term in the DSM-5. The DSM-5 is the guide used by mental health providers to diagnose and treat mental health conditions.
Is Munchausen by proxy a form of child abuse?
Yes, Munchausen by proxy is a form of child abuse. Some people refer to it as “medical child abuse.”
Can you report someone for Munchausen by proxy?
Yes, you can report a perpetrator of Munchausen by proxy to the appropriate authorities, including the police, child protective services (CPS), or elder abuse authorities.
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