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Munchausen Syndrome by Proxy: Sick kid or sick parent?

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Biology 202
2002 Second Paper
On Serendip

Munchausen Syndrome by Proxy: Sick kid or sick parent?(4)

Jenny Maryasis

In relating the details of Munchausen Syndrome by Proxy (MSBP), the initial reaction is usually shock, followed quickly by fascination. The reason for the latter is that the medical community has yet to make up their minds about what exactly MSBP is. The debate: psychiatric disorder v. child abuse. Essentially the arguments for both create a divide between the brain and behavior, though not relating the two.

Munchausen Syndrome "is a condition manifest by persons feigning or inducing illness in themselves for no other apparent gain than adopting the sick role and thus exposing themselves to painful and sometimes damaging and disfiguring medical procedures (7)." The name of the syndrome originates from an eighteenth-century Baron, Hiernymous Karl Friedrich von Munchausen, who was a military mercenary widely known for regaling fantastical stories of exploits (6). While the Baron had no psychiatric condition or any further ties with the medical nature of the syndrome, as it is known today, his connection to the syndrome derives from the proven fabrication of all his tales. In 1977, the British journalist Roy Meadow first used the term "Munchausen By Proxy" in an article that named children as the primary victims of the syndrome.

At the time, the literature revealed the natural mother of the child to be the perpetrator of induced and at times actual, illness (3). It is important to note that Meadow's intended to apply MSBP to the problem of child abuse and while it is still extensively classified as such in child abuse and medical journals, the boundaries of the syndrome have been stretched with increased prevalence. The popular view of MSBP remains that it is a form of child abuse in which a parent of caretaker continually fabricates information about the child's health in order to assume the sick person's role by proxy (1).

The perpetrator is often a parent and typically the mother. However, there have been cases where the father acts as perpetrator. The first reported case of MSBP with a male caretaker occurred in 1990 when a father complained to physicians that his newborn baby would often stop breathing, turn blue and have seizures. Following extensive evaluation of apnea, it was discovered that the father, himself was suffocating and shaking the baby (5). Perpetrators show an avid interest for hospital care and usually have experience in the medical field. Munchausen syndrome is present in 10% of such perpetrators (3).

Munchausen syndrome and MSBP are included in the DSM-III R category of factitious disorders and therefore are elusive syndromes that are difficult to diagnose and recognize (2). "Because symptoms in factitious disorders are not connected with obvious gain, the absence of external gain suggests that factitious disorders like Munchausen syndrome serve some psychological need, but do so by maladaptive methods (2)." The syndrome is not recognized by the American Medical Association or the American Psychiatric Association (10). Lack of official recognition from the medical community has created an air of confusion around MSBP. Munchausen syndrome is decidedly a psychiatric disorder involving the patient assuming a role, but the reason for skepticism concerning MSBP is that is clearly a form of child abuse, as well as a vehicle for further role assumption by the perpetrator. Therefore, diagnosis is often relegated to close surveillance of the perpetrator's behavior toward the child.

While the medical community questions the validity of MSBP, I am more likely to adopt the opinion that the two can be reconciled - the syndrome being a form of child abuse that demonstrated behavior typical to that of a psychological disorder. The debate over the status centers on the perpetrator. Studies have shown that the perpetrator "rarely suffers from overt mental illness..." though, they have been known to have "one of various personality disorders associated with attempts to deceive - most commonly, the historic and borderline disorder types (1)." Some past medical history could show Munchausen syndrome, depression, family dysfunction, and somatization disorders (1). Thus, it is clear that MSBP serves a psychological need for the perpetrator because there is no external evidence of physical gain.

MSBP is a sort of enigma - which brings me to my original purpose; a quest for the truth about MSBP. The most important question for me being: what causes Munchausen Syndrome By Proxy? It is a disturbing disorder, which is closely tied to behavior and, on the surface, loosely connected to the brain. No concrete psychological or neurological data exists on the causes of child abuse. Most theories on the causes of child abuse point to past abuse, family dysfunction and depression - the same symptoms existing in MSBP perpetrators. However, it seems far too simple to write off MSBP as child abuse and ignore the psychological components of the syndrome, such as the perpetrator assuming the role of a sick individual by proxy. Above all, this speaks to the prevalence of the I-function in the individual.

