Münchausen syndrome by proxy

Munchausen syndrome by proxy (MSbP or MbP) is a term often used when a caregiver or spouse fabricates, exaggerates, or induces mental or physical health problems in those who are in their care, with the primary motive of gaining attention or sympathy from others. Its name is derived from the term Munchausen syndrome, a psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention, sympathy, or reassurance to themselves. However, unlike in Munchausen syndrome, in MSbP, the deception involves not themselves, but rather someone under the person's care. MSbP is primarily distinguished from other forms of abuse or neglect by the motives of the perpetrator. Some experts consider it to be an elusive, potentially lethal, and frequently misunderstood form of child abuse or medical neglect. However, others consider the concept to be problematic, since it is based largely on supposition regarding a person's motives, which can be open to radically different interpretations.

MSbP has also spawned much heated controversy within the legal and social services communities. In a handful of high-profile cases, mothers who have had several children die from sudden infant death syndrome have been declared to have MSbP. Based on MSbP testimony of an expert witness, they were tried for murder, convicted, and imprisoned for several years. In some cases, that testimony was later impeached, resulting in exoneration of those defendants.

MSbP is rare. A recent systematic study in Italy found that in a series of over 700 patients admitted to a pediatric ward, 4 cases met the diagnostic criteria for MSbP (0.53%). In this study, stringent diagnostic criteria were used, which required at least one test outcome or event that could not possibly have occurred without deliberate intervention by the MSbP person.

In Munchausen syndrome by proxy, an adult caregiver makes a child or elderly person appear mentally or physically ill or impaired by either fabricating symptoms or actually causing harm to the child or elderly person to gain the attention of medical providers and others. To perpetuate the medical relationship, the caregiver systematically misrepresents symptoms, fabricates signs, manipulates laboratory tests, or even purposely harms the child (e.g. by poisoning, suffocation, infection, physical injury). Studies have shown a mortality rate of between 6% and 10% of MSbP victims, making it perhaps the most lethal form of abuse.

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