Condition Basics

What is Munchausen syndrome by proxy (MSBP)?

Munchausen syndrome by proxy (MSBP) is a mental health condition in which a caregiver makes up or causes an illness or injury in a person under their care, such as a child, an elderly adult, or a person who has a disability. Because vulnerable people are victims, it is a form of child abuse or elder abuse. MSBP is sometimes called other things, such as medical child abuse.

Since most cases of MSBP are between a caregiver (usually a mother) and a child, this information describes that relationship. But it is important to remember that MSBP can involve any vulnerable person who has a caregiver.

The caregiver with MSBP may:

• Lie about the child's symptoms.
• Change test results to make a child appear to be ill.
• Physically harm the child to produce symptoms.

Victims are most often small children. They may get painful medical tests they don't need. They may even become seriously ill or injured or may die because of the actions of the caregiver.

Children who are harmed by a caregiver with MSBP can have lifelong physical and emotional problems. These children may have Munchausen syndrome as adults. This is a condition in which a person causes or falsely reports their own symptoms.

What causes it?

Doctors aren't sure what causes MSBP. But it may be linked to problems during the abuser's childhood.

The attention that caregivers get from having a sick child may encourage their behavior. Caregivers may get attention not only from doctors and nurses but also from others in their community. For example, neighbors may try to help the family in many ways. These include doing chores, bringing meals, or giving money.

How does somebody with MSBP act?

A person with MSBP often:

• Has medical skills or experience.
• Seems devoted to their child.
• Looks for sympathy and attention.
• Tries too hard to become close and friendly with medical staff.
• Needs to feel powerful and in control.
• Does not see their behavior as harmful.

What are the signs?

Checking a child's medical records for past tests, treatments, and hospital stays may help a doctor or nurse find out if a health problem is real.

Doctors or nurses may suspect a problem when:

• A child has a repeated or unusual illness, and no reason can be found.
• The child doesn't get better, even with treatments that should help. Symptoms only occur when the caregiver is with or has recently been with the child. But symptoms get better or go away when the caregiver is not there or is being closely watched.
• The other parent is not involved in the child's treatment, even though the child's condition may be serious.
• A caregiver suddenly changes doctors and lies about prior testing and treatment.
• Normal test results don't reassure the caregiver. And the caregiver may be strangely calm or happy when the child's condition is getting worse.
• The caregiver is seen (or videotaped or recorded) harming the child or causing symptoms.
• Another child in the family has had unexplained illness or death.

How is MSBP treated?

Child protective services, law enforcement, and doctors are all involved in treatment for MSBP. Caregivers who have this condition need long-term counseling. They may resist treatment or deny that there is a problem. Medicines are used only when the caregiver has another health problem, such as anxiety disorder, along with MSBP.

Even after treatment, caregivers may repeat their behavior. So doctors, counselors, and family members need to closely watch how the caregiver interacts with their children.

If a child has a caregiver with MSBP, the first step is to move the child into safe custody. Then a doctor will monitor the child for symptoms. Most of the time, the child's symptoms stop after the child is away from the caregiver. Some children need counseling or other help.

What should you do if you think someone has MSBP?

MSBP is child abuse. If you suspect a caregiver has this condition, don't confront them. It might make the problem worse. Instead, think about these options:

• Keep a journal of the child's symptoms and other related events.
• Talk with your doctor about your concerns.
• Report your concerns to your local child welfare agency. You may be able to make a report without using your name (anonymous).