Then, What Is Munchausen Syndrome by Proxy?

Munchausen syndrome by proxy is named after Munchausen syndrome, a mental disorder where a person makes up symptoms or illness in his or her self. In contrast, in Munchausen syndrome by proxy, "A perpetrator feigns or induces illness in a child in order to garner internal satisfaction," says Marc Feldman, MD, professor of psychiatry at the University of Alabama in Birmingham. While the Diagnostic and Statistical Manual of Mental Disorders describes research criteria for Munchausen syndrome by proxy, it is not yet categorized as a true psychiatric disease.

No matter how professionals categorize Munchausen syndrome by proxy, it is still extremely dangerous. Victims, who are usually preschool children who cannot speak up for themselves, can be seriously injured and even killed because of this condition. Perpetrators (most commonly mothers) lie, exaggerate, or even cause symptoms in the victim, usually their own child.

For example, one mother gave her daughter a substance to cause asthma attacks. Other perpetrators have given medicines that cause vomiting or seizures. These people may also willingly allow a child to undergo risky surgeries to explore problems they know are not there. If confronted by a doctor, they deny any wrongdoing. However, the child gets better when the perpetrator is not around.

Looking For Attention

"The main thing these mothers are after," says Louisa J. Lasher, MA, an international expert on the subject, "is the attention that they get from having a child with problems." Commonly, these mothers will receive sympathy from friends and family. Sometimes church groups or community groups praise these mothers for their selfless duty to their sick child. Of course, to keep the praise coming, the lies must continue. Thus, the children suffer.

The media often reports on some of the more dramatic stories, like children who are hospitalized numerous times or subjected to countless tests and procedures. Sometimes the mothers are hailed as "super moms" who dedicate their lives to taking care of their children until a new doctor discovers the truth.

But many of these situations actually occur in the outpatient setting. And, Lasher says, "Most perpetrators are people who you'd see around the church or the grocery store. On the surface they look like good average mothers, below the surface they are not."

The sign of a perpetrator, says Lasher, is deception throughout the person's life. She leaves a trail of lies and inconsistencies behind her. Yet she gives seemingly plausible answers for her behavior.

Understanding and Awareness TOP

Dr. Feldman believes this condition occurs more commonly than is recognized. Even when pediatricians see differences between what a mother says and what the findings show, they often don't think of the possibility of a Munchausen syndrome by proxy. "There is lack of understanding and lack of awareness…," says Dr. Feldman.

Treatment usually involves removal of the child from the perpetrator. This is followed by intensive individual and family therapy. While eventually reuniting the child and family is always a goal, treatment of abusing parents may not be successful. The perpetrator may have to give up parental rights.

While Cora W. thrived in the hospital, her mother could not accept this. Cora was later sent to foster care. She returned to school, made new friends, and stayed healthy requiring only routine follow-up with a doctor.