Munchausen Syndrome by Proxy Clinical Presentation

  • Author: Guy E Brannon, MD; Chief Editor: Eduardo Dunayevich, MD   more...
 
Updated: Sep 1, 2011
 

History

Factitious disorder by proxy

The DSM-IV-TR includes the following research criteria for factitious disorder by proxy:

  • The perpetrator intentionally produces or feigns physical or psychological signs or symptoms in another person who is under his or her care.
  • The motivation for the perpetrator's behavior is to assume the sick role by proxy.
  • External incentives for the behavior (eg, economic gain) are absent.
  • Another mental disorder does not account for the behavior.

Factitious disorder not otherwise specified

The category of factitious disorder not otherwise specified includes disorders with contrived symptoms that do not meet the criteria for a factitious disorder, such as factitious disorder by proxy (ie, the intentional production or feigning of physical or psychological signs or symptoms in another person for the purpose of indirectly assuming the sick role).

  • Characteristics of the mother
    • Past exposure and experience with the healthcare system
    • Past training or work as a nurse or medical receptionist
    • Biologic mother (95% of known cases)
    • Excellent interactions with all medical staff
    • More concerned with appearance than with substance
    • Seemingly excellent care of the child in the hospital (Eg, She never leaves the hospital and never leaves the child's side.); yet, in some cases, less concern for the child or loved one than for herself
    • Inappropriate affect when discussing the child's illness
    • Lack of emotion
    • Possible history of Munchausen syndrome in the past (found in about 25% of patients)
    • Past abuse or at least a reported story of abuse
    • Possible reporting of falsehoods about their lives (eg, earning of a law degree)
    • Poor relationship skills
    • Poor coping skills
  • Characteristics of the father
    • Dependent
    • High denial
    • Very supportive of the spouse
    • Little involvement - May never visit the hospital
  • Warning signs of Munchausen syndrome by proxy
    • Unexplainable, persistent, or recurrent illnesses
    • Discrepancies among the history, clinical findings, and child's general health
    • Working diagnosis of a rare disorder
    • Symptoms and signs occurring only in the mother's presence
    • Mother who is extremely attentive and always in the hospital
    • Child who is frequently intolerant of treatment
    • Mother who appears less worried about her child's illness than about the medical staff
    • Seizures that do not respond to appropriate therapy
    • Families in which unexplained sudden infant death occurs
    • Mother with previous medical or nursing experience or with an extensive history of illness
Next

Physical

Obtain a complete history and perform complete mental status, physical, and neurologic examinations to assist with the evaluation and to exclude other disease processes.

Previous
Next

Causes

Research does not yet show a single cause for Munchausen syndrome by proxy.

Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Guy E Brannon, MD  Associate Clinical Professor of Psychiatry, Louisiana State University Health Sciences Center; Director, Adult Psychiatry Unit, Chemical Dependency Unit, Clinical Research, Brentwood Behavior Health Company

Guy E Brannon, MD is a member of the following medical societies: American Medical Association, American Medical Writers Association, American Psychiatric Association, American Society of Addiction Medicine, Association of Clinical Research Professionals, Louisiana State Medical Society, and Southern Medical Association

Disclosure: AstraZeneca Grant/research funds Other; Janssen Grant/research funds Other; Pfizer Honoraria Speaking and teaching; Sunovion Honoraria Speaking and teaching; Eli Lilly Grant/research funds Other; Forrest Grant/research funds Other

Specialty Editor Board

Ronald C Albucher, MD  Chief Medical Officer, Westside Community Services; Consulting Staff, California Pacific Medical Center

Ronald C Albucher, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

Eduardo Dunayevich, MD  Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories

Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed, Text Revision. Washington, DC: American Psychiatric Association; 2000:517, 781-3.

  2. Bass C, Jones D. Psychopathology of perpetrators of fabricated or induced illness in children: case series. Br J Psychiatry. Aug 2011;199:113-8. [Medline].

  3. Forsyth B. Munchausen syndrome by proxy. In: Melvin Lewis, ed. Child and Adolescent Psychiatry: A comprehensive textbook. 2nd ed. Baltimore, MD: Williams & Wilkins; 1996:1048-1054.

  4. Sheridan MS. The deceit continues: an updated literature review of Munchausen Syndrome by Proxy. Child Abuse Negl. Apr 2003;27(4):431-51. [Medline].

