Munchausen Syndrome by Proxy (MSP)

Munchausen Syndrome by Proxy (MSP)

By

Dr. David Koehn

A Vignette

A 30+ young man died of an apparent drug overdose after attending a party. While in the hospital dying and comatose, his mom did not inform his dad, who she was divorced from, of his condition. In fact, she stated things to the hospital team that leads them to not communicate with the dad. This young man throughout his life was in and out of trouble with drugs and the law. His mom and dad were divorced when he was very young. His mom had him seeing numerous doctors for various physical and behavioral conditions. She made her ex-husband’s life difficult by accusing him of causing problems with their son. This young man’s dad spent numerous years confronting his mother’s handling of her son and getting nowhere with the legal or medical community. A book that I will be collaborating on will be forthcoming detailing the plight of a father who became exhausted and exasperated in dealing with a woman who had Munchausen by proxy. Hopefully, it will provide insight where others can benefit from lessons learned so that a tragic event such as what happened to his son can be averted in the future. 

What is MSP?

Based on WebMD and Healthline, Munchausen syndrome by proxy (MSP) -- or Munchausen by proxy -- is a psychological disorder marked by attention-seeking behavior by a caregiver through those who are in their care. It's a mental disorder that causes a person with a deep-seated need for attention to fake sickness or injury. Munchausen syndrome by proxy (MSP) is a disorder in which the caretaker of a child either makes up fake symptoms or causes real symptoms to make it appear as though the child is injured or ill. The term “by proxy” means “through a substitute.” Though MSP is primarily a mental illness, it’s also considered a form of child abuse.

MSP can affect anyone, but it’s most commonly seen in mothers of children under age 6. People who have MSP have an overwhelming need for attention and go to great lengths to achieve it, even if it means risking a child’s life. According to the Cleveland Clinic, approximately 1,000 of the 2.5 million cases of child abuse reported each year may be related to MSP.

MSP is a relatively rare behavioral disorder. It affects a primary caretaker, often the mother. The person with MSP gains attention by seeking medical help for exaggerated or made-up symptoms of a child in his or her care. As healthcare providers strive to identify what's causing the child's symptoms, the deliberate actions of the mother or caretaker can often make the symptoms worse.

The person with MSP does not seem to be motivated by a desire for any type of material gain. While healthcare providers are often unable to identify the specific cause of the child's illness, they may not suspect the mother or caretaker of doing anything to harm the child. In fact, the caregiver often appears to be very loving and caring and extremely distraught over her child's illness.

People with MSP may create or exaggerate a child's symptoms in several ways. They may simply lie about symptoms, alter tests (such as contaminating a urine sample), falsify medical records, or they may actually induce symptoms through various means, such as poisoning, suffocating, starving, and causing infection.

What are the Symptoms of Munchausen Syndrome By Proxy?

Many people with MSP exaggerate or lie about a child’s symptoms to get attention. They may also create symptoms by poisoning food, withholding food, or causing an infection. Some people may even have a child undergo painful or risky tests and procedures to try to gain sympathy from their family members or community. It’s also believed that people with MSP may enjoy the satisfaction of deceiving people whom they perceive to be more powerful than themselves, particularly medical professionals.

Certain characteristics are common in a person with MSP, including:

• Is a parent or caregiver, usually a mother
• May be a healthcare professional
• Is very friendly and cooperative with the healthcare providers
• Appears quite concerned (some may seem overly concerned) about their child
• May suffer from Munchausen syndrome (a related disorder in which a person repeatedly acts as if he or she has a physical or mental illness when he or she is not really sick)
• Attention-seeking behavior
• Striving to appear self-sacrificing and devoted
• Becoming overly involved with doctors and medical staff
• Refusing to leave the child’s side
• Exaggerating the child’s symptoms or speaking for the child
• Appearing to enjoy the hospital environment and the attention the child receives

Other possible warning signs of MSP include:

• The child has a history of many hospitalizations, often with a strange set of symptoms.
• Worsening of the child's symptoms generally is reported by the mother and is not witnessed by the hospital staff.
• The child's reported condition and symptoms do not agree with the results of the tests.
• There may be more than one unusual illness or death of children in the family.
• The child's condition improves in the hospital, but symptoms recur when the child returns home.
• Blood in lab samples may not match the blood of the child.
• There may be signs of chemicals in the child's blood, stool, or urine.

What Causes Munchausen Syndrome By Proxy?

The exact cause of MSP is not known, but researchers are looking at the roles of biological and psychological factors in its development. Some theories suggest that a history of abuse or neglect as a child or the early loss of a parent may be factors in its development. Many people diagnosed with MSP were physically, emotionally, or sexually abused when they were children. Some grew up in families in which being sick or injured was a way to receive love or care. It’s also believed that stress may play a role in the development of MSP. This stress could be due to a previous traumatic event, marital problems, or perhaps a serious illness.

How Common is Munchausen Syndrome By Proxy?

There are no reliable statistics regarding the number of people in the U.S. who suffer from MSP, and it's difficult to assess how common the disorder is because many cases go undetected. MSP is generally considered a rare condition, and its exact cause is unknown.

