Disease by proxy

Munchausen syndrome by proxy: MedlinePlus Medical Encyclopedia

Munchausen syndrome by proxy is a mental illness and a form of child abuse. The caretaker of a child, most often a mother, either makes up fake symptoms or causes real symptoms to make it look like the child is sick.

No one is sure what causes Munchausen syndrome by proxy. Sometimes, the person was abused as a child or has Munchausen syndrome (fake illness for themselves).

The caretaker can do extreme things to fake symptoms of illness in the child. For example, the caretaker may:

Add blood to the child's urine or stool
Withhold food so the child looks like they can't gain weight
Heat up thermometers so it looks like the child has a fever
Make up lab results
Give the child drugs to make the child throw up or have diarrhea

Infect an intravenous (IV) line to make the child sick

What are signs in a caretaker?

Most people with this problem are mothers with small children. Some are adult children taking care of an older parent.
The caretakers often work in health care and know a lot about medical care. They can describe the child's symptoms in great medical detail. They like to be very involved with the health care team and are liked by the staff for the care they give the child.
These caretakers are very involved with their children. They seem devoted to the child. This makes it hard for health professionals to see a diagnosis of Munchausen syndrome by proxy.

What are signs in a child?

The child sees a lot of health care providers and has been in the hospital a lot.
The child often has had many tests, surgeries, or other procedures.
The child has strange symptoms that don't fit with any disease. The symptoms do not match the test results.
The child's symptoms are reported by the caretaker. They are never seen by health care professionals. The symptoms are gone in the hospital, but start again when the child goes home.
Blood samples do not match the child's blood type.
Drugs or chemicals are found in the child's urine, blood, or stool.

To diagnose Munchausen syndrome by proxy, providers have to see the clues. They have to review the child's medical record to see what has happened with the child over time. Very often, Munchausen syndrome by proxy goes undiagnosed.

The child needs to be protected. They may need to be removed from the direct care of the caretaker in question.

Children may require medical care to treat complications from injuries, infections, medicines, surgeries, or tests. They also need psychiatric care to deal with depression, anxiety, and post-traumatic stress disorder that can happen with child abuse.

Treatment most often involves individual and family therapy. Because this is a form of child abuse, the syndrome must be reported to the authorities.

If you think a child is being abused, contact a provider, the police, or child protective services.

Call 911 or the local emergency number for any child in immediate danger because of abuse or neglect.

You can also call this national hotline. Crisis counselors are available 24/7. Interpreters are available to help in 170 languages. The counselor on the phone can help you figure out the next steps. All calls are anonymous and confidential. Call Childhelp National Child Abuse Hotline 1-800-4-A-CHILD (1-800-422-4453).

Recognition of Munchausen syndrome by proxy in the child-parent relationship can prevent continued abuse and unnecessary, expensive, and possibly dangerous medical testing.

Factitious disorder by proxy; Child abuse - Munchausen

Byrne R, Kirschner K. Unusual behaviors. In: Kliegman RM, Lye PS, Bordini BJ, Toth H, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. Philadelphia, PA: Elsevier; 2018:chap 27.

Carrasco MM, Wolford JE. Child abuse and neglect. In: Zitelli BJ, McIntire SC, Nowalk AJ, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 6.

Dubowitz H, Lane WG. Abused and neglected children. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 16.

Lindberg D. Child abuse. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 177.

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Munchausen Syndrome by Proxy (MSP) or Induced Illness by Carers

Written by WebMD Editorial Contributors

What Are the Symptoms of Munchausen Syndrome by Proxy?
What Causes Munchausen Syndrome by Proxy?
How Common Is Munchausen Syndrome by Proxy?
How Is Munchausen Syndrome by Proxy Diagnosed?
How Is Munchausen Syndrome by Proxy Treated?
What Is the Outlook for Victims of People With Munchausen Syndrome by Proxy?
What Is the Outlook for People With Munchausen Syndrome by Proxy?
Can Munchausen Syndrome by Proxy Be Prevented?

Munchausen syndrome by proxy (MSP) -- or Munchausen by proxy -- is a psychological disorder marked by attention-seeking behavior by a caregiver through those who are in their care.

MSP is a relatively rare behavioral disorder. It affects a primary caretaker, often the mother. The person with MSP gains attention by seeking medical help for exaggerated or made-up symptoms of a child in their care. As health care providers strive to identify what's causing the child's symptoms, the deliberate actions of the parent or caretaker can often make the symptoms worse.

The person with MSP does not seem to be motivated by a desire for any type of material gain. While health care providers are often unable to identify the specific cause of the child's illness, they may not suspect the parent or caretaker of doing anything to harm the child. In fact the caregiver often appears to be very loving and caring and extremely distraught over their child's illness.

