Munchausen by Proxy Syndrome

By the time she was 8 years old, J.B. had been hospitalized 200 times and had undergone more than 40 operations, including the removal of most of her intestines.

K.C., a 2-year-old boy, was hospitalized more than 20 times due to complications from asthma, severe pneumonia, mysterious infections, and sudden fevers. His doctors were baffled and unable to determine the cause of these illnesses.

What do these seemingly unrelated cases have in common? They were the result of Munchausen by Proxy Syndrome (MBPS), or Factitious Disorder by Proxy, as it's listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision, also known as DSM-IV-TR).

This relatively uncommon condition involves the exaggeration or fabrication of illnesses or symptoms by a primary caretaker. One of the most harmful forms of child abuse, Munchausen by Proxy Syndrome was named after Baron von Munchausen, an eighteenth-century German dignitary known for telling outlandish stories.

J.B.'s medical history was traced to her mother, who manufactured her daughter's illnesses. Similarly, when K.C. was thought to have AIDS, he eventually complained to his mother's friend that his thigh was sore because "Mommy gave me shots" (indicating that the mother was giving her son something to cause his symptoms).

What Is Munchausen by Proxy Syndrome?

In MBPS, an individual - usually a mother - deliberately makes another person (most often his or her own preschool child) sick or convinces others that the person is sick. The parent or caregiver misleads others into thinking that the child has medical problems by lying and reporting fictitious episodes. He or she may exaggerate, fabricate, or induce symptoms. As a result, doctors usually order tests, try different types of medications, and may even hospitalize the child or perform surgery to determine the cause.

Typically, the perpetrator feels satisfied when he or she has the attention and sympathy of doctors, nurses, and others who come into contact with him or her and the child. Some experts believe that it isn't just the attention that's gained from the "illness" of the child that drives this behavior, but there is satisfaction gained by the perpetrator in being able to deceive individuals that they consider to be more important and powerful than themselves.

Because the parent or caregiver appears to be so caring and attentive, often no one suspects any wrongdoing. A perplexing aspect of the syndrome is the ability of the parent or caregiver to fool and manipulate doctors. Frequently, the perpetrator is familiar with the medical profession and is very good at fooling the doctors. Even the most experienced doctors can miss the meaning of the inconsistencies in the child's symptoms. It's not unusual for medical personnel to overlook the possibility of Munchausen by Proxy Syndrome because it goes against the belief that a parent or caregiver would never deliberately hurt his or her child.