Munchausen Syndrome by Proxy

FDIA or factitious disorder imposed on another, erstwhile known as MSBP or Munchausen syndrome by proxy, is a comparatively rare type of child abuse involving the fabrication or exaggeration of symptoms or illnesses by a primary support giver or caretaker.

Also called MCA or medical child abuse, this syndrome was named after the eighteenth-century German nobleman Baron von Munchausen for crafting fictitious tales about his journeys and anecdotes to steal the limelight. The term by proxy refers to the fact that either of the parents or any other adult is exaggerating or fabricating symptoms in a kid, and not in oneself. MSBP is necessarily a mental illness that requires treatment.

Munchausen Syndrome by Proxy Causes

The precise cause of this disorder is not known yet, but researchers and doctors are examining the psychological and biological stakeholders that could be held accountable for its manifestation. Some theories do infer that a history of neglect or abuse as a kid or the early demise of any one of the parents may be instrumental in its development. Some evidence likely concludes that a significant stressor, such as marital discord, can potentially trigger MSBP.

Munchausen Syndrome by Proxy Symptoms

The following characteristics are typical in an MSBP patient

  • Most often is a parent; generally a mother; though can happen to be the professional caregiver of a differently abled adult, spouse, or the adult offspring of an aged patient
  • Could be health care providers
  • Is very cooperative and friendly with the medical professionals
  • Seemingly over-concerned or reasonably concerned about the designated patient or the child

Other potential warning signs of MSBP in kids include the following

  • The kid has an extensive history of hospitalizations for many times, which were often accompanied by an obscure set of symptoms
  • Worsening of the victim’s symptoms is usually reported by the perpetrator and is not seen by the staffs at the hospital
  • The reported symptoms and conditions of the child do not correspond with the outcomes of the diagnostic procedures
  • There could be at least two instances of unusual illness or incidents of death concerning the kids in the family
  • The condition of the child improves when admitted to the hospital, but resurfaces when the kid returns home
  • Blood in pathological samples might not correspond with that of the child
  • The urine or stool of the kid might contain signs of chemicals as well

Munchausen Syndrome by Proxy Diagnosis

  • A kid with numerous medical issues that are not responsive to therapies or that happen to follow a puzzling and persistent course
  • Pathological or physical findings that are found to be highly atypical do not match with the medical history of the child or are deemed to be clinically or physically impossible
  • Short-term signs that typically improve or cease when the perpetrator is not left with the victim, for instance, when the kid is hospitalized
  • A caregiver or a parent who is not relieved by the good news; when test results do not find any medical problems, and instead continues to demand that the kid is not well, and may even shop for a doctor who believes that the child is genuinely ill
  • A caregiver or a parent who is seemingly medically knowledgeable, or preoccupied with the medical nitty-gritty, or likes the hospital settings as well as the undivided attention the sick kid receives
  • A caregiver or a parent who is found to be encouraging and overly supportive of the medical practitioner, or one who happens to be angry and asks for more procedures, second opinions, further investigations, or even transfers to more advanced facilities

Differential diagnosis

The differential diagnosis is indeed pretty diverse and is not merely restricted to organic disorders. It also includes somatic symptom disorder, conversion disorder, malingering, and BPD or borderline personality disorder. The diagnosis of severe, fatal types of MSBP remains difficult, and the differentiating factor to distinguish Munchausen from these diseases involve the self-inflicted injury that is associated with deception as well as the absence of apparent secondary gain. As many patients are found to be seemingly productive and functional beyond the hospital settings, even close caregivers find it pretty challenging to detect such people.

Some self-injurious behaviors could lead to true disease eventually, such as pulmonary talcosis. Though other behaviors happen to be more episodic, nonetheless, they can still result in death, as in L-thyroxine ingestion. Presenting complaints or symptoms often pose as organic disorders, and if allowed to remain untreated, might lead to life-threatening repercussions.

Munchausen Syndrome by Proxy Treatment

Shifting the patient

The primary concern in MSBP is to assure the protection and safety of any potential or real victims. Now, this may well require that the kid is shifted to as far as possible from the vicinity of the perpetrator. Honestly speaking; effective management of MSBP cases often calls for the intervention of concerted efforts of a team that involves foster care organizations, social care, doctors, and also the law enforcement officers.

Making the Patient Realize About the Disorder

The odds of success for treating MSBP patients is pretty slim, as such people are in a constant state of denial that they do have an issue. Additionally, the degree of success depends on the individual telling what is true, and people suffering from this syndrome are often found to be such credible liars that they start to face trouble separating fact from fiction.

Cognitive behavioral therapy

Cognitive behavioral therapy or CBT, in short, is a kind of psychotherapy or psychiatric counseling that typically concentrates on altering the behavior and also the thought process of the individual diagnosed with MSBP. The principal objective of CBT is to help the affected person to identify the feelings and thoughts that can be attributed to the attitude, and to learn how to form relationships, which are not linked with being ill.

Munchausen Syndrome by Proxy Prevention

There does not exist any single method to prevent this disease, though, it might prove to be beneficial to start therapy in affected persons as early as the symptoms start to surface. Disengaging the victim from the person diagnosed with MSBP can ensure that the victim will not be harmed any further.


The prognosis for this syndrome happens to be pretty poor if the kid involved is made to stay in the home. It is also difficult to gauge the overall rate of mortality but is believed to be between six to ten individuals for every hundred. It can very well rise to as high as thirty-three to thirty-four if acts of suffocation or poisoning are involved. An increased rate of morbidity, as well as mortality, is found in siblings of MSBP children too.

When to visit a doctor?

Consider calling the local CPSA or child protective service agency to seek professional help as soon as one or more of the symptoms begin to appear.


Images Copyright: Ilya Andriyanov

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