Munchausen Syndrome by Proxy

Today is an exciting (and also gruesome) day! I have banded together with the awesome Dr. Lydia Kang and the equally awesome Dr. Laura Diamond to discuss a really fascinating and (I strongly suspect) misunderstood ailment.

Lydia's post is about the medical aspects of Munchausen Syndrome and Laura's post is about the more psychological aspects. You might want to go read their posts to get a little background on this disorder. As for me: hey! I'm a child psychologist, so I am going to tell you all about Munchausen Syndrome by Proxy (MSP).

The basics: A caregiver (often a mother, but it could be a father) either feigns or induces symptoms in the person (often a young child, though it could also be an elderly parent) under her care. The caregiver does this for purely psychological reasons (e.g., not for financial gain).

MSP, which is considered very rare (like, 1 in 50,000), is not a formal disorder listed in the DSM IV, so it would be diagnosed as Factitious Disorder, Not Otherwise Specified (NOS). Factitious Disorder is a mental illness wherein the person feigns either physical OR psychological symptoms with the focus on assuming the "sick role" (not for external reasons like avoiding legal responsibility). MSP is usually considered a form of child abuse.

In MSP, we have a parent making a kid sick, solely for the purposes of gaining sympathy. They appear devoted, dedicated, tireless. They also tend to be really knowledgeable about the kid's symptoms and medical condition and very interested in having positive relationships with the medical professionals caring for the child. Warning signs include:

• Multiple hospitalizations of the child. If the symptoms go away in the hospital, they usually come back when the kid goes home.
• The parent reports the symptoms are getting worse (even when they aren't)
• Reported symptoms don't match the lab tests
• Some evidence of fakery in lab tests (the blood/urine isn't the child's)
• Some evidence of weird chemicals in the lab tests
• Siblings who have died under mysterious medical circumstances
• The parent may have very similar symptoms, or a history of them

Examples:

• Administration of excessive laxatives (or poison) to produce severe diarrhea, vomiting, or other symptoms
• A mysterious skin condition produced by rubbing caustic substances on the child's skin

On a personal note, here's a pet peeve of mine: when professionals toss this label around casually. I find it really upsetting. Because as soon as a professional decides a parent is MSP, it's a recipe for nastiness. I'm not saying that parents don't sometimes contribute to children's conditions, but deciding it's happening with deliberate intention is a different thing entirely.

It's not that MSP doesn't exist, because it does. And it's not like we don't need to pay attention to the psychological processes that are active for a parent caring for a symptomatic child, because we do. But I get concerned when something this big and scary gets raised without very careful consideration of 1) all the other possible explanations for the parent's behavior and the child's symptoms, and 2) a great deal of knowledge about what MSP actually is (and is not--for example, I've heard professionals accuse a mom of MSP because she was desperate to get her kid on disability. That's financial gain, folks, which immediately eliminates MSP).

Parents of kids with rare medical disorders sometimes get accused of MSP, and it makes things so much worse. So. Just a note of caution. There's a lot of controversy about this disorder. For some solid, more detailed general information about MSP, go here.

What do you think of MSP? Horrifying, no? Somehow, I think it's even worse than Munchausen Syndrome, because with MSP, the person is inflicting symptoms on another, more vulnerable person. Now--if you haven't yet, go read Laura's and Lydia's posts!