Munchausen By Proxy: Everything you need to know

What is Munchausen by proxy? Who is at risk? Continue reading for an overview of this rare mental disorder and form of child abuse.

Munchausen By Proxy
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What is Munchausen By Proxy?

Munchausen by proxy is a severe, behavioral mental health disorder that occurs when a caregiver causes or creates an illness in a child, an elderly person, or someone with a disability. Caregivers with Munchausen by proxy are mothers of young children in the majority of cases. However, victims can be anyone.

The behavior is not motivated by monetary gain, but rather, an intense need for attention. There are three main ways a caregiver makes up an illness. They fabricate or lie about symptoms, change test results, or physically harm the individual under their care.

Munchausen Syndrome VS Munchausen By Proxy

Munchausen by proxy should not be confused with Munchausen syndrome. While the disorders are similar, Munchausen syndrome does not include the caregiver. An individual with Munchausen syndrome creates an illness in themselves.

Signs of Munchausen By Proxy In The Caregiver

Caregivers with Munchausen by proxy create illness and present with numerous behaviors.

 Symptoms consist of the following:

  • Attention-seeking behavior
  • Lying about a child’s symptoms
  • Changing test results by contaminating samples (i.e. blood in stool samples, etc.)
  • Inducing symptoms in an individual under their care by withholding food, poisoning, etc.
  • Refusal to leave the child’s side
  • Refusal to allow the doctor to speak with other family members
  • Overly friendly with healthcare professionals
  • Becomes upset when told nothing is wrong  
  • Reports of the child’s symptoms worsening without medical proof
  • Low-self esteem

Signs and Symptoms of Munchausen By Proxy In The Victim

Although the caregiver is the one with the disorder, Munchausen by proxy is evident in signs and symptoms portrayed in the victim’s medical care. For example:

  • Repeated injury or illness
  • History of numerous hospitalizations and/or specialist appointments in various locations
  • Symptoms that improve when the caregiver is absent
  • Treatments that should work remain ineffective
  • Test results do not match the condition and/or symptoms
  • Undergoing unnecessary tests, surgeries, or procedures

Causes of Munchausen By Proxy

Up to 1% of the population displays signs of Munchausen by proxy. The cause is unknown. However, researches have connected the disorder to underlying psychological and biological factors. Imaging studies show abnormalities in the brain structure in patents with both  Munchausen syndrome and Munchausen by proxy.

Many instances of Munchausen by proxy are the result of previous childhood stress. The caregiver suffered from physical, emotional, or sexual abuse that has emerged in the form of Munchausen by proxy.

Other stressful life events can trigger Munchausen by proxy in those who are already susceptible. Such events are relational—like a death in the family or marital conflict. Having a serious illness in the past has also led to Munchausen by proxy as a manner of coping with those emotions.

Who Is At Risk For Munchausen By Proxy?

Certain individuals are at risk for Munchausen by proxy. Women between the ages of 20 and 40 who have young children, along with unmarried white men between the ages of 30 and 50 are more prone to developing the condition. Munchausen by proxy is prevalent in healthcare workers, as it provides the caregiver with the knowledge necessary to create illness. Those with a history of low self-esteem, anxiety, depression, or any mental health disorder are also at risk.

How The Child Is Affected By Munchausen By Proxy

Children, as well as other victims of Munchausen by proxy, are significantly affected by the actions of the caregiver. There are negative repercussions on physical and mental wellbeing. Experts have researched the topic by following Munchausen by proxy victims from childhood into adulthood. Study participants experienced poisonings, bone fractured, and other deceptions at the hands of their caregiver. Long term, they report symptoms of post-traumatic stress disorder and anger towards their caregiver. Physically, children are subjected to unnecessary tests that take a toll on their body. In severe cases, deaths have been reported. A study by Rosenburg documents two deaths out of ten cases. Later in life, these children can develop Munchausen syndrome or even inflict Munchausen by proxy behaviors on others they are caring for.

Is Munchausen By Proxy Child Abuse?

Munchausen by proxy is considered child abuse. Statistics claim that 1,000 out of every 2.5 million cases of reported child abuse are due to Munchausen by proxy. The child is directly harmed when caregivers induce symptoms through potentially fatal means—whether it is withholding food so that the child becomes malnourished or poisoning the child. Because of the nature of the symptoms, indirect harm is inflicted on the child as they undergo invasive, unnecessary medical procedures. The surgeries and medications prescribed by physicians do have side effects.

