Frequently Asked Questions
1. What is Munchausen by Proxy?
Munchausen by Proxy is the most commonly known term, which is why we have used it throughout this site. The way the term is used, however, actually encompasses two separate things: the first is Medical Child Abuse (MCA) in which a caregiver (almost always the mother of a young child) fabricates, exaggerates, or induces illness in another, generally in a child. MCA is a criminal act and should be handled accordingly. The second is a psychopathology known as Factitious Disorder Imposed on Another (FDIA) in which a caregiver fabricates, exaggerates, or induces illness in their victim for the purpose of getting attention and sympathy from medical professionals and/or those in their community. FDIA is extremely difficult to treat, and the mental health of the perpetrator should never be the main focus. Rather the health and well-being of the child being harmed should be the focal point.
2. Is Munchausen by Proxy a Mental Illness?
Though there is frequently an underlying psychological condition—Factitious Disorder Imposed on Another—that drives the behavior of perpetrators of Munchausen by Proxy, experts on MBP are unanimous in their agreement that this should be first and foremost considered maltreatment.
The success rate for treating perpetrators is vanishingly small and requires full accountability and cooperation of the perpetrator. MBP offenders are not delusional and they’re not hypochondriacs. This abuse is characterized by intentional deception, and perpetrators have a profound lack of empathy their victims. MBP offenders are extremely dangerous, and the welfare of the child must be foremost in the minds of anyone who suspects this abuse may be happening.
3. What Are the Warning Signs of Munchausen by Proxy?
According to the American Professional Society on the Abuse of Children (APSAC), here are some common signs of MBP maltreatment to watch out for:
- Reported symptoms or behaviors that are not congruent with observations. For example, the abuser says the child cannot eat, and yet the child is observed eating without the adverse symptoms reported by the abuser.
- Discrepancy between the abuser’s reports of the child’s medical history and the medical record.
- Extensive medical assessments do not identify a medical explanation for the child’s reported problems.
- Unexplained worsening of symptoms or new symptoms that correlate with the abuser’s visitation or shortly thereafter.
- Laboratory findings that do not make medical sense,; are clinically impossible or implausible;, or identify chemicals, medications, or contaminants that should not be present.
- Symptoms resolve or improve when the child is separated and well protected from the influence and control of the abuser.
- Other individuals in the home or the caregiver have or have had unusual or unexplained illnesses or conditions.
Animals in the home have unusual or unexplained illnesses or conditions – possibly similar to the child’s presentation (e.g., seizure disorder).
- Conditions or illnesses significantly improve or disappear in one child and then appear in another child, such as when another child is born, and the new child begins to have similar or other unexplained symptoms.
- Caregiver is reluctant to provide medical records, claims that past records are not available, or refuses to allow medical providers to discuss care with previous medical providers.
- The abuser reports that the other parent is not involved, does not want to be involved, and is not reachable.
- A parent, child, or other family member expresses concern about possible falsification or high healthcare utilization.
- Observations of clear falsification or induction by the caregiver. This may take the form of false recounting of past medical recommendations, test or exam results, conditions, or diagnoses.
Munchausen by Proxy
(APSAC Practice Guidelines 2017)
The full practice guidelines for professionals can be accessed here.
4. What Are the Effects on Victims?
Munchausen by Proxy may be the deadliest form of child abuse, and victims can suffer lifelong physical damage such as: blindness, hearing loss, altered gut function, brain damage, scarring, removal of organs, surgical altercation of anatomy, limps, etc. Victims also suffer psychological damage including significant confusion about their heath and relationships, loss of positive self-image, post-traumatic stress disorder, and disordered eating.
Although Munchausen by Proxy affects entire families and communities, the emotional cost of this abuse is especially high for its victims who are often isolated and cut off from anyone around them who may suspect the abuse is taking place.
Survivors also struggle with feelings of shame, isolation, and stigma. If you are a survivor seeking information and treatment, please see this page.
5. What Should I Do If I Suspect Abuse?
If you observe the warning signs (link), you should contact the medical professionals treating the victim if possible, CPS, AND the police. Professionals are often not well-informed about Munchausen by Proxy, so you may need to be proactive in educating them. You can refer them to the APSAC guidelines and relevant resource pages (link) of this site for more information.
Pediatricians, nurses, educators, daycare workers, social workers, and others who work with children are mandatory reporters in many states and must file a report at the time of a reasonable, good-faith suspicion.
If you suspect abuse, document as much of your interaction with the perpetrator as possible, including text messages, emails, phone calls, and social media posts, as these may be important evidence in a case.
When confronted, MBP perpetrators will typically deny the abuse even when presented with direct evidence. They commonly turn on anyone who suspects them. If possible, it’s best to maintain contact and avoid direct confrontation until the children can be safely removed.
6. Are Munchausen by Proxy Perpetrators Treatable?
Experts agree that perpetrators are extremely difficult to treat and that safe reunification with children is often not a realistic outcome. Most perpetrators deny the behavior even when confronted with direct evidence and/or convicted in a court of law. In order for treatment to be effective, full accountability for the abuse is necessary. The high occurrence of personality disorders such as Narcissistic and Borderline also complicates the treatment process. The safety of the children involved should always be paramount and any contact with their abuser should be extremely closely monitored, if allowed at all.
For more about treatment, see the resource page.
7. Why Would Someone Do This?
Munchausen by Proxy perpetrators get emotional gratification from the sympathy and attention they receive for being the ‘heroic’ parent of a sick child. Perpetrators may also feel a sense of satisfaction in deceiving authority figures such as medical professionals. MBP can be likened to an addiction or compulsion as the behavior can develop as a coping mechanism, using the child to meet the perpetrator’s emotional needs. Perpetrators understand their actions and are believed to feel little true bond with or empathy for their child.
Though there is a high instance of fraud in Munchausen by Proxy cases, money is not the primary goal. There is a separate disorder call Malingering (or Malingering by Proxy) which involves faking illness for material gain.