eMedicine Specialties > Psychiatry > Psychosomatic

Munchausen Syndrome by Proxy: Treatment & Medication

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

Treatment

Medical Care

Indications for inpatient treatment include suicidal or homicidal ideations and grave disability (ie, patients who are dangerous to themselves or others or who cannot care for themselves).

Treatment of Munchausen syndrome by proxy involves treating the child (victim), the patient, and the family.

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

Treatment for the child

Treatment for the child comprises several areas, as follows:

  • First, the child must be placed in a safe environment where his or her symptoms can be monitored in the absence of the patient with Munchausen syndrome by proxy. There, the child can receive appropriate therapies.
  • Treatment may involve play therapy and/or individual therapy depending on his or her age.
  • Another important aspect is clarifying the child's health status.
  • A single practitioner who is familiar with the case should be responsible for monitoring and treating the child.
  • Depending on local laws, child welfare and/or protective services may need to be notified.

Treatment for the patient with Munchausen syndrome by proxy

Treatment of the person with Munchausen syndrome by proxy involves thorough evaluation, individual therapy, and parenting classes, among other facets. Without treatment, the relapse rate is high. It is important not to overlook any medical and other psychiatric illnesses.

  • Clinical investigations are conducted to determine if other problems that require treatment are present. Studies include the following:
    • Physical examination
    • Laboratory evaluation
    • Psychiatric and/or psychological evaluations
  • Individual therapy is aimed at decreasing anxiety, stressors, and other problems that perpetuate the illness.
    • Identified problems must be appropriately managed.
    • Successful treatment is predicated on the patient's ability to break through denial and willingness to undergo therapy.
    • If the patient cannot overcome the issues found, his or her prognosis for recovery is poor.
  • Parenting classes are also needed to teach the patient how to parent effectively while meeting his or her needs.

Hospitalization

Hospitalization of the patient and/or child may be necessary to ensure that both the patient and the child are in safe but separate environments. The patient's condition must be understood without becoming judgmental toward him or her, as this attitude can hamper therapy.

Family therapy

Family therapy starts with education regarding Munchausen syndrome by proxy and discussions about whether reunification of the patient and child might be possible.

If other children live in the patient's home, their health status should be evaluated, and appropriate treatment given. All members of the family should receive therapy; they include parents, siblings, and the affected child.

If the family is reunited, supervision is mandatory to ensure the child's safety.

Consultations

Consultations with the following individuals may be indicated:

  • Attorney
  • Law enforcement personnel - To conduct covert video surveillance
  • Family court personnel - To terminate parental rights
  • Child welfare authorities - To arrange for foster care

Activity

Restrict activity if patients are a danger to themselves or others or if they are gravely disabled.

Medication

No information is available regarding the use of medications in the treatment of Munchausen syndrome by proxy.

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
[ CLOSE WINDOW ]

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].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

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

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
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.