The I-function provides an idea of self, from an objective perspective. Therefore, the perpetrator's I-function is closely linked to their behavior as individuals and caretakers. The behavior of the perpetrator involves imagining themselves in a role outside of their bodies and I would argue this aspect can be attributed the I-function. The notion of fictitious experience takes the perpetrator away from the physical reality and to a completely psychological, imaginary space. The correlation between I-function and the perpetrator's actions can informally explain their motives for MSBP. To clarify, I am not suggesting that the I-function is a cause of, or an indicator of intent to engage in MSBP for two reasons: 1. There is no physical evidence of the I-function to point to, 2. The I-function could only account for the perpetrator's personal experience (imagination, dreaming, planning, etc.) in order to isolate the person from other caretakers that do not partake in MSBP. Arguably, the role of the I-function is to individualize each human, but working in conjunction with a history of psychological disorders and abuse, it helps in producing the mind frame of a perpetrator of MSBP.

Information on Munchausen Syndrome By Proxy is unanimous on several basic points: the identification, symptoms of the perpetrator and consensus (more or less) that is at least, a form of child abuse. The vast black hole of diagnosis, treatment for the perpetrator and victim and concrete warning signs poses a great risk to the victims. The perpetrators are not overtly inadequate caretakers, but in fact the very opposite. Furthermore, coupled with their ability to deceive and lie to obtain their desired ends creates difficulty in diagnosing MSBP for doctors. The perpetrator is most likely deeply caught in their psychological, internal experience, while the child suffers through physical, external experience. Lack of medical data and psychological mapping of the perpetrator causes MSBP to continue and increase in frequency over time. The issue of the proxy further complicates the reality in questioning what is true and what ailments are genuine. Surveillance is the only answer offered right now, but I hope that there will soon be medical aid available for the perpetrators.

WWW Sources

1) General information on MSBP, Clinician Reviews (August, 2001) article.

2) Information on Munchausen syndrome and Munchausen syndrome by proxy, The Journal of Psychology (May, 1997) article.

3) Case reports of MSBP, Journal of Toxicology: Clinical Toxicology (April, 2001) article.

4) Case of MSBP, Newsweek (April, 1996) article.

5) MSBP: father as perpetrator, Pediatrics magazine (March, 1990) article.

6) MSBP - The deadly game; Saturday Evening Post (July, 1996) article.

7) MSBP: child abuse in the medical system, Archives of Pediatrics & Adolescent Medicine(July, 1996) article.

8) Fabricated or induced illness in children, British Medical Journal (August, 2001) article.

9) Information on MSBP.

10) Mothers Against Munchausen Syndrome by Proxy Allegations (M.A.M.A) home page.



Comments made prior to 2007

I am creating a databank of information on Munchausen Syndrome by Proxy. In particular, I am interested in studying Munchausen Syndrome by Proxy in order to have it discredited as an entity. In order to do so, I need those with and without the disorder to come forward with the information about themselves. Please send information to me at the following address:

Lisa Jacobs, MD
PO Box 488
Weston, MA 02493

I want to show that mothers with risk factors for Munchausen Syndrome by Proxy do not have Munchausen Syndrome by Proxy, and that just because mothers have some characteristic behavior profile that it does not mean that they have this theoretical construct which is not a scientifically valid syndrome. I remain very concerned that the statistics do not support the very existence of this syndrome ... Lisa Jacobs, 27 July 2004


CB's picture


I am also a father of 2 daughters who have been through a nasty divorce. My ex has been suffering from bi polar disorder since childhood and her mother is severely bi polar as well. My ex began abusing drugs and we separated , during that time she left town. She moved over 500 miles away an left me with the girls. She moved in with another man and got pregnant , brought him back to town and is now living with her mother and new husband . None of them are working, grandma has retired and they now have a new baby. I have been keeping track of the amount of times this has happened and it has been happening consecutively 7 times in a row now. Each time we change possession, me being the custodial parent, sometimes this possession change is only 1 day and each time our youngest daughter has something wrong with her. It all began with panic attacks, which she never has had in my possession and today was pink eye...and everything in between. I can't confront anyone in that house about this because being bi polar and not medicated they are unaware of their own reality so it will undoubtedly cause a fight. How do i handle this

