eMedicine Specialties > Psychiatry > Psychosomatic

Munchausen Syndrome by Proxy: Follow-up

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
Coauthor(s): Kimberly S Carroll, MA, Clinical Research Coordinator, Brentwood Research Institute
Contributor Information and Disclosures

Updated: Jan 17, 2008

Follow-up

Further Inpatient Care

Patients may require further inpatient care if they are a danger to themselves or others or if they are gravely disabled.

Further Outpatient Care

The literature provides little information regarding psychotherapy for Munchausen syndrome by proxy.

Inpatient & Outpatient Medications

No information is available.

Transfer

If patients are charged with a crime or if they have been arrested, they may be incarcerated.

Deterrence/Prevention

Deterrence and/or prevention may encompass these aspects:

  • Education
  • Legal ramifications

Complications

Complications of Munchausen syndrome by proxy and its management include the following:

  • Noncompliance with therapy
  • Difficulty in proving the syndrome

Prognosis

Patients with a good prognosis have the following characteristics:

  • They are able to assume responsibility for their behavior.
  • They can improve their coping skills.
  • They can place child's needs above their own.

Patients with a poor prognosis may exhibit the following signs:

  • They demonstrate a high degree of denial.
  • They are uncooperative with therapy.
  • They may have a personality disorder.

Patient Education

Educating the patient, family, and medical staff about Munchausen syndrome by proxy is important.

  • Patient education is directed at increasing the patient's coping and stress-management skills, among other areas.
  • Family education regarding patterns of this disorder in previous generations of the family is needed to effectively treat patients.
    • If other children are present in the home, they should be evaluated for possible abuse.
    • A helpful endeavor is instructing the patient in techniques to reduce stress and anxiety in the home to improve his or her prognosis.
    • The family should also be educated about healthy ways for the patient to express anger. The family members should allow the patient to appropriately express anger and not consider it a hindrance to the recovery process.

For excellent patient education resources, visit eMedicine's Mental Health and Behavior Center. Also, see eMedicine's patient education article Munchausen Syndrome.

Miscellaneous

Medicolegal Pitfalls

  • Failure to be familiar with local laws
  • Failure to maintain or appropriately break patient confidentiality (eg, failure to report patients to the proper authorities)

Special Concerns

  • Munchausen syndrome by proxy is difficult to prove. Patients are typically not caught, and cases are usually based on circumstantial evidence.
  • A high index of suspicion is necessary to be able to detect Munchausen syndrome by proxy, eg, on the basis of the level of dishonesty a patient exhibits. One considers a diagnosis of Munchausen syndrome by proxy only after physical illnesses in the child are ruled out.
  • Review the child's medical history and the family history to look for a history of Munchausen syndrome in the patient. The adult—and not the child—is the patient in whom Munchausen syndrome by proxy is diagnosed.
  • Video surveillance may assist in confirming the diagnosis.
 


More on Munchausen Syndrome by Proxy

Overview: Munchausen Syndrome by Proxy
Differential Diagnoses & Workup: Munchausen Syndrome by Proxy
Treatment & Medication: Munchausen Syndrome by Proxy
Follow-up: Munchausen Syndrome by Proxy
References
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References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed, Text Revision. Washington, DC: American Psychiatric Association; 200:517, 781-3.

  2. 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.

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

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

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

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

  7. 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].

  8. 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].

  9. 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].

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

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

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

  13. 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].

  14. 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].

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

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

  17. 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.

  18. 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].

  19. 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].

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

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

  22. 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].

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

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

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

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

  27. 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].

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

  29. 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].

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

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

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

  33. 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].

  34. 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].

  35. 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].

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

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Further Reading

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Keywords

Münchhausen syndrome by proxy, MSBP, Munchausen syndrome, Munchausen syndrome emergency, Munchausen syndrome by proxy emergency, Asher, Baron von Munchausen, Polle syndrome, Polle's syndrome, children of Munchausen, pediatric condition falsification, PCF, FD, factitious disease, factitious disorder, factitious disorder by proxy, factitious disorder not otherwise specified, factitious disorder NOS

malingering, psychiatric disorder, pseudosickness, pseudologues, mental disorder, child abuse emergency, physical child abuse, tampering, infection of unknown origin, unexplained death, feigned illness, faked illness, hospital hobo, pathomimicry disease forgery, doctor addicts, hospital addicts, hospital hoppers, professional patients, false patients, operation addicts, peregrinating problem patients, dissociative pseudologia fantastica, hypochondriasis, hypochondriacs, black-hole patients, fabricated symptoms, invented symptoms, personality disorders, somatoform disorder, sudden infant death syndrome

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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 Honoraria Speaking and teaching; Takeda Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Janssen Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Coauthor(s)

Kimberly S Carroll, MA, Clinical Research Coordinator, Brentwood Research Institute
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing 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.

CME Editor

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; BMS Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Other; Northstar Grant/research funds Other; Novartis  Other; Pfizer Honoraria Speaking and teaching

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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