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Munchausen Syndrome by Proxy

Topic Overview

What is Munchausen syndrome by proxy?

Munchausen syndrome by proxy (MSBP) is a mental health problem in which a caregiver makes up or causes an illness or injury in a person under his or her care, such as a child, an elderly adult, or a person who has a disability. Because vulnerable people are the victims, MSBP is a form of child abuse or elder abuse.

Note: Since most cases of MSBP are between a caregiver (usually a mother) and a child, the rest of this topic will describe that relationship. But it is important to remember that MSBP can involve any vulnerable person who has a caregiver.

The caregiver with MSBP may:

  • Lie about the child's symptoms.
  • Change test results to make a child appear to be ill.
  • Physically harm the child to produce symptoms.

Victims are most often small children. They may get painful medical tests they don't need. They may even become seriously ill or injured or may die because of the actions of the caregiver.

Children who are victims of MSBP can have lifelong physical and emotional problems and may have Munchausen syndrome as adults. This is a disorder in which a person causes or falsely reports his or her own symptoms.

What causes Munchausen syndrome by proxy?

Doctors aren't sure what causes it, but it may be linked to problems during the abuser's childhood. Abusers often feel like their life is out of control. They often have poor self-esteem and can't deal with stress or anxiety.

The attention that caregivers get from having a sick child may encourage their behaviour. Caregivers may get attention not only from doctors and nurses but also from others in their community. For example, neighbours may try to help the family in many ways—such as by doing chores, bringing meals, or giving money.

How does someone with Munchausen syndrome by proxy act?

A person with MSBP often:

  • Has medical skills or experience.
  • Seems devoted to his or her child.
  • Looks for sympathy and attention.
  • Tries too hard to become close and friendly with medical staff.
  • Needs to feel powerful and in control.
  • Does not see his or her behaviour as harmful.

What are the clues that a person may have Munchausen syndrome by proxy?

Checking a child's medical records for past tests, treatments, and hospital stays may help a doctor or nurse find out if a health problem is real.

Doctors or nurses may suspect a problem when:

  • A child has a repeated or unusual illness, and no reason can be found.
  • The child doesn't get better, even with treatments that should help. Symptoms only occur when the caregiver is with or has recently been with the child. But symptoms get better or go away when the caregiver is not there or is being closely watched.
  • The other parent (usually the father) is not involved in the child's treatment, even though the child's condition may be serious.
  • A caregiver suddenly changes doctors and lies about prior testing and treatment.
  • Normal test results don't reassure the caregiver. And he or she may be strangely calm or happy when the child's condition is getting worse.
  • The caregiver is seen (or videotaped or recorded) harming the child or causing symptoms.
  • Another child in the family has had unexplained illness or death.

How is it treated?

Child protective services, law enforcement, and doctors are all involved in treatment for Munchausen syndrome by proxy. Caregivers who have this condition need long-term counselling. They may resist treatment or deny that there is a problem. Medicines are used only when the caregiver has another health problem, such as anxiety disorder, along with MSBP.

Even after treatment, caregivers may repeat their behaviour. So doctors, counsellors, and family members need to closely watch how the caregiver interacts with his or her children.

For victims, the first step is to protect the child by moving him or her into safe custody. Then a doctor will monitor the child for symptoms. Most of the time, the child's symptoms stop after the child is away from the caregiver. Some children need counselling or other help.

What should you do if you think someone has Munchausen syndrome by proxy?

MSBP is child abuse. If you suspect that a child is a victim, don't confront the suspected caregiver. It might make the problem worse. Instead, think about these options:

  • Keep a journal of the child's symptoms and other related events.
  • Talk with your doctor about your concerns.
  • Report your concerns to your local child welfare agency. You can make a report without using your name (anonymous).

Frequently Asked Questions

Learning about Munchausen syndrome by proxy:

Other Places To Get Help

Organizations

Canadian Paediatric Society
2305 Saint Laurent Boulevard
Ottawa, ON  K1G 4J8
Phone: (613) 526-9397
Fax: (613) 526-3332
Email: To contact the CPS via email, go to www.cps.ca/en/about-apropos/staff.
Web Address: www.cps.ca
 

The Canadian Paediatric Society (CPS) promotes quality health care for Canadian children and establishes guidelines for paediatric care. The organization offers educational materials on a variety of topics, including information on immunizations, pregnancy, safety issues, and teen health.



Provincial Helplines and Websites
 

Many of the resources below provide help 24 hours a day, 7 days a week in multiple languages. In an emergency, call 911.

Canada-wide resources

  • To find a suicide prevention crisis centre phone number or website in your province, visit the Canadian Association for Suicide Prevention Crisis Centre's webpage at www.suicideprevention.ca/in-crisis-now/find-a-crisis-centre-now.
  • Kids and teens can call Kids Help Phone at 1-800-668-6868 (toll-free 24/7) or visit http://org.kidshelpphone.ca/en/.

