In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is factitious disorder imposed on another, also known as Munchausen syndrome by proxy.
While Munchausen by proxy is likely the name that’s most recognizable, the name for the disorder in the current version of the Diagnostic and Statistical Manual of Mental Disorders (the DSM-5) is factitious disorder imposed on another. I’ll use the acronym FDIA for the rest of the post since it’s so much shorter.
So, who is Munchausen and what is their disorder? Baron Munchausen is a fictional character from the 18th-century German novel Baron Munchausen’s Narrative of his Marvellous Travels and Campaigns in Russia. Baron Munchausen told wildly exaggerated tales of things that had happened to him. In 1951, Dr. Richard Asher coined the term Munchausen’s Syndrome to describe patients who presented with fabricated accounts and symptoms of illness.
Factitious Disorder Imposed on Another
Munchausen by proxy/FDIA involves an individual feigning illness in another person (most often a child) that they are caring for. Elderly parents of adult children may also be targets of FDIA. This is not done in a way that would provide any clear tangible benefit (e.g. monetary reward); rather, the main purpose appears to be garnering attention and sympathy.
This feigning of illness can include lying, contaminating samples for lab tests, and actively causing harm through measures like poisoning, suffocation, and starvation. The measures that the person with FDIA takes can be lethal, and the mortality rate among victims may be as high as 10%.
The University of Michigan identifies a number of characteristics typical of someone with FDIA:
- most commonly a mother
- has prior medical skills or experience
- seems very devoted to the child (or other victim)
- seeks out sympathy and attention
- makes excessive attempts to become close with health care providers
- needs power and control
- doesn’t believe their behaviour is harmful
Risk factors for developing FDIA include pregnancy complications, a history of childhood abuse, and factitious disorder imposed on self (also known as Munchausen syndrome).
Recognizing warning signs
Medscape lists several potential warning signs of FDIA, including:
- unexplained illnesses that are persistent or recurring
- a mismatch between the reported symptoms and what’s clinically observed
- there are signs and symptoms that only occur when the parent is present
- the parent is highly attentive and always present when the child is receiving care
- the child is often unable to tolerate forms of treatment that are tried
When apparent illnesses can’t be explained, this may lead to extensive testing and risky procedures being performed in an attempt to determine what the underlying medical condition might be. This only ends up reinforcing the pattern of the person with FDIA.
Diagnosing the disorder involves some careful investigative work. This may involve removing the child from the mother’s care, or using video surveillance. An article on Medscape states that “if a multidisciplinary team agrees on the procedure, hidden cameras can be used to record the interactions of the child and the suspected perpetrator in the hospital setting.” While this is something that would usually be considered a breach of privacy, it may be the only way to definitely establish the presence of FDIA.
FDIA is rare, involving only about 2 in 100,000 children as targets. A literature review by Feldman and Brown found articles from 24 different countries describing cases of FDIA, including non-Western nations. In the 122 cases described, the mother was the sole perpetrator 86% of the time. There were slightly more male than female victims. The presentation of the disorder was very similar worldwide.
Legal issues
Legal precedents have been established in the UK and Australia that FDIA is a description of behaviours rather than a psychiatric illness. As a result, testimony from psychiatrists is inadmissible in court unless it refers specifically to harm done to the child.
The legal precedents raise an interesting question. Is this a twisted behavioural pattern, or is it an illness? I think I’d tend to have more sympathy when it comes to factitious disorder imposed on self (i.e. Munchausen syndrome) than FDIA (Munchausen by proxy), and I’d be more willing to accept that as an illness. It’s hard to have sympathy, though, when it comes to harming a child. It’s understandable that sometimes parents who are in a psychotic or severe mood episode can harm their children without being able to appreciate the nature of what they are doing as a result of their illness, but there’s something very distasteful about a parent harming their child for the sake of attention. I think at that point it would shift from being a question of illness to a matter of child abuse, albeit with a clearly distorted way of thinking.
What are your thoughts on the validity of FDIA/Munchausen syndrome by proxy?
