Alternative Names factitious disorder, Munchausen syndrome by proxy, MSP
Definition Munchausen syndrome is a psychiatric disorder in which a person consciously fakes the symptoms of a physical disorder for attention. The person may have many medical tests and surgical procedures.
Munchausen syndrome by proxy (MSP) is a parenting disorder. The parents, usually mothers, fake symptoms in their children. The child is then subjected to unnecessary tests or surgeries.
What is going on in the body? A person with Munchausen syndrome fakes or pretends to have symptoms. Sometimes the symptoms are those of a specific illness. The individual fakes symptoms for psychological reasons rather than for financial gain or to get out of responsibilities. The person convincingly presents with intentional symptoms. For example, someone may inject germs into his or her own bloodstreams to cause illness.
What are the signs and symptoms of the condition? The signs and symptoms of Munchausen syndrome include:
fabrication of an illness without any physical symptoms
willingness to undergo numerous procedures, often painful, despite being fully aware there is no physical problem
poorly formed identity and severe problems with self-esteem
making up information, such as a medical history of an illness or serious disorder
changing doctors or hospitals frequently
In Munchausen syndrome by proxy, symptoms may be faked in a number of ways. These include adding blood to the child's urine, withholding food, falsifying fevers, and giving medication to make the child vomit. These children are often hospitalised with an unusual pattern of symptoms.
What are the causes and risks of the condition? The causes of Munchausen syndrome are not well understood. Little is known about its psychological components. The person is usually very unwilling to enter any kind of therapy. So it's difficult to do research on the disorder. Some case reports have suggested a history of childhood abuse, combined with frequent illnesses that required hospitalisation. Hospitalisations may have been the only time when the child felt safe or nurtured.
A person with Munchausen syndrome often describes his or her parents as having been rejecting and distant. A person with Munchausen syndrome seems to be trying to create a nurturing parent-like bond with the doctors by faking illness.
There is profile of a parent who is likely to have Munchausen syndrome by proxy. These parents are usually mothers. They are very friendly with health professionals and very cooperative with medical procedures. They appear quite concerned about the child, and are sometimes described as overly concerned.
What can be done to prevent the condition? There is no known prevention for Munchausen syndrome. Recognising MSP can prevent continued abuse. Unnecessary, expensive, and possibly dangerous medical testing can then be avoided.
How is the condition diagnosed? This diagnosis of Munchausen syndrome is made when it is certain that there is no organic cause for the person's symptoms. If there is some secondary motive for the person to remain ill, Munchausen syndrome ruled out. The only motivation for the behaviour must be to assume the sick role. When there is a family history of more than one unusual illness or death, MSP should be suspected.
What are the long-term effects of the condition? A person may undergo many unnecessary tests and procedures before Munchausen syndrome is diagnosed.
What are the risks to others? Munchausen syndrome by proxy can lead to the death of the child.
What are the treatments for the condition? No one treatment has been very effective for Munchausen syndrome. A person with this condition is generally active in seeking treatment for the factitious disorder. However, the person is usually extremely reluctant to seek treatment for the Munchausen syndrome itself.
Treatment focused on managing Munchausen syndrome, rather than trying to cure it, is more realistic. The aim is to help the person avoid unnecessary, costly, and risky medical procedures.
Once Munchausen syndrome by proxy is recognised, the parent needs to be confronted and offered help. Because it is a form of child abuse, MSP must be reported to the authorities. Psychiatric counselling will probably be recommended.
What are the side effects of the treatments? There are no side effects to treatment.
What happens after treatment for the condition? No treatment has been shown to be effective. The person may continue to go to different hospitals to prevent suspicion.
How is the condition monitored? A person with Munchausen syndrome is generally unwilling to undergo therapy.
Author: Ann Reyes, Ph.D. Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