Serendip Visitor's picture

1991, They adopted my 2 children, SS lied

I had 2 children adopted. My only 2 children. Judge Sir Matthew Thorpe at RCJ released them, after a 3 year battle. They were 2 and 3 years old. There is no defence. It has nearly killed me and my husband. Recently we discovered our daughter, now 26, got married last summer and had a baby last November 2013. We will never see our first grandchild. We do not know where our son is, now 28. They will never know the truth. Despite having expert witnesses, a criminal case thrown out of court with "no case to answer", our children were taken, adopted against our wishes and lost to us forever.
We kept all documentation, in the hope that one day we could tell them the truth.
No one ever offered us any support. One day I was a mother, the next I was not.
One mistake was one two many.
The Social services had an expert witness, he never saw me, read my medical notes or spoke to my GP or any doctor who treated me. Women were released from prison when he was unmasked as a fraud, his name was Dr. Roy Meadows.
My children were gone, never to return and I was held under a "gagging order" due to the secret Family Courts.
Who is there to get me justice, tell my children that I never did anything. What do they know?
I am still angry, 25 years later.
Yes, protect our children, but don't steal them to meet a quota.
It is time people realised that adoption mistakes are not new and are irreversible.

Tony L's picture

I don't know what to do.

I am a father that has 50/50 custody of my son. My son did have encephalitis 3 years ago and almost died from it. He came back and was doing really well. Since he's been out his mother has been claiming his having seizures. The thing is he only has them when he is with her, but never when he's with me. It also seems like she tries to keep me in the dark when it comes to his medical. He gotten to the point where he's now seen at CHOC. They run test every time, EEGs, MRIs, Video EEGs and they never see any seizures. In fact the last doctor check up, the doctor said he wasn't having any. My ex still is stuck on that he has them and that they are just not noticeable. Like the past few days he had been sick and he got pneumonia, he was doing better the past few days while he was with me, then the first night at her place he gets worse and she's taking him to the ER. I can't talk to his primary doctor about what I'm seeing because he is a personal friend of her family.

My ex did the same thing with herself, she was know as a frequent flyer by the hospitals, addicted to medication and what seemed to me addicted to the attention. Things got bad enough and I left with my son and that's why we ended up divorced. I thought it was a drug addiction but she fits Muchausen so well. Now I'm worried that she's doing it with my son.

What should I do? I Don't know where to start.

Serendip Visitor's picture

sick or not

I would attend doctors appointments. Be very involved in his care. If he is really having these problems be there every minute you can. If you truly participate in his appts and care then you will see the truth.

Fleur Black's picture

16 poiny checklist

Anyone wondering how to diagnose a person with MSbP can use this checklist to decide if the person has MSbP or is a Control Freak or has Sadistic Personaility Disorder.

Serendip Visitor's picture


is it possible that my nephews are always sick at doctors every 2 weeks something sounds strange

katie's picture

My mom has this for a long

My mom has this for a long time and i want to help kids who parents have this is there any way i could do that as a career or anything similar does anyone know.

Serendip Visitor's picture

I believe my mother has this

Mother has feigned cancer five times, heart attack, celiac disease (got caught by a nurse in the hospital sticking her finger down her throat), diabetes, several large tumors, etc. She is now feigning blindness (but been caught reading a book and plays solitaire all the time), asthma and as of yesterday, a stroke. My sister took her to the Dr. and he said she did not have a stroke. She goes from Dr. to Dr. until she finds one that will agree with her diagnosis and put her in a cast or do some surgery or another. She has been "dying" since i was eight and I am now in my mid-fifties. She won't get help and I'm afraid she is really going to have something and the rest of the family won't believe her (especially now that she has been caught making herself sick, etc.). She is angry at me because I did not get a hysterectomy by the time I was 40. There is nothing wrong with me.
Thing is - I don't know how to help her. She lives with my older sister who is trying to cope as best she can - but it is really frustrating when there's nothing wrong and she insists she's dying of some malady.
Any suggestions as to how we can help her or at least not become co-dependents?

Michael M's picture

Humm interesting ... The

Humm interesting ... The debate: psychiatric disorder v. child abuse.

Serendip Visitor's picture

I am wondering if there are

I am wondering if there are vearing levels of severaity with this disorder. I am currently trying to get my husbands ex-wife to be looked at for this. Although she is not so bad that she is killing anyone at the same time I can see the effects of her actions on the kids. The kids now have grown mostly beyond child hood but are always sick without any symptoms. All three were healthy apearing to others and at the doctors at least once a month as younger children and once they became older, all of a sudden had severe behivoral issues including claims by their mother of molestion, which have been disproven but the mother still claims to be true.

