What is Munchausen syndrome by proxy?
Munchausen syndrome by proxy (MSP), a type of factitious disorder, is a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick. People with MSP assume the role of a sick person indirectly by producing or lying about illness in another person under their care, usually a child under 6 years of age. However, cases have been reported of adult victims of MSP. (The term "by proxy" means "through a substitute.")

People with MSP have an inner need for the other person (often his or her child) to be seen as ill or injured. It is not done to achieve a concrete benefit, such as financial gain. People with MSP are even willing to have the child or other patient undergo painful or risky tests and operations in order to get the sympathy and special attention given to people who are truly ill and their families. Factitious disorders are considered mental illnesses because they are associated with severe emotional difficulties.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), which is the standard reference book for recognized mental illnesses in the United States, organizes factitious disorders into four main types: those with mainly psychological symptoms, those with mainly physical symptoms, those with both physical and psychological symptoms, and those that do not match the conditions for the other three types. MSP falls into the fourth category.

MSP most often occurs with mothers—although it can occur with fathers—who intentionally harm or describe non-existent symptoms in their children to get the attention given to the family of someone who is sick. A person with MSP uses the many hospitalizations as a way to earn praise from others for her devotion to the child’s care, often using the sick child as a means for developing a relationship with the doctor or other health care provider.

People with MSP might create or exaggerate the child’s symptoms in several ways. They might simply lie about symptoms, alter diagnostic tests (such as contaminating a urine sample), falsify medical records, or induce symptoms through various means, such as poisoning, suffocating, starving, and causing infection.

What are the symptoms of Munchausen syndrome by proxy?
Certain characteristics are common in a person with MSP:

• Often is a parent, usually a mother, but can be the adult child of an elderly patient
• Might be a health care professional
• Is very friendly and cooperative with the health care providers
• Appears quite concerned (some might seem overly concerned) about the child or designated patient
• Might also suffer from Munchausen syndrome (This is a related disorder in which the caregiver repeatedly acts as if he or she has a physical or mental illness when he or she has caused the symptoms.)

Other possible warning signs of MSP in children include the following:

• The child has a history of many hospitalizations, often with a strange set of symptoms.
• Worsening of the child’s symptoms generally is reported by the mother and is not witnessed by the hospital staff.
• The child’s reported condition and symptoms do not agree with the results of diagnostic tests.
• There might be more than one unusual illness or death of children in the family.
• The child’s condition improves in the hospital, but symptoms recur when the child returns home.
• Blood in lab samples might not match the blood of the child.
• There might be signs of chemicals in the child’s blood, stool, or urine.

What causes Munchausen syndrome by proxy?
The exact cause of MSP is not known, but researchers believe both biological and psychological factors play a role in the development of this disorder. Some theories suggest that a history of abuse or neglect as a child or the early loss of a parent might be factors in its development. Some evidence suggests that major stress, such as marital problems, can trigger an MSP episode.

How common is Munchausen syndrome by proxy?
There are no reliable statistics regarding the number of people in the United States who suffer from MSP, and it is difficult to assess how common the disorder is because many cases go undetected. However, estimates suggest that about 1,000 of the 2.5 million cases of child abuse reported annually are related to MSP.

In general, MSP occurs more often in women than in men.

How is Munchausen syndrome by proxy diagnosed?
Diagnosing MSP is very difficult because of the dishonesty that is involved. Doctors must rule out any possible physical illness as the cause of the child’s symptoms, and often use a variety of diagnostic tests and procedures before considering a diagnosis of MSP.

If a physical cause of the symptoms is not found, a thorough review of the child’s medical history, as well as a review of the family history and the mother’s medical history (many have Munchausen syndrome themselves) might provide clues to suggest MSP. Remember, it is the adult, not the child, who is diagnosed with MSP. Indeed, the most important or helpful part of the work-up is likely to be the review of all old records that can be obtained. Too often, this time-consuming, but critical, task is forgotten and the diagnosis is missed.

[excerpt retrieved from the Cleveland Clinic ]