Factitious Disorder by Proxy (Munchausen by Proxy)

Factitious Disorder by Proxy, also known as Munchausen by Proxy, is a rare condition where there is a deliberate intention to make the other person sick.

The victim if usually a child and the perpetrator is often the child's mother. The motivation for the perpetrator's behavior is presumed to be a psychological need to assume the sick role.

External incentives for the behavior, such as economic gain, are absent. The behavior is not better accounted for by another mental disorder.

The perpetrator induces or simulates the illness or disease process in the victim and then presents the victim for medical care while disclaiming any knowledge about the actual problem.

Warning Signs

Possible warning signs include:

• The perpetrator is overly cooperative and friently with the health providers.

• Appears significantly concerned about the child.

• The child has a history of frequent hospitalizations with unusual symptoms.

• The results of medical tests don't agree with the reported symptoms.

• The child's condition improves in the hospital, but recur when the perpetrator returns.

• Blood in lab samples might not match the blood of the child.

• Chemicals in the child's stool, urine or blood.

The most common induced and simulated conditions include:

• Persistent vomiting or diarrhea

• Respiratory arrest

• Asthma

• Central nervous system dysfunction (e.g., seizures, uncoordination, loss of consciousness).

• fever

• Infection

• Bleeding

• Failure to thrive

• Hypoglycemia

Associated Features

Perpetrators may have a history of having been abused. Somatoform Disorders and Personality Disorders may be present.

They commonly have considerable experience in health-related areas and seem to thrive in a medical environment. Victims may suffer a significant morbidity and mortality rate as a consequence of the induced conditions or associated problems, such as iatrogenic complications from medications, diagnostic tests, and surgical procedures. Typically the perpetrator focuses on only one victim at a time, although other siblings or individuals may have been or might become victims.

When confronted with the consequences of their behavior, perpetrators may become depressed and suicidal. Some become angry with the health care providers, deny the accusations, attempt to remove the victim from the hospital against medical advice, and seek care from other providers even at a considerable distance. Perpetrators may face criminal charges ranging from abuse to murder.

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

Munchausen Syndrome by Proxy. (nd). Diseases and Conditions. Cleveland Clinic. Retrieved 7/21/2012 from: http://bit.ly/VLNni