People with MSP may create or exaggerate a child's symptoms in several ways. They may simply lie about symptoms, alter tests (such as contaminating a urine sample), falsify medical records, or they may actually 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, including:

Is a parent or caregiver, usually a mother
May be a health care professional
Is very friendly and cooperative with the health care providers
Appears quite concerned (some may seem overly concerned) about their child
May suffer from Munchausen syndrome (a related disorder in which a person repeatedly acts as if they have a physical or mental illness when they are not really sick)

Other possible warning signs of MSP include:

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 parent and is not witnessed by the hospital staff.
The child's reported condition and symptoms do not agree with the results of tests.
There may 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 may not match the blood of the child.
There may 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 are looking at the roles of biological and psychological factors in its development. Some theories suggest that a history of abuse or neglect as a child, or the early loss of a parent may be factors in its development. Some evidence suggests that major stress, such as marital problems, can trigger MSP.

How Common Is Munchausen Syndrome by Proxy?

There are no reliable statistics regarding the number of people in the U.S. who suffer from MSP, and it is difficult to assess how common the disorder is because many cases go undetected.

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 before a diagnosis of MSP can be made.

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 parent's medical history (many have Munchausen syndrome themselves) may provide clues to suggest MSP. Remember, it is the adult, not the child, who is diagnosed with MSP.

How Is Munchausen Syndrome by Proxy Treated?

The first concern in MSP is to ensure the safety and protection of any real or potential victims. This may require that the child be placed in the care of another. In fact, managing a case involving MSP often requires a team that includes a social worker, foster care organizations, and law enforcement, as well as doctors.

Successful treatment of people with MSP is difficult because those with the disorder often deny there is a problem. In addition, treatment success is dependent on the person telling the truth, and people with MSP tend to be such accomplished liars that they begin to have trouble telling fact from fiction.

Psychotherapy (a type of counseling) generally focuses on changing the thinking and behavior of the individual with the disorder (cognitive-behavioral therapy). The goal of therapy for MSP is to help the person identify the thoughts and feelings that are contributing to the behavior, and to learn to form relationships that are not associated with being ill.

What Is the Outlook for Victims of People With Munchausen Syndrome by Proxy?

This disorder can lead to serious short- and long-term complications, including continued abuse, multiple hospitalizations, and the death of the victim. (Research suggests that the death rate for victims of MSP is about 10%.) In some situations, a child victim of MSP learns to relate getting attention to being sick and develops Munchausen syndrome themselves.

What Is the Outlook for People With Munchausen Syndrome by Proxy?

In general, MSP is a very difficult disorder to treat and often requires years of therapy and support.

In addition, MSP is considered a form of child abuse, which is a criminal offense.

Can Munchausen Syndrome by Proxy Be Prevented?

There is no known way to prevent this disorder.

“It is important to prove the disease” How to defend your rights if you are not fit for mobilization for health reasons? Soon there were reports that, by mistake, summons were received by citizens who were not subject to mobilization for health reasons: for example, in the Sverdlovsk region, a surgeon who survived cancer was called in, and in the Volgograd region, a pensioner with cerebral ischemia and second-degree diabetes was mobilized. Later, those illegally called up were returned home, military commissars in a number of regions received a reprimand. Lenta.ru learned from lawyer Anastasia Kopteeva about how to protect a person who is not subject to mobilization from illegal conscription, and what package of medical documents needs to be collected. nine0003

“It is necessary to issue a notarized power of attorney”

Lenta. ru: What can sick people do when they receive a summons by mistake?

Kopteeva : As a lawyer with experience in the field of medical law, I receive requests from people who have received summonses. I came across specific examples when summons came with a request to appear at the military registration and enlistment office, including people with category “B”, with serious illnesses.

Therefore, for those who did not receive a summons or received a summons, but did not arrive at the military enlistment office, it is necessary to issue a notarized power of attorney for any person who can represent the interests of the conscript, including on medical issues

Today, our legislation clearly interprets that only the patient himself has the right to receive his medical documentation in full in a medical institution. If the patient cannot personally demand such documentation for some reason (if, for example, he has already been called), then he draws up a power of attorney so that his representative demands the documentation - by notarized power of attorney.

What should be written in the power of attorney?

It must specifically state that Ivanov Ivan Ivanovich trusts his wife (but this does not have to be a close relative) to demand any medical documentation under the federal law "On the Basics of Protecting the Health of Citizens in the Russian Federation." It is better to write this down, because sometimes there are cases when medical organizations require a specific indication in a power of attorney, but it must be remembered that there is also a general power of attorney - for access to bank accounts, financial and personal issues. If the right to medical documentation is not prescribed, problems may arise. nine0003

Photo: Maxim Blinov / RIA Novosti

After such a power of attorney is issued, provided that the person has already been called up, his authorized representative can further resolve his medical issues by proxy. I would recommend making such a power of attorney for a long time and with the right of substitution. In the process of resolving medical issues, a person may understand that a sick person can manage on his own, then he needs to seek professional advice from a lawyer or lawyer. nine0003

“It is necessary to collect the entire package of medical documents”

What documents can be submitted if a person passed the draft board several years ago, but his health has deteriorated over this period of time?