  5. The Nemours Foundation. Munchausen by proxy syndrome. 2007;5 Nov:Accessed Jan 4, 2008. Available at www.kidshealth.org/parent/general/sick/munchausen.html.

  6. Adshead G, Bluglass K. Attachment representations in mothers with abnormal illness behaviour by proxy. Br J Psychiatry. Oct 2005;187:328-33. [Medline].

  7. Ayoub CC, Schreier HA, Keller C. Munchausen by proxy: presentations in special education. Child Maltreat. May 2002;7(2):149-59. [Medline].

  8. Bartsch C, Risse M, Schütz H, Weigand N, Weiler G. Munchausen syndrome by proxy (MSBP): an extreme form of child abuse with a special forensic challenge. Forensic Sci Int. Nov 26 2003;137(2-3):147-51. [Medline].

  9. Baskin DE, Stein F, Coats DK, Paysse EA. Recurrent conjunctivitis as a presentation of munchausen syndrome by proxy. Ophthalmology. Aug 2003;110(8):1582-4. [Medline].

  10. Bauer KA. Covert video surveillance of parents suspected of child abuse: the British experience and alternative approaches. Theor Med Bioeth. 2004;25(4):311-27. [Medline].

  11. Bools C. Factitious illness by proxy. Munchausen syndrome by proxy. Br J Psychiatry. Sep 1996;169(3):268-75. [Medline].

  12. Bools C, Neale B, Meadow R. Munchausen syndrome by proxy: a study of psychopathology. Child Abuse Negl. Sep 1994;18(9):773-88. [Medline].

  13. Bornemann MA, Mahowald MW, Schenck CH. Parasomnias: clinical features and forensic implications. Chest. Aug 2006;130(2):605-10. [Medline].

  14. Boros SJ, Ophoven JP, Andersen R, Brubaker LC. Munchausen syndrome by proxy: a profile for medical child abuse. Aust Fam Physician. May 1995;24(5):768-9, 772-3. [Medline].

  15. Brown P, Tierney C. Munchausen syndrome by proxy. Pediatr Rev. Oct 2009;30(10):414-5; discussion 415. [Medline].

  16. Children's Bureau. Child Welfare Information Gateway. Available at http://www.childwelfare.gov. Accessed Nov 1, 2010.

  17. Clin B, Ferrant O, Dupont C, Papin F. Recurrent caustic esophagitis: a clinical form of Münchausen syndrome by proxy. Child Abuse Negl. May 2009;33(5):293-5. [Medline].

  18. Donald T, Jureidini J. Munchausen syndrome by proxy. Child abuse in the medical system. Arch Pediatr Adolesc Med. Jul 1996;150(7):753-8. [Medline].

  19. Feldman MD, Brown RM. Munchausen by Proxy in an international context. Child Abuse Negl. May 2002;26(5):509-24. [Medline].

  20. Folks DG. Munchausen's syndrome and other factitious disorders. Neurol Clin. May 1995;13(2):267-81. [Medline].

  21. Forsyth BWC. Munchausen syndrome by proxy. In: Lewis M, ed. Child and Adolescent Psychiatry: A Comprehensive Textbook. 2nd ed. Baltimore, Md: Lippincott Williams & Wilkins; 1996:1048-54.

  22. Green RP, Hollander AS, Thevis M, Thomas A, Dietzen DJ. Detection of surreptitious administration of analog insulin to an 8-week-old infant. Pediatrics. May 2010;125(5):e1236-40. [Medline].

  23. Jacobi G, Dettmeyer R, Banaschak S, Brosig B, Herrmann B. Child abuse and neglect: diagnosis and management. Dtsch Arztebl Int. Apr 2010;107(13):231-39; quiz 240. [Medline]. [Full Text].

  24. Kannai R. Munchausen by mommy. Fam Syst Health. Mar 2009;27(1):105-12. [Medline].

  25. Lee JC, Lin KL, Lin JJ, Hsia SH, Wu CT. Non-accidental chlorpyrifos poisoning-an unusual cause of profound unconsciousness. Eur J Pediatr. Apr 2010;169(4):509-11. [Medline].

  26. Lesaca TG. At mother's mercy: the nightmare of Munchausen syndrome by proxy. W V Med J. Nov-Dec 1995;91(7):318-9. [Medline].