How is Munchausen Syndrome By Proxy Diagnosed?

Diagnosing MSP is very difficult because of the dishonesty that is involved. Doctors must rule out any possible physical illness as the cause of the child's symptoms before a diagnosis of MSP can be made. Since a parent or caretaker with MSP often appears to be caring and attentive, doctors usually don’t suspect any wrongdoing. Diagnosis can also be difficult due to the person’s ability to manipulate doctors and induce symptoms in the child. As a result, MSP goes undetected in many cases. Doctors may begin to suspect child abuse when a child frequently experiences illnesses and injuries. They may also become suspicious if a child’s symptoms worsen when home alone with the caretaker and improve when under medical care. 

It’s likely that the doctor will first try to diagnose the child with a specific illness. If a child repeatedly presents with unexplained illness or injury, the doctor may begin to suspect child abuse or MSP. They may also become suspicious if any symptoms suddenly stop or improve when the child isn’t with their caretaker. The doctor’s first duty is to protect the child from abuse by reporting these suspicions to the proper authorities. While under a doctor’s care, the child will be diagnosed and treated for any illness, injury, or emotional trauma.

If a physical cause of the symptoms is not found, a thorough review of the child's medical history, as well as a review of the family history and the mother's medical history (many have Munchausen syndrome themselves) may provide clues to suggest MSP. Remember, it's the adult, not the child, who is diagnosed with MSP.

How is Munchausen Syndrome By Proxy Treated?

The treatment for MSP must involve both the child and the adult. It may also be beneficial for the entire family to participate in treatment. The first concern in MSP is to ensure the safety and protection of any real or potential victims. Once it’s determined that the child is being abused, they must be protected. This usually means contacting Child Protective Services and removing all children from the care of the abuser. Treatment for the child usually involves removing the child from the care of the abuser. Any existing physical illness or injury must be treated accordingly. Psychological counseling may also be necessary.

The abuser may face criminal charges, and long-term psychiatric counseling is often recommended. This may require that the child be placed in the care of another. In fact, managing a case involving MSP often requires a team that includes a social worker, foster care organizations, and law enforcement, as well as doctors.

Successful treatment of people with MSP is difficult because those with the disorder often deny there is a problem. In addition, treatment success is dependent on the person telling the truth, and people with MSP tend to be such accomplished liars that they begin to have trouble telling fact from fiction. For a caretaker to be diagnosed with MSP, they’ll need to admit to the abuse and submit to psychiatric treatment. However, people with MSP are prone to dishonesty, so diagnosing the condition can be extremely difficult. Additionally, with attention focused on a sick or injured child, it’s easy for doctors and family members to overlook the possibility of MSP.

Psychotherapy (a type of counseling) generally focuses on changing the thinking and behavior of the individual with the disorder (cognitive-behavioral therapy). The goal of therapy for MSP is to help the person identify the thoughts and feelings that are contributing to the behavior, and to learn to form relationships that are not associated with being ill.

What is the Outlook for Victims of People With Munchausen Syndrome By Proxy?

This disorder can lead to serious short- and long-term complications, including continued abuse, multiple hospitalizations, and the death of the victim. (Research suggests that the death rate for victims of MSP is about 10%.) In some situations, a child victim of MSP learns to relate getting attention to being sick and develops Munchausen syndrome themselves. Children who are abused by caretakers with MSP can develop multiple illnesses or injuries, some of which may be life-threatening. They can also be subjected to painful and frightening medical procedures. As a result, some children may experience depression and anxiety for many years. They’re also at an increased risk for Munchausen syndrome themselves.

What is the Outlook for People With Munchausen Syndrome By Proxy?

In general, MSP is a very difficult disorder to treat and often requires years of therapy and support. In addition, MSP is considered a form of child abuse, which is a criminal offense. If you experience a desire to harm your child, seek medical help immediately. Child abuse as stated earlier, regardless of the reason, is a criminal offense. For the caretaker being treated for MSP, psychiatric counseling is often required for many years. It’s a very difficult condition to treat effectively. For the child, the long-term outlook will depend on the extent of their physical and psychological injuries. Many victims of child abuse are prone to depression and anxiety throughout their lives. 

Can Munchausen Syndrome By Proxy Be Prevented?

There is no known way to prevent this disorder. To reiterate, the treatment for MSP must involve both the child and the adult. It may also be beneficial for the entire family to participate in treatment. Individual or family therapy may help all parties cope with the situation. There’s no way to predict who will develop MSP, and there’s no known way to prevent it. However, if MSP is suspected, there are ways to prevent the disorder from escalating.

If you have symptoms of MSP, seek psychiatric counseling immediately, before you hurt your child. If you think a child is being abused, contact the police or Child Protective Services. Call 911 if any child is in immediate danger due to abuse or neglect. The Childhelp National Child Abuse Hotline is also a great resource for caretakers who need crisis intervention and for concerned people who suspect a child is being abused. There are crisis counselors available 24 hours a day, seven days a week who can help you figure out the next steps. You can reach them at 800-4-A-CHILD (800-422-4453).