Alberta

  • Provincial Health Information Line. HEALTHLink Alberta. Call 1-866-408-5465 (toll-free 24/7) or visit https://myhealth.alberta.ca.
  • Family Violence Info Line. Call 310-1818 (toll-free 24/7) or visit http://humanservices.alberta.ca/abuse-bullying.html.
  • Child Abuse Hotline. Call 1-800-387-5437 (toll-free (24/7) or visit http://humanservices.alberta.ca/abuse-bullying.html.
  • Sexual Assault Centre of Edmonton (SACE). Call 780-423-4121 (24/7) or visit www.sace.ab.ca.
  • Bully Free Alberta. Call 1-888-456-2323 (toll-free (24/7) or visit www.bullyfreealberta.ca.
  • Mental Health Help Line. Call 1-877-303-2642 (toll-free 24/7).
  • Addiction Services Helpline. Call 1-866-332-2322 (toll-free 24/7).

British Columbia

  • Provincial Health Information Line. HealthLinkBC. Call 8-1-1 (toll-free 24/7) or visit www.healthlinkbc.ca.
  • Domestic Violence Helpline. Call 1-800-563-0808 (toll-free 24/7) or visit www.domesticviolencebc.ca.
  • VictimLink BC. Call 1-800-563-0808 (toll-free 24/7) or visit www.victimlinkbc.ca.
  • Child Abuse Prevention Website: Helpline. Call 310-1234 (toll-free) or visit www.safekidsbc.ca/helpline.htm.
  • BC Mental Health and Addiction Services. Visit www.bcmhas.ca.
  • Crisis Intervention and Suicide Prevention Centre of British Columbia. Call 1-800-784-2433 (toll-free 24/7) or visit www.crisiscentre.bc.ca.

New Brunswick

  • Provincial Health Information Line. Tele-Care 811: Call 8-1-1 (toll free 24/7) or visit www.gnb.ca/0217/Tele-Care-e.asp.
  • Emergency Social Services. During regular office hours (Monday to Friday, 8 a.m. to 5 p.m.), visit www2.gnb.ca/content/gnb/en/departments/social_development/about_us/emergency_socialservices.html to find the number for the office nearest you. After hours, call 1-800-442-9799 (toll-free).
  • Fredericton Sexual Assault Crisis Centre. Call (506) 454-0437 (24/7) or visit www.fsacc.ca/content/45357#.
  • Chimo Crisis Line. Call 1-800-667-5005 (24/7) or visit www.gnb.ca/0055/index-e.asp.

Ontario

  • Provincial Health Information Line. Telehealth Ontario: Call 1-866-797-0000 (toll-free 24/7) or visit www.health.gov.on.ca/en/public/programs/telehealth.
  • Assaulted Women's Helpline. Call 1-866-863-0511 (toll-free 24/7) or visit www.awhl.org.
  • Distress Centres Ontario. Visit www.dcontario.org/help.html to find the phone number for a crisis line in your calling area.
  • Drug and Alcohol Helpline. Call 1-800-565-8603 (toll-free 24/7) or visit www.drugandalcoholhelpline.ca.
  • Mental Health Helpline. Call 1-866-531-2600 (toll-free 24/7) or visit www.mentalhealthhelpline.ca.

Saskatchewan

  • Provincial Health Information Line. HealthLine. Call 811 or visit www.health.gov.sk.ca/healthline.
  • Family Violence Outreach. Go to www.justice.gov.sk.ca/FVO for a list of community-based organizations and their contact information, or visit www.justice.gov.sk.ca/IVAP.
  • Child Protection. Go to www.socialservices.gov.sk.ca/child-protection.pdf for a list of local child protection offices and their contact information, or visit www.socialservices.gov.sk.ca/child-protection.
  • Mental Health and Addictions. Go to www.health.gov.sk.ca/treatment-services-directory for a list of local alcohol and drug treatment services and their contact information, or visit www.health.gov.sk.ca/alcohol-and-drug-services.

Yukon

  • Provincial Health Information Line. Yukon HealthLine: Call 811 or visit www.hss.gov.yk.ca/811.php. If you are calling from a satellite phone, you can dial (604) 215-4700 to reach the Health Services Representative at HealthLink BC.
  • Family and Children's Services. Call 1-867-667-3002 or visit www.hss.gov.yk.ca/family_children.php.
  • Family Violence Prevention Unit. Call 1-800-661-0511 (toll-free). Or visit the Department of Justice "Need Help? Phone Directory" at www.justice.gov.yk.ca/prog/cor/vs/phonedir.html.
  • Alcohol and Drug Services. Call 1-800-661-0408 ext. 5777 during business hours or 1-800-661-0408 ext. 8473 after hours or visit www.hss.gov.yk.ca/ads.php.

Other provinces

Check your local phone book or provincial or territorial website.



Related Information

References

Other Works Consulted

  • Dubowitz H, Lane WG (2011). Factitious disorder by proxy (Munchausen syndrome by proxy). In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 146–147. Philadelphia: Saunders.
  • McDermott BE (2008). Factitious disorder and malingering. In RE Hales et al., eds., The American Psychiatric Publishing Textbook of Psychiatry, 5th ed., pp. 643–664. Washington, DC: American Psychiatric Publishing.
  • Wang DL, et al. (2009). Factitious disorder. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 1, pp. 1949–1964. Philadelphia: Lippincott Williams and Wilkins.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Donald Sproule, MDCM, CCFP - Family Medicine
Specialist Medical Reviewer Lisa S. Weinstock, MD - Psychiatry
Last Revised July 16, 2013
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