  27. Marcus A, Ammermann C, Klein M, Schmidt MH. Munchausen syndrome by proxy and factitious illness: symptomatology, parent-child interaction, and psychopathology of the parents. Eur Child Adolesc Psychiatry. Oct 1995;4(4):229-36. [Medline].

  28. Marks V. Murder by insulin: suspected, purported and proven-a review. Drug Test Anal. Apr 2009;1(4):162-76. [Medline].

  29. Maxmen JS, Ward NG. Factitious disorders. In: Essential Psychopathology and Its Treatment. 2nd ed. New York, NY: W.W. Norton & Company; 1995:304-9.

  30. Meadow R. Munchausen syndrome by proxy. Arch Dis Child. Feb 1982;57(2):92-8. [Medline].

  31. Moldavsky M, Stein D. Munchausen Syndrome by Proxy: two case reports and an update of the literature. Int J Psychiatry Med. 2003;33(4):411-23. [Medline].

  32. Murray JB. Munchausen syndrome/Munchausen syndrome by proxy. J Psychol. May 1997;131(3):343-52. [Medline].

  33. Ozon A, Demirbilek H, Ertugrul A, Unal S, Gumruk F, Kandemir N. Anemia and neutropenic fever with high dose diazoxide treatment in a case with hyperinsulinism due to Munchausen by proxy. J Pediatr Endocrinol Metab. Jul 2010;23(7):719-23. [Medline].

  34. Pankratz L. Persistent problems with the Munchausen syndrome by proxy label. J Am Acad Psychiatry Law. 2006;34(1):90-5. [Medline].

  35. Rand DC, Feldman MD. An explanatory model for Munchausen by proxy abuse. Int J Psychiatry Med. 2001;31(2):113-26. [Medline].

  36. Repper J. Munchausen syndrome by proxy in health care workers. J Adv Nurs. Feb 1995;21(2):299-304. [Medline].

  37. Rogers R. Diagnostic, expanatory, and detection models of Munchausen by proxy: extrapolations from malingering and deception. Child Abuse Negl. Feb 2004;28(2):225-38. [Medline].

  38. Rosenberg DA. Munchausen Syndrome by Proxy: medical diagnostic criteria. Child Abuse Negl. Apr 2003;27(4):421-30. [Medline].

  39. Sahin F, Kuruoglu A, Isik AF, Karacan E, Beyazova U. Munchausen syndrome by proxy: a case report. Turk J Pediatr. Oct-Dec 2002;44(4):334-8. [Medline].

  40. Schreier HA, Libow JA. Munchausen syndrome by proxy: diagnosis and prevalence. Am J Orthopsychiatry. Apr 1993;63(2):318-21. [Medline].

  41. Siegel DM. Munchausen Syndrome by Proxy: a pediatrician's observations. Fam Syst Health. Mar 2009;27(1):113-5. [Medline].

  42. Skau K, Mouridsen SE. Munchausen syndrome by proxy: a review. Acta Paediatr. Sep 1995;84(9):977-82. [Medline].

  43. Sugandhan S, Gupta S, Khandpur S, Khanna N, Mehta M, Inna P. 'Munchausen syndrome by proxy' presenting as battered child syndrome: a report of two cases. Int J Dermatol. Jun 2010;49(6):679-83. [Medline].

  44. Thomas K. Munchausen syndrome by proxy: identification and diagnosis. J Pediatr Nurs. Jun 2003;18(3):174-80. [Medline].

  45. Truman TL, Ayoub CC. Considering suffocatory abuse and Munchausen by proxy in the evaluation of children experiencing apparent life-threatening events and sudden infant death syndrome. Child Maltreat. May 2002;7(2):138-48. [Medline].

  46. Ulinski T, Lhopital C, Cloppet H, Feït JP, Bourlon I, Morin D. Munchausen syndrome by proxy with massive proteinuria and gastrointestinal hemorrhage. Pediatr Nephrol. Jul 2004;19(7):798-800. [Medline].

  47. Von Burg MM, Hibbard RA. Munchausen syndrome by proxy: a different kind of child abuse. Indiana Med. Sep-Oct 1995;88(5):378-82. [Medline].

  48. Wenk RE. Molecular evidence of Munchausen syndrome by proxy. Arch Pathol Lab Med. Jan 2003;127(1):e36-7. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.