What Is Munchausen by Proxy?

Jan 19, 2018 at 8:00 a.m. ET
Image: HBO/Design: Ashley Britton/SheKnows (Stills From HBO’s ‘Mommy Dead And Dearest,’ A Documentary About MBP.)

If you’ve heard of Munchausen by proxy, it’s probably because you’ve seen it featured in an episode of Law and Order: Special Victims Unit or in the HBO true-crime documentary Mommy Dead and Dearest. But the condition is more than a pop-culture plot twist: It’s abuse.

MBP, also called “factitious disorder imposed on another,” is a condition in which a person (typically a parent, usually a mother) either makes up or causes a person in their care to be seriously ill or injured. While most cases involve a mother and young child, MBP can also occur in situations in which someone is caring for an elderly or disabled person, Dr. Gail Saltz, psychiatrist and author of The Power of Different: The Link Between Disorder and Genius, tells SheKnows. And around 7 percent of MBP cases involve fathers, she adds.

What is it actually called?

First of all, let’s address the name — or rather, the multiple terms used to describe this condition. It was given the name Munchausen in 1951, which refers to German nobleman Karl Friedrich Hieronymus, Baron Münchhausen (1720 – 1797), who was famous for exaggerating his adventures and exploits. Some argue that “factitious disorder imposed on another” is more precise and should be favored moving forward.

However, Dr. Marc D. Feldman, a psychiatrist who has researched the condition for more than 25 years and was featured throughout the documentary Mommy Dead and Dearest, tells SheKnows that he finds the term “factitious disorder imposed on another” term to be “unduly complex and unclear.”

“It makes it sound like a child is being forced to have factitious disorder, which is obviously not the case,” Feldman, whose book Dying to Be Ill: True Stories of Medical Deception will be published in May, explains, “The child generally isn't colluding — the child is manipulated.” 

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And although it is not outdated to use the term “Munchausen syndrome by proxy,” Feldman says if you're committed to the term, he prefers “Munchausen by proxy” because it’s “not simply some kind of ‘syndrome.’” Overall, though, Feldman prefers the term "medical child abuse." He explains, “The MCA term is much more descriptive and, despite a couple of potential limitations, is much clearer to judges, juries and the general public.”

Feldman also points out that “Munchausen syndrome” is a completely different condition itself in which people feign, exaggerate or induce medical or psychiatric symptoms in themselves, rather than in other (that’s the “by proxy” part). And typically, when the single word “Munchausen” is used, it is referring to MBP or MCA.

“It is rather a shame that so many different terms have been used because it has confused the public as to just what we're really talking about,” Feldman says. “It is first and foremost a form of abuse.”

What does MBP entail?

In situations of MBP, the caretakers either make up symptoms that actually have not happened or actively cause the person in their care to become ill or injured, Saltz explains.

“The purpose, as far as we can tell, is mostly to gain attention and sympathy and interest from medical staff, from people in the community, from other people, but it is considered a form of child abuse,” she says.

In fact, MBP is one of the more dangerous forms of child abuse, Saltz points out, because it is premeditated and more often results in death of the child from repeatedly inflicting something on the child. According to Feldman, 9 percent of published cases of MBP results in the child’s death because of the behavior.

A common way MBP manifests is through the caretaker repeatedly suffocating a child to the brink of death, Saltz says, adding that when she was a medical student, she learned that MBP can be present when there’s a repeated symptom that doctors can’t figure out despite extensive medical tests. And even if the child receives proper medical care, the symptom does not go away.

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As far as the type of parent typically observed in MBP situations, Saltz says they “seem to be most jovial and relieved when the child is ill,” and are “incredibly dedicated and ever-present.” She gives the example of a child she treated who came in with progressive muscle wasting, which looked like muscular dystrophy.

“No one could figure out why the child was extremely ill and often vomiting,” Saltz says. Eventually, she started to become suspicious and ultimately figured out the mother was giving the child ipecac (a medication administered to induce vomiting). The toxic levels of ipecac found in the child’s blood was the cause of their muscle disintegration.

Dean Tong, a forensic trial expert who specializes in cases of false or unfounded child abuse who consults on a few cases of MBP each year, points out that although parents, of course, are allowed to challenge doctors' findings and opinions, they cannot force providers to administer prescriptions or perform surgeries or other medical procedures. Parents do have the ability, however — like in Saltz’s example — to actively harm their child through administering widely available medications incorrectly or causing them to suffer from malnutrition.

What can be done about it?

According to Saltz, the most important thing is discovery and removing the victim from the caregiver. She says that if the victim is not removed, the caregiver will likely turn back to the abusive behavior, even if they are discovered. Unfortunately, sometimes, when the child is removed, the perpetrator moves on to another child or person, Saltz adds.

Taking action is so important if you suspect someone you know is a victim of MBP, Saltz says, because children who grow up under those conditions typically either grow up to develop it themselves or develop post-traumatic stress disorder to the point where they aren’t able to seek medical treatment regardless of the severity of the condition because of their lingering fear of doctors.

Unfortunately, there are no great treatments for MBP, Saltz explains. Although mental health professionals can treat underlying disorders like anxiety, it doesn’t really treat the MBP. Psychotherapy can also be useful, she says, but most perpetrators are not insightful and don’t see what they’re doing as harmful, “and with no insight, it’s pretty difficult to make change.”

“The public has to understand that this is a form of child abuse and just as you would with any form of child abuse, you would report it,” she says.

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If you suspect someone you know is affected by MBP, Saltz suggests reporting it anonymously to a child welfare agency or to your own doctor or pediatrician. What you shouldn’t do is to confront the caregiver in question about their behavior, as they will likely deny it and then “go further underground” and continue their harmful actions, she adds.

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