What are Münchausen syndrome and Münchausen syndrome by proxy?

Introduction

Munchausen syndrome is often used interchangeably with factitious disorder; however, Munchausen syndrome describes a specific form of factitious disorder. Factitious disorders are characterized by the deliberate creation or simulation of physical or psychological symptoms.

In 1951, physician Richard Asher identified a pattern of patients who were fabricating medical histories and symptoms. He termed it Munchausen syndrome after Baron Münchhausen, an eighteenth-century Prussian cavalry officer who created fantastical stories about his exploits.

Munchausen syndrome represents one of the most severe form of factitious disorder, in which individuals complain of serious physical symptoms although they are aware that they are fabrications. It differs from malingering, in which patients deliberately report nonexisting symptoms, in its motivation. Malingerers seek specific rewards such as time off from work or monetary benefits; people with Munchausen syndrome are motivated by internal needs such as a desire for approval or attention.

The serious symptoms reported by those with Munchausen syndrome often result in multiple hospitalizations, and individuals may travel between hospitals or engage in “doctor shopping” to earn a desired diagnosis. Patients usually describe their symptoms in dramatic detail; they can be highly knowledgeable about symptoms, terminology, and procedures. However, they may become vague when questioned. They often eagerly accept recommendations for invasive procedures and may display multiple surgical scars. In extreme cases, individuals may sabotage their laboratory samples or aggravate existing symptoms. If they are hospitalized, few friends visit, and patients are reluctant to have medical professionals query prior medical providers. Tests often reveal no medical causes for the reported symptoms. After initial tests are negative, patients with Munchausen syndrome often will report that their previous symptoms are gone, but new ones have appeared. After medical professionals have failed to substantiate reported symptoms, patients are either released or diagnosed with Munchausen syndrome. If confronted, patients may deny the diagnosis of Munchausen syndrome or suddenly discharge themselves, only to seek another opinion.

Munchausen Syndrome by Proxy

In 1977, pediatrician Roy Meadow reported that one mother poisoned her child with salt and another injected her own blood into her baby’s urine. He termed this behavior Munchausen syndrome by proxy. Munchausen syndrome by proxy describes a condition in which caregivers create symptoms or actual illness in a person under their care. The caregiver is usually the mother, and the victim typically a child under the age of six; however, cases have occurred in which adults create or lie about illnesses in their elderly parents. The caregiver ensures that the child experiences afflictions that warrant medical attention and presents the child to medical authorities while claiming not to know how symptoms began. Rarely, those with Munchausen syndrome by proxy may be medical professionals who create symptoms in their patients.

Individuals with Munchausen syndrome by proxy may use their child’s illness as a way to gain sympathy. Their hospitalized child gets them attention from medical professionals, and they may use this as a way to earn praise for their devotion to the child’s care, often developing friendships with medical personnel. These caregivers may have previously experienced Munchausen syndrome themselves, but when they make their child ill, they learn that they can receive psychological rewards for playing the “hero” role.

Individuals with Munchausen syndrome by proxy may exacerbate a child’s condition by lying about symptoms, altering samples, feeding the child contaminated or poisoned food, or injecting the child with bacteria, causing symptoms such as gastrointestinal upset or infection. The child may improve while hospitalized but become ill again after discharge.

When confronted, individuals with Munchausen syndrome by proxy may become depressed and suicidal. Some respond with anger and hastily remove the child from medical care. Since Munchausen syndrome by proxy has a victim, it is considered a form of abuse and is a criminal offense. It is estimated that approximately 10 percent of victims of Munchausen syndrome by proxy die. In some cases, the child learns that sickness gains him or her attention and manifests Munchausen syndrome in adulthood. It has been recognized that children and adolescents may falsify their own illnesses and have Munchausen syndrome rather than be victims of Munchausen syndrome by proxy.

Possible Causes and Treatments

There are no reliable statistics on the prevalence of the disorders because of the inherent dishonesty involved. Individuals with these disorders may visit various hospitals, making any statistics suspect. The causes of both are also not known, but theories center on existing mental or personality disorders or a major life stress as possible origins. In some instances, the impulse to cause illness stems from rage, jealousy, or the desire to control others. Individuals with Munchausen syndrome may have had childhood illnesses that required extensive hospitalization or may have experienced family disturbances or abuse. Munchausen syndrome is associated with low self-esteem and severe emotional disturbances. It is very difficult to treat and often requires years of therapy. The patients’ first goal is to acknowledge that they are lying. Psychotherapy aids in working through underlying psychological issues. Family therapy might be indicated to teach family members not to reward “sick” behavior on the part of the patient. In Munchausen syndrome by proxy, the first concern is the victim’s safety. Psychotherapists, law enforcement, foster care organizations, and social workers all may be involved in treatment.

Bibliography

"Diseases and Conditions: An Overview of Factitious Disorders." Cleveland Clinic. Cleveland Clinic, 11 June 2013. Web. 3 Mar. 2014.

Doyle, Celia, and Charles Timms. Child Neglect and Emotional Abuse. London: Sage, 2014. Print.

Feldman, Marc. Playing Sick? Untangling the Web of Munchausen Syndrome, Münchhausen Syndrome by Proxy, Malingering, and Factitious Disorder. New York: Routledge, 2004. Print.

Gregory, Julie. Sickened: The True Story of a Lost Childhood. New York: Bantam Books, 2004. Print.

Kamm, F. M. Bioethical Prescriptions: To Treat, End, Choose, and Improve Lives. Oxford: Oxford UP, 2014. Print.

Lasher, Louisa J., and Mary S. Sheridan. Munchausen by Proxy: Identification, Intervention, and Case Management. New York: Haworth Maltreatment and Trauma Press, 2004. Print.

Olsen, Gregg. Cruel Deception: A Mother’s Deadly Game, a Prosecutor’s Crusade for Justice. New York: St. Martin’s True Crime, 2005. Account of a mother whose daughter died suddenly of suspected sudden infant death syndrome (SIDS) and whose newborn son then developed the same symptoms. Details the criminal aspects of Munchausen syndrome by proxy, including trial and aftermath.

Shaw, R., et al. “Factitious Disorder by Proxy: Pediatric Condition Falsification.” Harvard Review of Psychiatry 16 (July, 2008): 215-224. This comprehensive overview of Munchausen syndrome by proxy discusses definitions and causes, and gives information on assessment, legal issues, and treatment.