First of all, you need an outpatient card, which is issued for each patient at the place of residence in his clinical unit. The second is an inpatient card. It is issued to the patient during the period of inpatient treatment. Suppose a person suffers from a severe form of hypertension and undergoes periodic inpatient treatment. The period of each inpatient treatment is noted in the card. It can and should be demanded. Where to submit the required application? Specifically, where these cards were issued. When submitting an application, it is recommended to indicate the period of inpatient treatment as accurately as possible, but if you cannot remember the dates, then at least you need to remember the year, try to indicate the most accurate dates. nine0003

Photo: Shutterstock

I've already come across an example: a man approached me who has a category "B" (limited eligibility), but more than 20 years have passed since he was assigned this category. When the summons came to him, he could not even remember exactly by what diagnosis this category of suitability was established for him. In general terms, he knew that he had a genetic disease associated with a bleeding disorder, but he could not remember exactly what this diagnosis sounded like, and in order to establish this, it is necessary to examine various medical records. nine0003

In this case, you need to refer to the order of the Ministry of Health of July 31, 2020 No. 789n "On approval of the procedure and terms for the provision of medical documents (their copies) and extracts from them." In addition, there is the Federal Law "On the Fundamentals of Protecting the Health of Citizens of the Russian Federation", Article 22 "Information on the state of health", which says that any citizen has the right to receive medical documentation and get acquainted with it. These are the main points. Further, it must be remembered that both types of cards are stored for 25 years

What to do after the documents are collected?

As soon as the package of documents is ready, it is already possible to write a competent application for passing the examination. This is just for the case if a person was called up, and he is in reserve. In the header of the application, it is necessary to write that the application is addressed to the military commissar, the specific military enlistment office, city, region, full name of the recruit. Next, you need to indicate where you are registered with the military, what disease you suffer from. Based on medical records, you can provide an up-to-date picture of your health status. Indicate what exactly confirms this disease, what documents are there that must be requested earlier. It could be such a general statement. nine0003

Photo: Kirill Braga / RIA Novosti

Next, you can start from the Decree of the Government of the Russian Federation of July 4, 2013 "On approval of the Regulations on the military medical examination. " There is a clause there that says that citizens called up for mobilization have the status of military personnel. According to this, citizens must be examined for fitness for military service. Further, the resolution states that a citizen in medical organizations undergoes diagnostic tests according to the list: fluorography, a general blood test, urine ... Mandatory tests of human biological fluids for narcotic and psychotropic drugs are carried out. nine0003

Referring to your documentation, you can indicate in the application that an additional examination is required by a neurologist, urologist or other specialist, depending on the disease

In the example I mentioned earlier, a man who suffers from a genetic it was necessary to consult a geneticist - only he could confirm his disease.

What laws still need to be guided by?

In general, this is the Government Decree of July 4, 2013 "On approval of the Regulations on the military medical examination." It should be at hand, it clearly spells out how the examination and examination of citizens should take place. For example, this resolution has a third section, it refers to the current situation. nine0003

Photo: Vitaliy Timkiv / RIA Novosti

How this will work in practice - no one will reveal this topic, because there is no judicial practice yet. So far, there is no practice of solving these issues directly by the military registration and enlistment office. We don't know how this will work and how the Government's decree of July 4, 2013 will work - whether it will fully apply to the category of those citizens who are now subject to mobilization.

But in order not to waste time, you can already demand all the documentation, draw up a power of attorney, and then any other person will be able to deal with this issue. It is important to show and prove that the disease has progressed or other diseases have appeared

If a person was called up for mobilization, I can hardly imagine that he will be able to solve these issues himself - that's why a power of attorney is needed. You need to solve them yourself, while you are not yet called.

As for specific diseases that fall under the categories of conscription, they can be found in the same Decree of July 4, 2013 in the section "Schedule of diseases".

What is included in the schedule of illnesses from the Government Decree of 07/04/2013 N 565 (as amended on 06/29/2022) "On approval of the Regulations on military medical expertise"? nine0005

1. Infectious and parasitic diseases

2. Neoplasms

3. Diseases of the blood, hematopoietic organs and certain disorders involving the immune mechanism

4. Diseases of the endocrine system, eating disorders and metabolic disorders

5. Mental disorders 9003

6. Diseases of the nervous system

7. Diseases of the eye and its accessory organs

8. Diseases of the ear and mastoid process

9. Diseases of the circulatory system

10. Diseases of the respiratory system

11. DISTRACTION DISEASES

12. Diseases of the skin and subcutaneous tissue

13. Diseases of the musculoskeletal system, connective tissue, system vasculitis

14. Diseases of the genitourinary system

15. Pregnancy , childbirth and the postpartum period

16. Consequences of injuries, poisoning and other influences of external factors

17. Other diseases

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