Too Much In Common

A Web of Deceit

The term "Munchausen syndrome by proxy" (MBP) was coined around twenty years ago, and hundreds of reports have appeared since then. In most cases, a mother either claims that her child is sick, or she goes even further to actually make the child sick. This "devoted" parent then continually presents the child for medical treatment, all the while denying any knowledge of the origin of the problem--namely, herself. As a result, MBP victims may undergo extraordinary numbers of lab tests, medication trials, and even surgical procedures that aren't really needed. For example, by the age of eight, Jennifer Bush had had more than 40 operations, including the removal of much of her intestines. Other children have scarcely experienced a day of their young lives without being brought to the doctor's office or confined to the hospital. In the vast majority of cases, the perpetrator is the mother and the victim an infant or toddler.

The web of deceit the caregiver spins can be buttressed by medical signs and symptoms that mislead the most skillful of physicians. Their acting skills can match those of a veteran performer. For instance, the MBP perpetrator might induce "apnea" (a cessation of breathing) by suffocating her child to the point of unconsciousness, then frantically display the limp child to the hospital or clinic staff as the tears roll down her cheeks. She may secretly place a drop of blood in the child's urine specimen, then appear aghast at lab results that alarm the unsuspecting physicians and nurses. Behind closed doors, she may scrub the child's skin with oven cleaner to cause a baffling blistering rash that lasts for months. Since it may take many years of illness for doctors finally to arrive at the truth, it should not be surprising that this form of child abuse has a mortality rate of nine to ten percent.

Struggling to Understand

Why would anyone do such a thing? That question haunts everyone who encounters MBP, since few other behaviors so sharply challenge our concept of what "motherhood" is supposed to be all about. Typically, it seems, the MBP parent is on a misguided mission to feel "special," to garner attention from people--family, friends, and community--as the heroic caretaker of a tragically ill child. Other perpetrators crave a perverse relationship with doctors in which they simultaneously engage and defeat them through their carefully-crafted deceptions. And virtually all have personality disorders that lead them to behave in odd and even destructive ways, especially when they feel under stress.

Protecting the Defenseless

When MBP is suspected, health care providers are required by law in all fifty states to report their concerns. Since MBP can be a deadly form of abuse, law enforcement will usually step in to investigate while social service agencies focus on the highest priority of all: ensuring continued protection of the child. Though the media frenzy surround the startling cases of Kathleen Bush and Yvonne Eldridge has already faded away, the rest of us bear the responsibility of continuing to educate ourselves and others about MBP. Each of us will need to carry the banner for the appropriate recognition of this perplexing phenomenon and, in so doing, help to protect those who are too young to protect themselves.

About the Author:

Marc D. Feldman, M.D. is the author of "Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder" (2004) and co-author of "Stranger Than Fiction: When Our Minds Betray Us" (1998).

Originally published 5/28/98

Revised 12/12/08 by Dr. Feldman

Marc D. Feldman, M.D. is the co-author of "Patient or Pretender: Inside the Strange World of Factitious Disorders" (1994) and co-editor of "The Spectrum of Factitious Disorders" (1996).