Munchausen By Proxy: Everything you need to know
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The effects are not only physical. The child can have extensive emotional distress. They have anxiety over the painful symptoms and depression when unable to partake in childhood activities because of the illness their caretaker has caused. In the future, they may develop  Munchausen syndrome or Munchausen by proxy too.

Diagnosing Munchausen By Proxy

Diagnosing Munchausen by proxy is not a simple process. In most cases, the caretaker with Munchausen by proxy is a parent of a young child. The doctor treating the person under the care of the afflicted caretaker is typically the first to suspect Munchausen by proxy. However, accusing a parent of creating an illness in their child is unethical without strong evidence. It is the physicians responsibility to rule out a true medical conditions prior to reporting suspicion of Munchausen by proxy.

Reviewing the child’s medical history can indicate the problem, especially when the child is frequently hospitalized for mysterious illness without a known cause. One of the main ways a medical professional confirms Munchausen by proxy is to remove the child from their care. If the child’s health does not improve, Munchausen by proxy is unlikely.

Non-medical professionals suspecting Munchausen by proxy can anonymously report their suspicions to child welfare services.

Conditions Related To Munchausen By Proxy

Munchausen by proxy is a mental disorder. Rarely does it occur alone. Individuals with  Munchausen by proxy tend to have underlying personality disorders such as borderline personality disorder and narcissistic personality disorder. Both disorders include characteristics frequently reported with the manipulative behavior of those with Munchausen by proxy. For example, borderline personality disorder features lying, unstable moods, and poor self-image, while narcissistic personality disorder manifests as a strong need for attention, admiration, and an inflated self-worth.

As documented in the Journal of Substance Abuse Treatment, depression and substance abuse are also related to Munchausen by proxy. Their risk of suicide increases dramatically with these comorbidities.

Munchausen By Proxy Treatment

Treatment for Munchausen by proxy involves the care of professionals in medicine, as well as child protective services and law enforcement. The disorder has a vast impact on the individual with Munchausen by proxy, the victim, and their loved ones. However, ensuring the child is safe from harm is of utmost priority.

Treatment For The Caregiver

Treatment for a caregiver with Munchausen by proxy is difficult, as they deny there is a problem. Depending on the extent of the disorder and damage to the victim, some caregivers with Munchausen by proxy face criminal charges for abuse.

Cognitive-behavioral therapy is essential to the treatment regimen. Cognitive-behavioral therapy is a type of psychotherapy in which a trained mental health professional helps the individual identify cognitive distortions that contribute to unwanted behaviors. This therapy is continued for a prolonged period to prevent a relapse in symptoms. Aside from cognitive behavioral therapy, family therapy is beneficial to heal estranged family relationships.

Anti-anxiety and anti-depressant medications are used when the caregiver has another mental disorder, but no medication is successful in treating Munchausen by proxy.

Treatment For The Child

The victim’s safety, regardless of their age, is the primary focus in treatment for Munchausen by proxy. In many cases, this entails removing a child from the care of their parent. Law enforcement and child protective services place the child under state custody or the care of a non-involved relative.

Medical professionals treat any medical condition or injury caused by the caregiver. If the child has lingering depression and anxiety, psychotherapy is beneficial. A trained mental health professional monitors for any secondary psychiatric issues. With proper care and support, overcoming Munchausen by proxy is possible!

References

Jaghab, K., Skodnek, K. B., & Padder, T. A. (2006). Munchausen’s Syndrome and Other Factitious Disorders in Children: Case Series and Literature Review. Psychiatry (Edgmont (Pa. : Township))3(3), 46–55.

Kent JD. Munchausen’s syndrome and substance abuse. J Subst Abuse Treat. 1994 May-Jun;11(3):247-51. doi: 10.1016/0740-5472(94)90082-5. PMID: 8072053.

Libow JA. Munchausen by proxy victims in adulthood: a first look. Child Abuse Negl. 1995 Sep;19(9):1131-42. doi: 10.1016/0145-2134(95)00073-h. PMID: 8528818.