Munchausen Syndrome by Proxy

Munchausen syndrome by proxy is a mental disorder, as well as a form of abuse that tends to be directed at children.
Munchausen Syndrome by Proxy
Laura Ruiz Mitjana

Written and verified by la psicóloga Laura Ruiz Mitjana.

Last update: 27 May, 2023

Have you ever heard of Munchausen syndrome by proxy? It’s a disorder that affects a person who invents or causes symptoms to another person (generally a mother to her child or a child to their elderly parent). Therefore, in turn, it’s a form of abuse on a psychological and physical level.

In this regard, the statistics in Spain in 2002 found that there were a total of 11,148 minor victims of abuse in the family environment. The composition of these victims was as follows:

  • 86.37% suffered negligence
  • 35.38% suffered psychological abuse
  • 19.91% suffered physical abuse
  • 3.55% suffered sexual abuse

The data is alarming. Today we’ll focus on this type of abuse that often remains hidden and we’ll answer the following: What symptoms does this mental illness entail? Can it be prevented? How should the consequences be dealt with?

Munchausen syndrome by proxy: What is it?

Munchausen syndrome by proxy (MPS) is a mental disorder as well as a type of child abuse. It consists of the fact that the child’s caregiver (frequently the mother) invents a series of false symptoms of the child or produces them to make it appear that the child is sick.

We must differentiate here the Munchausen syndrome from Munchausen syndrome by proxy. In the first case, the person causes the symptoms to themself or invents and simulates them.

Factitious disorders or malingering

Munchausen syndrome by proxy is referred to in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a factitious disorder applied to another. In factitious disorders, the main characteristic is that the person consciously and deliberately acts as if they have a physical or mental illness, when in fact they don’t.

In factitious disorders, no benefit is perceived nor is it sought to take advantage of the condition of illness to manipulate another individual or obtain a benefit, as occurs in malingering. Therefore, in the simulation, also cataloged in the DSM-5, a series of disproportionate or false symptoms motivated by external incentives are intentionally produced.

Child suffers child abuse.
Child abuse takes several variants and one of them is this syndrome.

The symptoms of Munchausen syndrome by proxy

The symptoms of Munchausen syndrome by proxy involve the invention or simulation of a series of symptoms in another person, usually a child. Whoever suffers from it can also cause the symptoms in the victim and take extreme actions to fake the symptoms of a certain disease in the child. Some examples of this would be the following:

  • Inventing false laboratory test results
  • Heating a thermometer to make it look like the child has a fever
  • Giving the child medicine to cause certain symptoms, such as vomiting or diarrhea
  • Adding blood to urine or stool
  • Withholding food or liquids to make it appear that the child is unable to gain weight or is dehydrated

As we can see, these are extreme and very serious actions that could make the child truly sick. It’s a complex disorder and very dangerous for the health of the victim.

What are caregivers with this syndrome like?

What can we observe in the child’s caregiver? That is, in the person who suffers from the syndrome. What are these people usually like?

  • In most cases, we’re talking about mothers with small children. In others, adult children caring for an elderly father or mother.
  • Often, the person works in healthcare and knows a lot about health or about certain diseases and how to fake them.
  • The person describes the symptoms in great detail and likes to be involved with your child’s care team.
  • They’re people who are highly appreciated by the medical team for the (false) involvement they show toward the care of their child, which makes it difficult to diagnose the syndrome.
  • They report the child’s symptoms, but healthcare professionals rarely see them. The caretaker argues that the signs have disappeared, but that they reappear at home.

What are victims like?

Some of the characteristics of the victims are the following:

  • They visit many healthcare providers accompanied by their caregiver.
  • They’re children who’ve been in the hospital for a long time.
  • They’ve been subjected to tests, examinations, surgeries, and various interventions.
  • They manifest strange symptoms that don’t always fit with any disease. In addition, the signs almost never agree with the test results.
  • Various chemicals or drugs appear in the urine, blood, or feces.
  • They come and go to the hospital, depending on the caregiver’s demands and tricks.


The exact cause of Munchausen syndrome by proxy is unknown, although sometimes the person with it was sexually abused or abused as a child. Another possible cause is that the abuser has or has had Munchausen syndrome, which implies that the symptoms are also caused.

On the other hand, they’re people with significant emotional difficulties. They may also suffer from underlying psychological illness, such as a personality disorder that explains the appearance of the syndrome. They seek at all costs to have the role of caretaker and to be indispensable to the other.

In the case of Munchausen syndrome (not by proxy) we find a study by Gelenberg from 1977 (cited in Zubeldia et al., 2003) that describes a 24-year-old patient with a series of emotional symptoms and that they interpret as the expression of a need to maintain the role of victim that allows them to achieve a sense of control over the environment.

A child in a hospital bed holding their caregiver's hand.
Repetitive hospitalizations are recorded in the history of the victims of this abuse.

Munchausen syndrome treatment by proxy

What actions can be taken when a case of Munchausen syndrome by proxy is detected? The first thing of all will be to notify social services and report to the relevant authorities.

It’s important that the child be removed from the caregiver as soon as possible to prevent further harm from being caused. Both the victim and the carrier of the syndrome must be tended to, as the latter will need psychiatric and psychological monitoring.

At the same time, the child may need medical attention to treat the complications derived from the simulation of symptoms, not to mention possible mental problems derived from such a situation (for example, the appearance of a post-traumatic stress disorder or important alterations in their self-esteem).

They’re children who may have injuries, infections, or have taken medicines that they didn’t need. Each case must be assessed specifically and a complete medical study carried out to determine their current state and the possible damage suffered.

The duty to pay attention

Munchausen syndrome by proxy is a serious disorder and a form of child abuse. For this reason, prevention will be essential here, as well as being able to be vigilant and observe any abnormal behavior in the children’s caregivers, especially those who frequently visit the hospital.

The detection of the syndrome in a parent-child or child-parent relationship can prevent the continued abuse suffered by the victim and all the physical and emotional consequences that this may entail. In addition, subjecting a person to examinations, tests, and the injection of drugs that they don’t need is a path to physical and mental complications.

  • American Psychiatric Association -APA- (2014). DSM-5. Manual diagnóstico y estadístico de los trastornos mentales. Madrid. Panamericana.
  • Pellitero Maraña, Ariana, Mª Alonso Álvarez, and Lucía González-Carloman González. “Síndrome de Munchausen por poderes: dificultades diagnósticas y terapéuticas.” Pediatría Atención Primaria 20.80 (2018): 105-108.
  • American Psychiatric Association -APA- (2000). DSM-IV-TR. Diagnostic and statistical manual of mental disorders (4thEdition Reviewed). Washington, DC: Author.
  • Gelenberg, A.J. (1977). Munchausen’syndrome with a psychiatric presentation. Diseases of the Nervous System. 38 (5): 378-380.
  • Zubeldia et al. (2003). Síndrome de Munchausen por poderes con sintomatología psíquica. Ilustración de un caso clínico. Clínica y Salud, 14(1): 101-113.
  • Seguí, Sara Salort, and María Irigoyen Otiñano. “Cuando diagnosticamos al cuidador. Síndrome de Munchausen por poderes.” Psicosomática y psiquiatría 3 (2017): 30-36.

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