Understanding Munchausen by Proxy Syndrome

Munchausen by proxy is an extremely rare and widely misunderstood mental health condition that is characterized by medical deception and abusive behaviors toward a child. 

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What Is Munchausen by Proxy Syndrome?

Before we dive into the details of Munchausen by proxy syndrome, let’s take a moment to talk about that eye-catching name:

• The term “Munchausen syndrome by proxy” was coined in 1977 by Roy Meadow, a British pediatrician who is credited with being the first person to identify its symptoms.
• It is related to Munchausen syndrome, a condition was that originally described by another British doctor, Richard Asher, in a 1951 article in the journal The Lancet. 
• As explained in an April 2024 Smithsonian Magazine article, the names of both conditions were inspired by Baron Munchausen, a fictional character from the 1700s who was known for telling outlandish tall tales. 

The clinical name of the disorder, as established in both the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the 11th revision of the International Classification of Diseases (ICD-11), is factitious disorder imposed on another (FDIA).

Keeping with this naming convention, the DSM-5 and ICD-11 both refer to Munchausen syndrome as factitious disorder imposed on self (FDIS).

In a May 2023 episode of the American Psychological Association’s “Speaking of Psychology” podcast, Munchausen by proxy expert Marc Feldman, MD, said he prefers to use the term “medical child abuse” when discussing the condition.

Munchausen vs. Munchausen by Proxy

Munchausen and Munchausen by proxy both involve the intentional falsification of the symptoms of diseases, illnesses, or injuries:

• People with Munchausen syndrome, or FDIS, falsely claim that they are ill or injured.
• Those with Munchausen by proxy syndrome, or FDIA, falsely claim that someone else has the illnesses or injuries. 

In most cases, people with Munchausen by proxy syndrome are parents (usually mothers) and their victims are their own children. 

Having Munchausen by proxy syndrome doesn’t mean that a parent is a hypochondriac, or that they’re consumed by overwhelming fear that their child might be ill. 

People who have this condition are not imagining symptoms. Instead, they actively and intentionally lie about – and, in many cases, cause or worsen – their children’s symptoms, with the apparent goal of receiving attention and sympathy.

Prevalence

As noted at the top of today’s post, Munchausen by proxy is far from common, though experts have had a difficult time determining its true prevalence. The DSM-5 estimates that about 1% of people who are treated in hospitals “have presentations that meet the criteria for factitious disorder.”

But research on Munchausen by proxy suggest that it occurs far less than that among the general public:

• A July 1996 study in the journal Archives of Disease in Childhood estimated that the combined annual rate of Munchausen by proxy involving children ages 16 and under is 0.5 per 100,000 people (0.0005% of the population in that age range). 
• The Archives of Disease in Childhood study also estimated that Munchausen by proxy involving infants under age 1 affects about 2.8 per 100,000 people (or 0.0028% of that population).
• According to a report by Rebecca Rodriguez-Pou, MD, of the First Coast Child Protection Team, there were 163 confirmed cases of Munchausen by proxy in Florida between Jan. 1, 2010, and Dec. 31, 2020. This put the state’s average annual rate at 0.00036% for children ages 18 and under. For children ages 5 and under, the state’s annual rate was 0.00044%.
• Using the Florida data, Dr. Rodriguez-Pou estimated that there are probably about 260 cases of Munchausen by proxy each year throughout the United States.

Warning Signs of Munchausen by Proxy Syndrome

The nature of the condition makes it difficult to detect and diagnose, but potential warning signs include:

• The child’s history includes far more doctor’s appointments and hospital visits than are normal for someone of their age.
• The parent has a history of “doctor shopping,” or taking their child to multiple physicians and hospitals.
• The parent is vague about the details of their child’s interactions with other doctors or hospitals, and refuses to allow the person who is currently treating their child to contact their previous caregivers.
• The child’s many medical evaluations rarely identify a definitive cause of their symptoms, and attempts to treat them often don’t resolve those symptoms.
• There is often a considerable disconnect between the symptoms the parent reports and what the child’s medical tests reveal.
• The child may begin to feel better when they are hospitalized, but once they return home they begin to exhibit symptoms again.
• The parent becomes argumentative or even hostile when doctors tell them that their child does not have a serious problem or doesn’t need extensive treatment.
• The parent seems to be more interested in interacting with doctors and other healthcare providers than actually finding out what’s wrong with their child.
• If an evaluation reveals that the child is OK, they may return to the hospital or doctor’s office soon afterward with symptoms of a different condition.

How Are Victims of Munchausen by Proxy Syndrome Affected?

Being a victim of Munchausen by proxy syndrome can be a highly traumatic experience for many reasons, including:

• Victims may have spent years believing that they had serious health problems.
• Their supposed health problems may have disrupted their performance in school and undermined their ability to develop healthy friendships with peers.
• When a parent is diagnosed with Munchausen by proxy syndrome – and likely charged with child abuse as a result – the victim may blame themselves or refuse to acknowledge that they did anything wrong.
• Being abused and manipulated by a parent or other caregiver can prevent a person from forming  trusting relationships with others, which can lead to isolation and reduced quality of life.

Victims may need extensive therapeutic support to help them overcome misplaced shame and guilt, rebuild their confidence and self-esteem, and recover from the trauma of enduring sustained abuse.

Find Treatment for Victims of Munchausen by Proxy Syndrome in Southern California

Hillcrest Adolescent Treatment Center offers personalized residential programming for adolescents and teens whose lives have been disrupted by trauma and other mental and behavioral health concerns. 

Our treatment center in Agoura Hills, CA, is a safe and supportive environment where individuals ages 12-18 receive comprehensive, customized care from a team of highly skilled professionals. Our phased approach helps young people achieve stabilization, address the core issues that have been negatively impacting their lives, and prepare for a successful reintegration into their families. 

To learn more about how we can help your child, or to schedule a free assessment, please visit our Contact page or call us today.