Anonymous's picture


Incidentally, the "I-function" describes it to a "T". I agree that it stems from the "I-function". My mother suffers from a facial abnormality which she was born with and has affected her phsychologically all of her life. It is located right below her eye (not sure which one it is since I have not seen her on too many occassions without heavy makeup to cover the abnormality). I do not believe that the facial abnormality is the only factor which attributes to her abnormal psychological disorder. I believe it is also encompassed in years of abuse (sexual and physical) from her years of growning up. I believe that famil values and a "rules based" up bringing play a huge role in the mind set of the MBPS perpetrator or lack thereof.

But the "I - function" is a HUGE, HUGE factor. It's the narcistic personality, which you may be referring within your article as the "I -function" which is the nucleus of the MBPS personality.

God, I wish the medical community and the mental health care profession would focus more on this problem. It's real. It needs to be looked at more seriously in our society.

Anonymous's picture


I am a vicitim of Shaken Baby Syndrome from the early sixties. Then it was not as recognized as it is today and I was returned to my parents for years of additional abuse. I now suffer a permanent dislocated jaw, a murdered child of mine and the murdering of the child's father. All to cover for my mother MBPS (Muchausen by Proxy Syndrome) by my co dependent father (who incidentally was the one who murdered the father of my child). It's been a long harrowing life for me which has included years and years of abuse and re vicitimization. I suffered skull fractures/sub dural hematoma at the age of six months of age and underwent surgery to save my life. I was blessed to have a wonderful neurosurgeon at Madison University Hospital in Madison, WI. I was lucky. Many children are not as lucky. Sad. Then, in 1960, there was little known about SBS and little was done by the authorties in terms of investigating and/or protecting the child by removing him/her from under the roof of the family until an investigation took place. I was returned to my parents as I previously stated. Years and years and years of abuse ensued. No matter how many times I tried to bring it to the attention of the authorities, I was ignored and even re-victimized by my having undergone brain surgery for the sub dural hematoma as six months of age used as the basis for their avoiding serving any time for their crimes that they committed not just against me but also against my dead/murdered child which I was forced to deliver dead after a saline induced abortion (more than six months pregnant). The father of the child got into an auto accident within weeks of my being forced to undergo the saline induced abortion at more than six months of pregnancy and went into a coma. He managed to regain his ability to walk, talk and even lived independently when my dad left the house and went to his apartment and murdered him. I heard an old phrase that secrets are easy to keep between three people when two are dead. Well, when I heard that on TV one day, I only then realized what I had been put through and what it would take to bring justice to my murdered child and high school sweetheart, the child's father. My parents are both juniors to their parents of the same gender. They are extremely co dependent. They seem to feed off each other's evilness. My mother went on to murder her own mother (on my paternal grandmother's birthday. Incidentally, my paternal grandmother took care of me after the SBS (sub dural hematoma/skull fracture and surgery). She was my mother figure as far back as I can remember. I do not remember my parents together as a couple. Just my paternal grandparents. I call that "God's Blessing" to me. They were wonderful. As was my paternal great grandmother. There was always a hostility between my mother and my paternal grandmother. This fortunately is documented in health/counseling records which I hope to utilze as "proof" that my mother did murder her own mother. I also have resons to believe she may have murdered her younger brother on his death bead when he was dying of aids in Pompano Beach, FL too. And also her third husband. It's a very tricky disease and calling it a syndrome is only trivializing this insidious, calculatingly horrendous crime against humanity. It should not be labeled a "syndrome" because it seems as if it is being compared to the common cold or flu at most. It is not a simple pathology to recognize. I being a victim have only realized it after years of abuse and damage to my life which rips at my heart and very soul every day of my life. I suffer physical scars from the abuse which will take lots of money to correct, if it can be corrected? I suffer deeper than the eye can see though. It is a sad malady which every parent should be educated in and every heathcare professional should be educated in as well. Even if a person without children suspects child abuse they should not think twice and report it immediately. Perpetrators of MBPS are grand manipulators and will go to no ends to cover up and portray the victim as crazy or 'off' and of course lying. So, do not hesitate to go with you 'gut instincts' and report child abuse if you suspect it in the slightest way.

P. from Weston MA's picture


Wow, this is really scary -- how common is this syndrome?

Joanna's picture


Munchausen by proxy is recognized by the APA, M.A.M.A. is an outdated (and biased) source.

Serendip Visitor's picture

Totally agree. M.A.M.A, was

Totally agree. M.A.M.A, was monopolised by certain people. John Hemming MP can't help as adoption had occurred. NO ONE WILL HELP IN U.K. SO LEAVE THE COUNTRY TO SAVE YOUR CHILDREN.

Why are drug addicts etc given help and support, yet others wh have done nothing loose their children for life?