Biology 202
2002 Second Paper
On Serendip

Munchausen Syndrome by Proxy: Sick kid or sick parent?(4)

Jenny Maryasis

In relating the details of Munchausen Syndrome by Proxy (MSBP), the initial reaction is usually shock, followed quickly by fascination. The reason for the latter is that the medical community has yet to make up their minds about what exactly MSBP is. The debate: psychiatric disorder v. child abuse. Essentially the arguments for both create a divide between the brain and behavior, though not relating the two.

Munchausen Syndrome "is a condition manifest by persons feigning or inducing illness in themselves for no other apparent gain than adopting the sick role and thus exposing themselves to painful and sometimes damaging and disfiguring medical procedures (7)." The name of the syndrome originates from an eighteenth-century Baron, Hiernymous Karl Friedrich von Munchausen, who was a military mercenary widely known for regaling fantastical stories of exploits (6). While the Baron had no psychiatric condition or any further ties with the medical nature of the syndrome, as it is known today, his connection to the syndrome derives from the proven fabrication of all his tales. In 1977, the British journalist Roy Meadow first used the term "Munchausen By Proxy" in an article that named children as the primary victims of the syndrome.

At the time, the literature revealed the natural mother of the child to be the perpetrator of induced and at times actual, illness (3). It is important to note that Meadow's intended to apply MSBP to the problem of child abuse and while it is still extensively classified as such in child abuse and medical journals, the boundaries of the syndrome have been stretched with increased prevalence. The popular view of MSBP remains that it is a form of child abuse in which a parent of caretaker continually fabricates information about the child's health in order to assume the sick person's role by proxy (1).

The perpetrator is often a parent and typically the mother. However, there have been cases where the father acts as perpetrator. The first reported case of MSBP with a male caretaker occurred in 1990 when a father complained to physicians that his newborn baby would often stop breathing, turn blue and have seizures. Following extensive evaluation of apnea, it was discovered that the father, himself was suffocating and shaking the baby (5). Perpetrators show an avid interest for hospital care and usually have experience in the medical field. Munchausen syndrome is present in 10% of such perpetrators (3).

Munchausen syndrome and MSBP are included in the DSM-III R category of factitious disorders and therefore are elusive syndromes that are difficult to diagnose and recognize (2). "Because symptoms in factitious disorders are not connected with obvious gain, the absence of external gain suggests that factitious disorders like Munchausen syndrome serve some psychological need, but do so by maladaptive methods (2)." The syndrome is not recognized by the American Medical Association or the American Psychiatric Association (10). Lack of official recognition from the medical community has created an air of confusion around MSBP. Munchausen syndrome is decidedly a psychiatric disorder involving the patient assuming a role, but the reason for skepticism concerning MSBP is that is clearly a form of child abuse, as well as a vehicle for further role assumption by the perpetrator. Therefore, diagnosis is often relegated to close surveillance of the perpetrator's behavior toward the child.

While the medical community questions the validity of MSBP, I am more likely to adopt the opinion that the two can be reconciled - the syndrome being a form of child abuse that demonstrated behavior typical to that of a psychological disorder. The debate over the status centers on the perpetrator. Studies have shown that the perpetrator "rarely suffers from overt mental illness..." though, they have been known to have "one of various personality disorders associated with attempts to deceive - most commonly, the historic and borderline disorder types (1)." Some past medical history could show Munchausen syndrome, depression, family dysfunction, and somatization disorders (1). Thus, it is clear that MSBP serves a psychological need for the perpetrator because there is no external evidence of physical gain.

MSBP is a sort of enigma - which brings me to my original purpose; a quest for the truth about MSBP. The most important question for me being: what causes Munchausen Syndrome By Proxy? It is a disturbing disorder, which is closely tied to behavior and, on the surface, loosely connected to the brain. No concrete psychological or neurological data exists on the causes of child abuse. Most theories on the causes of child abuse point to past abuse, family dysfunction and depression - the same symptoms existing in MSBP perpetrators. However, it seems far too simple to write off MSBP as child abuse and ignore the psychological components of the syndrome, such as the perpetrator assuming the role of a sick individual by proxy. Above all, this speaks to the prevalence of the I-function in the individual.

The I-function provides an idea of self, from an objective perspective. Therefore, the perpetrator's I-function is closely linked to their behavior as individuals and caretakers. The behavior of the perpetrator involves imagining themselves in a role outside of their bodies and I would argue this aspect can be attributed the I-function. The notion of fictitious experience takes the perpetrator away from the physical reality and to a completely psychological, imaginary space. The correlation between I-function and the perpetrator's actions can informally explain their motives for MSBP. To clarify, I am not suggesting that the I-function is a cause of, or an indicator of intent to engage in MSBP for two reasons: 1. There is no physical evidence of the I-function to point to, 2. The I-function could only account for the perpetrator's personal experience (imagination, dreaming, planning, etc.) in order to isolate the person from other caretakers that do not partake in MSBP. Arguably, the role of the I-function is to individualize each human, but working in conjunction with a history of psychological disorders and abuse, it helps in producing the mind frame of a perpetrator of MSBP.

Information on Munchausen Syndrome By Proxy is unanimous on several basic points: the identification, symptoms of the perpetrator and consensus (more or less) that is at least, a form of child abuse. The vast black hole of diagnosis, treatment for the perpetrator and victim and concrete warning signs poses a great risk to the victims. The perpetrators are not overtly inadequate caretakers, but in fact the very opposite. Furthermore, coupled with their ability to deceive and lie to obtain their desired ends creates difficulty in diagnosing MSBP for doctors. The perpetrator is most likely deeply caught in their psychological, internal experience, while the child suffers through physical, external experience. Lack of medical data and psychological mapping of the perpetrator causes MSBP to continue and increase in frequency over time. The issue of the proxy further complicates the reality in questioning what is true and what ailments are genuine. Surveillance is the only answer offered right now, but I hope that there will soon be medical aid available for the perpetrators.

WWW Sources

1) General information on MSBP, Clinician Reviews (August, 2001) article.

2) Information on Munchausen syndrome and Munchausen syndrome by proxy, The Journal of Psychology (May, 1997) article.

3) Case reports of MSBP, Journal of Toxicology: Clinical Toxicology (April, 2001) article.

4) Case of MSBP, Newsweek (April, 1996) article.

5) MSBP: father as perpetrator, Pediatrics magazine (March, 1990) article.

6) MSBP - The deadly game; Saturday Evening Post (July, 1996) article.

7) MSBP: child abuse in the medical system, Archives of Pediatrics & Adolescent Medicine(July, 1996) article.

8) Fabricated or induced illness in children, British Medical Journal (August, 2001) article.

9) Information on MSBP.

10) Mothers Against Munchausen Syndrome by Proxy Allegations (M.A.M.A) home page.

Comments made prior to 2007

I am creating a databank of information on Munchausen Syndrome by Proxy. In particular, I am interested in studying Munchausen Syndrome by Proxy in order to have it discredited as an entity. In order to do so, I need those with and without the disorder to come forward with the information about themselves. Please send information to me at the following address:

Lisa Jacobs, MD
PO Box 488
Weston, MA 02493

I want to show that mothers with risk factors for Munchausen Syndrome by Proxy do not have Munchausen Syndrome by Proxy, and that just because mothers have some characteristic behavior profile that it does not mean that they have this theoretical construct which is not a scientifically valid syndrome. I remain very concerned that the statistics do not support the very existence of this syndrome ... Lisa Jacobs, 27 July 2004