What Is Munchausen Syndrome by Proxy?

Learn what this mental health condition is and how to spot it.

Munchausen syndrome by proxy is the condition where a caregiver lies about a child's health resulting in unnecessary medical attention for the child and attention for the caregiver. This term was coined in the 1970s and is typically a problem that mothers, above all other caregivers, are accused of. The fabrication of health issues does nothing beneficial for the child and only serves to satisfy the caregiver's need for attention. According to the Clevland Clinic, it is now called factitious disorder imposed on another (FDIA). Dr. Jayme Coffman, child abuse pediatrician at Cook's Children's Medical Center in Fort Worth, TX and one of the country's leading experts on this mental illness, shares information you should know. 

How Does FDIA Happen? 

It seems that the job of a caregiver is to care for his or her child. FDIA goes directly against this instinct and may in fact cause permanent health damage to children. So, how does a caregiver treat a child in this way? FDIA is a mental illness that stems from another disorder such as borderline personality disorder or narcissistic personality disorder — both of which exhibit a need for personal attention. In these rare cases, the person with FDIA gains their need for attention through their child being chronically ill. And, since their child wasn't chronically ill to begin with they need to alter the state of reality in order to fulfill their delusions. This results in their child being sick and them being seen as the hero caregiver. 

Is It Considered Abuse? 

FDIA is most definitely considered a form of abuse. A caregiver is knowingly causing harm to a child. Additionally, it is premeditated harm that can last for a child's entire life if it's not caught. 

What the Medical Community is Doing to Prevent It

The Clevland Clinic says it's estimated that "1,000 of the 2.5 million cases of child abuse reported annually are related to FDIA," but many cases go undetected. Cook's Children's Medical Center has been specifically cited as one of the best places in the country at spotting FDIA. The reason for this is the child welfare worker who is on staff in addition to a case management system to raise any red flags on patients. Dr. Coffman reviews these cases personally, which she says are roughly five to 10 a month. Out of those monthly cases about one a month gets to the level that it needs to be reported. While many doctors' offices and hospitals have systems and training in place to look out for abuse, Dr. Coffman admits FDIA can be very hard to spot because the caregiver comes off as the perfect, concerned parent. She says that they "are extremely manipulative, very good liars, and so catching them is really difficult because they manipulate not only doctors and medical staff, but family and friends as well." 

How to Spot FDIA 

The best chance of spotting FDIA and getting a child help is for family and friends to look out for symptoms and red flags. Look for symptoms that might only be around when the caregiver is present — for example, if the caregiver says the child can't eat and needs to be fed through a tube but the child asks for food when not in the caregiver's presence. This will be the biggest indicator that something isn't right. Additional warning signs could include hospitalizations with odd symptoms, more than one illness, or symptoms only being reported by the caregiver and not medical professionals. 

What to Do if You Suspect Abuse 

There are a couple things you can do if you suspect a caregiver is abusing his or her child. The first is to contact child welfare and report the abuse. The second is to contact the child's medical team to gain more information and report any suspicions. The best thing you can do is to speak up if you suspect anything so the right people can intervene. In the case of FDIA, "see something, say somthing," really is the best policy. 


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