Munchausen Syndrome by Proxy: The Cruelest Breach of Trust

Baron von Münchhausen was a notorious 18th century German baron, who came to attention due to his proclivity for causing himself harm in order to garner the sympathy and attention of others. His infamy outlived him, and his peculiar psychological disturbance earned him a place in history, when his disorder became known through out the world as Munchausen Syndrome. Sadly, an offshoot of the disorder, known as Munchausen Syndrome by Proxy, has since come to be recognized as a more sinister form of the condition.

Munchausen Syndrome by Proxy is a rare psychiatric disorder in which parents fabricate illnesses in their children, sometimes even going so far as to cause them physical harm and even death. As with Munchausen Syndrome, it is believed that, in most cases, perpetrators of Munchausen Syndrome by Proxy are addicted to attention, particularly the sympathetic attention that the parent of a chronically ill child can garner.

Munchausen Syndrome by Proxy is far more common in mothers than in fathers. It is an extremely serious form of child abuse, which can have devastating affects on the health of the child or children of the afflicted parent. In some cases, the parent with Munchausen Syndrome by Proxy may make up symptoms in their child in order to continue taking the child in for medical attention. In more serious cases, the parent may actually cause the child harm in order to create actually conditions and illnesses that must then be treated. Even in cases where the parent reported fabricated symptoms, but did not actually harm the child, the damage can be irreversible when a perfectly healthy child becomes legitimately fragile, medically, due to invasive procedures performed to address medical problems that never existed in the first place.

Munchausen Syndrome by Proxy is an extremely insidious form of child abuse, which can often continue for years, or even indefinitely, without detection. It is rare that a child who is a victim of Munchausen Syndrome by Proxy will understand what is happening to him or her. Often the abuse will have been occurring since before the child was developed enough to understand what was happening. Furthermore, a parent with Munchausen Syndrome by Proxy is often extremely close to the victimized child- the two may be the largest part of each other's worlds. The child will rarely suspect that it is the actions of Mom or Dad that are actually causing the harm.

The social and professional dynamics of the typical parent with Munchausen Syndrome by Proxy can also complicate the diagnostic picture for some healthcare professionals. More often than now, a parent with Munchausen Syndrome by Proxy is educated, well spoken, and appears to be a strong, passionate, well-researched advocate for the health of her child. A surprisingly high percentage of parents afflicted with Munchausen Syndrome by Proxy work in healthcare, with a disproportionately high number working as respiratory therapists. People working in healthcare, particularly those who work with patients hands-on, tend to know what makes an effective advocate, and what sorts of behaviors raise red flags. Many healthcare professionals who are also parents with Munchausen Syndrome by Proxy are extremely adept at advocating for the health of their children in a professional, caring, responsible manner.

Sadly, for this reason and others, the presence of Munchausen Syndrome by Proxy in a parent can be incredibly difficult to detect, and even in cases where it is suspected, it can sometimes prove nearly impossible to substantiate. The gathering of important information that doctors need in order to formulate a theory about what is going on with their patients begins with the reporting of symptoms. For children, the most reliable reporter of those symptoms is usually thought to be the parents. Most physicians, nurses, social workers, and other healthcare personnel charged with the care of sick children will balk at accusing a parent of deliberately causing their child harm under potentially ambiguous circumstances. Often there is nothing more than a nontraditional path followed by the parents of a sick child or a gut feeling by a healthcare provider to suggest Munchausen Syndrome by Proxy.

Munchausen Syndrome by Proxy is child abuse, plain and simple. However, it is anything but a plain or simple form of child abuse. Children who are the victims of parents with the disorder rarely sustain broken limbs or bruised skin. Rather, they often find themselves embroiled in endless trails of doctor's appointments and unwarranted medical procedures. Determining the difference between a child who is medically complicated and a child who is the victim of Munchausen Syndrome by Proxy is tricky for healthcare professionals. Calling in social workers to help to determine whenever there is concern about the possibility that a pediatric patient is the victim of his or her parents, is always a good idea.