Munchausen Syndrome by Proxy Definition

Munchausen Syndrome by Proxy is a clinical event that is reported infrequently: A child is taken to
pediatric care with clinical symptoms of disease indicated or observed by an adult figure who is
responsible for providing care to them. It must be considered if the frequency of requests for
medical assistance from this adult figure (usually the mother of the infant) is higher than normal,
and there are no sustainable clinical reasons or a pattern.

What causes a mother (or less frequently, a father) to harm her son or daughter? These are
questions that we ask ourselves with some concern when we learn about cases related to
Munchausen Syndrome by proxy. Not only is it a pediatric phenomenon, there is a psychodynamic
factor that is activated during the very existence of this syndrome and that we can describe in a
didactic way.

Behavioral criteria

 Fictitious illness or health-related anomaly fabricated by one of the parents.

 The boy or girl is taken to the doctor for medical treatment very frequently.
 The parental figure that takes the child to medical treatment does not accept the diagnosis
provided by the specialists.
 The presence of other elements associated with abuse, abandonment or intentional death
of the infant.

What is the phenomenological description of this syndrome?

The presence of persistent or recurrent diseases in the child that can not be explained from the
medical - biological explanation, the medical diagnoses vary according to the general state of the
child's health and not according to the symptoms reported by the mother, also the symptoms and
signs observed by the specialists lead them to doubt their own knowledge since they can not identify
them with any known disease. The symptoms disappear when the mother is kept away from their
children and the medical treatments give poor results in the evolution of the case. The doctors
considers the organic symptomatology of the child as a disease strange and unusual and the clinical
syndrome found does not respond to the medical treatment provided. Commented [MP1]: Podrias por favor colocar esto en
parrafo contínuo, hilando la historia?
Parents Behaviour
The mother is pleasant, collaborative, grateful and in favor of good medical assistance (until it is Commented [MP2]: she is

informed of the technical diagnosis), intelligent and with extensive information on medical
treatments and diagnoses. The father is little integrated into the family, absent from home for Commented [MP3]: integration

prolonged periods, confirms the diagnoses reported by the mother although there is no evidence of
them.

One of the psychodynamic characteristics that can be observed clinically in the expression of the
behavior of these parents towards their "sick" children is the absence of healthy parental
attachments. Rather, the absence of the natural nexus that is exposed between father - mother -
infant is appreciated. There is no perception of emotional restraint but projection of discomfort of
the mother towards the affected child, seen as evicted objects, lost (or that can not be recovered),
loaded with persecutory fantasies (diseases), but that "obligatorily" you have to take care of them,
protect them from themselves since they are perceived in a destructive vision, as if they were death-
charged.

Mothers involved in this toxic dynamics have particular characteristics that allow them to be
identified beyond what is merely descriptive. Some of them seek medical attention for their children
as a way to project their own anxieties, burnout, depression or inability to take care of their sons or
daughters. Normally, they are an active part of a conflictive family context, where domestic
violence, and difficulty in relating to their partners. The presence of unwanted children are elements
rooted in their psychological and behavioral development. Usually, these mothers accept
psychotherapeutic help.

Other mothers related with the syndrome show an almost organic obsession in providing medical
treatment for nonexistent diseases in their children. They are able to construct false symptoms and
medical histories about them. Believing that their sons or daughters are really sick, denying medical Commented [MP4]: daughters

evidence that says otherwise, and performing their own treatments. They tend to show suspicion
towards the treatment given by the doctors, being antagonists and paranoid at clinical
environments. They tend to be distrustful and violent, conforming as a whole picture associated to
mental disorder, almost psychotic. These mothers can make others feel guilty by invoking love for
their children, family and professional conscience. They can exploit the moral feelings of others
(duty, generosity, courtesy, humanism) to meet their needs, questioning the competence,
personality, and quality of others, creating anguish and then remain as "champions" of the health
and well being of their children.

There is a typology of these mothers; they’re quite dangerous and they act as active inducers of
harm on their children. These mothers never feel responsible for anything. For them, others are
responsible for everything. Their behavior is dominated by cruelty, absence of guilt, generating in
their psyche a death wish on the child who is perceived and conceived as someone who deserves to
be hurt. They can get to procure death in the children.

This type of mother distorts, fabricates, and tells lies to hide (or discover) the truth. Lies (even by
omission) invoke the urgency to gain an advantage over others, achieve their objectives to the
detriment of others, and being able to get others to commit undesirable or criminal acts.

Many questions arise when we approach the psychodynamics of those who participate in
this syndrome. How was the relationship of these parents with their own parents? What
were their experiences during pregnancy? How is the psychodynamic of the victim of the
caregiver?

There is no evidence to suggest that the caregiver who suffers from Munchausen Syndrome by proxy
is unaware of their actions. It can be inferred that planning and organization involve even the
slightest attention and discretion, since attacks occur without the presence of witnesses, and the
web of lies expressed to the medical team suggest a conscious action. The action of the Munchausen
Syndrome by proxy is voluntary and also violent.

Many times the victim unconsciously assumes the position of the sick person as a way to obtain
positive maternal attention, a phenomenon that is associated with emotional and cognitive aspects
that allow recreating the son or daughter as another human being, but in the case that concerns us,
we know that sometimes this does not happen in the psyche of the mother. Knowing that the
psychological state of the mother influences the fetus, both at the neurobehavioral level and in the
alterations in development that manifest themselves in the postnatal period, we can assume that
some personality or mental alteration could significantly affect the mother-baby relationship.

The condition of victim can be adopted with some type of physical or psychological dependence in
such a way that the caregiver has the possibility of exaggerating or worsening the preexisting
symptoms or causing additional symptoms.
As we can see, it is a dynamic event between two or more, it is not unilateral. We must take into
account that the majority of victims of Munchausen Syndrome by proxy are infants and children
who start walking, so they're more affected because they cannot express orally and are physically
defenseless. Older children and teenagers victims of the Munchausen Syndrome by proxy, whose
abuse begins several years earlier, may adopt the fictitious symptoms and signs as their own,
suggesting that they may later develop Munchausen Syndrome or another type of personality
disorder.

How can we intervene effectively when we have detected the presence of Munchausen
Syndrome by proxy?

The most sensible thing is to protect the boy or girl victim of the caregiver, and the mother or father.
The responsible must address the case with a multidisciplinary team: social workers, psychologists, Commented [MP5]: The responsible must

doctors, nurses, and lawyers. A whole team that allows developing a comprehensive approach,
defining the intervention actions under clear indicators, and with an organized protocol.

The family must be evaluated but also needs support. After having confronted the family with the
diagnosis of Munchausen Syndrome by proxy, the mother, who is often the one who executes the
harmful actions, as well as the father, are in a research situation. The development of the child must
be evaluated, psychologically if their age allows to, as well as socially and physically.

A child victim of Munchausen Syndrome by proxy is at high risk of suffering harm. If the caregiver or
family member suspected of acting against the victim desisted abruptly from the attacks, it does not
ensure that the situation is over. The impulse to attack the child repeatedly, the ability to transform
the child's death impulse in the first place and then use it as a tool, reflects a problem with empathy
so deep that it completely obstructs the maternal capacity. They simply don't care about the extent
of the damage.

References
Burman D, Stevens D. Munchausen family. Lancet (1977)

Jennens, Roger. Munchausen Syndrome by Proxy: Implications for Professional Practice in Relation
to Children's Education. Journal: Child Care in Practice (2009)

Meadow R. Munchausen syndrome by proxy. The hinterland of child abuse. Lancet (1977)