While most people consider their and their family member’s health a precious gift and want to preserve it at all costs, there are also those who do the exact opposite. They make their children deliberately ill and they get satisfaction from the dependency situation.
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Overview and Introduction

The first cases of Munchausen syndrome by proxy were reported in the late 1970’s. In 1977 the British pediatrician and scientist Roy Meadow described two cases of mothers, who suffered from it. One of them poisoned her baby with salt until it died at the age of fifteen months; the other mixed her urine with that of her child in order to obtain false test results and to force a further diagnosis.

In contrast to the previously described Munchausen syndrome in which those affected feign symptoms to themselves, here, a second person assumes this role. “By proxy” means as much as “deputy”, which is why the disorder can also be called „Munchhausen Syndrome Deputy“. However, the term is to be used with caution, since the victims almost always have a passive role and the disorder does not have to do with them.

The forms of abuse are manifold and ingenious. Some mothers break their children’s bones, other feed them with poisonous food or medicines, or press their faces into the pillow so that respiratory arrest occurs. They infect wounds intentionally with dirt or inject fluids, causing eruptions and edemas.

Signs and Symptoms of Munchausen Syndrome by Proxy

Caring mother of others and a violent monster at home — these are the two faces of the women affected. Often the mothers quickly get in touch with doctors and nurses and they care about their recovery. They sacrifice themselves, they are constantly in the hospital and they are strongly involved in the treatment process. In doing so, they enjoy something that they painfully miss in their remaining lives — attention.

This is also the main reason of the affected mothers for inflicting such suffering on their children. They usually live separate from the child’s father and they are socially isolated. It is difficult for them to establish stable relationships with other people and to get the necessary confirmation there. This can be seen as a secondary gain.

Often, the perpetrators have medical knowledge, so about one-third of those affected work in the medical field. This combination of the strong need for attention and the necessary knowledge is the dangerous basis for the disorder, which, according to the World Health Organization, counts as one of the artificial disorders. Often, the perpetrators have already experienced abuse in the past or have been very often in the hospital.

Most important is certainly to sensitize people to the syndrome, so that the social environment may also be alerted to the abuse. There are certain signs that suggest a Munchausen syndrome by proxy:

  • Unstable medical history, which is told differently by different care receivers
  • Symptoms that occur only in the presence of a parent
  • The health status improves in the absence of the mother
  • Parents react calmly to the severity of the disease
  • Parents are perfectly informed about the disorder
  • Parents observe the staff and they are often above average present
  • Parents have a history of abuse or an eating disorder

Types of Mothers with Munchausen Syndrome by Proxy

There are three types that distinguish between the characters who use this form of abuse (Libow and Schreier, 1986):  Help Seekers, Doctor Addicts, and Active Inducers.

The Help Seekers are often anxious-depressive personality types that flee from a violent situation or excessive demands. If they receive help, they usually refrain from abuse, as they are primarily concerned with receiving care and attention.

The Doctor Addicts go usually with their older children from one doctor to another. They invent symptoms and break off treatments frequently, especially psychiatric measures.

The active perpetrators provoke symptoms to their child and then fight against treatments.

Epidemiology of Munchausen Syndrome by Proxy

Since it is a rare disease, there are also few studies on this. In an elaborate study, the professor of Psychiatry from Würzburg Martin Krupinski and his team interviewed 379 clinics in Germany.

About half of the clinics participated and they came to the following conclusion: during the observation period of 11 years 190 cases were documented, which were suspected of the Munchhausen syndrome by proxy; half of these cases were even verified.

The number of unreported cases is probably high, which has many reasons. On the one hand, the mothers always choose quite nonspecific symptoms, which can match with many diseases and complicate the diagnosis. Since they are often extraordinarily well-versed in the medical field or work in this sector, the story is often plausible and difficult to check. Through the free doctor’s choice in Germany, the treatment can be interrupted, as soon as the perpetrator suspects that she will get caught.

On the other hand, there is uncertainty on the part of the medical staff in the diagnosis. There are fluent symptoms to other mental disorders such as somatoform und hypochondriacal disorders. Often it is accepted also a not yet recognized or atypical symptom.

Management of Munchausen Syndrome by Proxy

If there is a suspicion of the presence of Munchausen syndrome, a careful procedure is required. Without a trusting relationship, it becomes very difficult to persuade the mother to a treatment and not to scare her, so that ultimately no interventions are possible because she changes the doctor or even moves out. On the other hand, the damage to the child must also be prevented. This is a dangerous tightrope walk.

The most secure proof is probably the video recording, on which the perpetrators are caught. This idea was put through almost 20 years ago by the Londoner pediatrician Christian Poets and proved to some mothers.

While the topic of surveillance cameras in hospitals in the USA and the UK is now being fairly liberal, Germany is still reluctant to implement it. In any case, it was necessary to install information signs in the corridor, in order not to violate the personality rights, and the perpetrators would already be warned.

Ultimate intervention must be done in close consultation with authorities, ranging from psychiatric care, temporary separation of perpetrators and victims, to the restriction of the right to custody of the child.

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