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syndrome by proxy (MSBP) is a mental health problem in which a caregiver makes
up or causes an illness or injury in a person under his or her care, such as a child, an elderly adult, or a person who has a disability. Because vulnerable people
are the victims, MSBP is a form of
child abuse or elder abuse.
Note: Since most cases of MSBP are between a
caregiver (usually a mother) and a child, the rest of this topic will describe that relationship. But it is important to remember that MSBP can involve any vulnerable person who has a caregiver.
The caregiver with MSBP
Victims are most often small children. They may get
painful medical tests they don't need. They may even become seriously ill or
injured or may die because of the actions of the caregiver.
Children who are victims of MSBP can have lifelong physical and emotional
problems and may have
Munchausen syndrome as adults. This is a disorder in
which a person causes or falsely reports his or her own symptoms.
aren't sure what causes it, but it may be linked to problems during the
abuser's childhood. Abusers often feel like their life is out of control. They
often have poor self-esteem and can't deal with stress or anxiety.
The attention that caregivers get from having a sick child may encourage
their behavior. Caregivers may get attention not only from doctors and nurses
but also from others in their community. For example, neighbors may try to help
the family in many ways—such as by doing chores, bringing meals, or giving
A person with MSBP often:
Checking a child's medical records for past tests, treatments, and hospital stays may help a doctor or nurse find out if a health problem is real.
Doctors or nurses may suspect a problem when:
Child protective services, law enforcement, and doctors are all involved in treatment for Munchausen
syndrome by proxy. Caregivers who have this condition need long-term
counseling. They may resist treatment or deny that
there is a problem. Medicines are used only when the caregiver has another
health problem, such as anxiety disorder, along with MSBP.
after treatment, caregivers may repeat their behavior. So doctors, counselors,
and family members need to closely watch how the caregiver interacts with his or her
For victims, the first step is to protect the child by
moving him or her into safe custody. Then a doctor will monitor the child for symptoms. Most
of the time, the child's symptoms stop after the child is away from the
caregiver. Some children need counseling or other help.
MSBP is child abuse. If you suspect that a child is a
victim, don't confront the suspected caregiver. It might make the problem
worse. Instead, think about these options:
Learning about Munchausen syndrome by proxy:
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Other Works Consulted
Dubowitz H, Lane WG (2011). Factitious disorder by proxy (Munchausen syndrome by proxy). In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 146–147. Philadelphia: Saunders.
McDermott BE (2008). Factitious disorder and malingering. In RE Hales et al., eds., The American Psychiatric Publishing Textbook of Psychiatry, 5th ed., pp. 643–664. Washington, DC: American Psychiatric Publishing.
Wang DL, et al. (2009). Factitious disorder. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1949–1964. Philadelphia: Lippincott Williams and Wilkins.
May 3, 2013
Kathleen Romito, MD - Family Medicine & Lisa S. Weinstock, MD - Psychiatry
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