References
- Cleveland Clinic. (n.d.). Factitious disorder imposed on another.
- Feldman, M. D., & Brown, R. M. (2002). Munchausen by proxy in an international context. Child Abuse & Neglect, 26(5), 509-524.
- Feldman, M.D. (2020). Factitious disorder imposed on another (Munchausen by proxy). Medscape.
- Healthwise Staff. (2020). Munchausen syndrome by proxy. University of Michigan Medicine.
- Wikipedia: Factitious Disorder Imposed on Another
The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
This has been a very interesting subject for me since the story about Gypsy Rose Blanchard killing her mother came out. They did a Hulu tv show about it and it was very interesting. You could really see and understand Gypsy’s struggle between wanting to be a “normal” person and obeying her mother.
It was upsetting to read/watch how badly Gypsy’s mom treated her.
I hadn’t heard about it. That sounds awful.
It’s a really crazy story! Below is a link to the story ABC did on Gypsy’s story. If you have 40 minutes to watch it, it’s very good.
https://abc.go.com/shows/2020/episode-guide/2018-01/05-010518-the-story-of-gypsy-blanchard
Cool, thanks!
I think it’s a combination of two elements. Mental illness and child abuse. Once in a while it will come out in the news about a child that was abused by their parental unit, but 8 times out of 10, the circumstances lead to the death of the child that was abused.
I also think in a way it’s genetic and environmental causes that lead to someone to cause such horrors.
This is one of the reasons why I can’t watch the news that often. I hear something like this, and my heart breaks for the innocence of a child.
Absolutely. And I think that combination of factors sounds spot on.
Thank you. 😌
It is an interesting and absolutely horrific at the same time. While I can appreciate that a person doing such harm to their child must have had really difficult experiences herself that made her mind so broken and can’t be thinking straight, I also tend to have more sympathy for those who have factitious disorder imposed on self. It’s also more comprehensible for me than seeking attention in such a roundabout way, through harming one’s child, especially that it is the child that gets most of the attention from the professionals anyway, with all the procedures and tests, and not the mother directly, which makes it feel even more twisted and sick.
Exactly.
I’m interested in knowing what happens to the abusers after the child/person is gone. Do they go to jail? Do their symptoms “disappear”? Do they seek out another victim?
I wonder, too, if this can be treated with psych meds if it is, indeed, an illness? Very interesting post!
Very good questions. From what I know they don’t seek out random victims; it’s somebody that they’re already providing care for. Psychotherapy is the treatment of choice.
That makes sense.
This is an absolutely superb post Ashley – you may have read in some of my own writing, that my mother was diagnosed when we returned to England from Australia with Munchausen and sadly l was her victim.
As an adult whilst l am slightly better’ with hospitals now, but as a child till the age of 13/14 my mother subjected me to constant hospitals in Australia uncder the guise of l was dreadfully ill. Back in the 60’s and 70’s doctors then believed everything that parents told them of their children.
I am close to my mother, but after suffering at her hands for year, we are not as close these days. She always did it for attention and wanted attention whenever she get it. My father was short on offering her that attention so she decided to use me as her guinea pig. I still have nightmares remembering some of the proceedures l had to undergo to verify to my mother l wasn’t ill.
Of course if there was one significant thing about me is the one thing that would not be diagnosed for another 30 odd years and that is the one thing she never ever made mention to doctors – she never said her son was weird just that he suffered from this and that. I actually remember with a 100% clarity one of the days l actually hated my mother. When l was receiving a lumbar ouncture that wasn’t needed because the doctors were apparently seeking out meningitis. I had to also endure a hand up my rectum, l recall screaming there was NOTHING wrong with me, but at ten l was not to be believed.
This is a nasty nasty thing . When l left home and prior my mother was a hypochondriac and still is this to this day. Obviously she is in her mid to later 70’s now, but she is always ill, despite the doctors informing her she is a very healthy dying woman.
Quality post Ashley.
What a truly horrible thing to have to go through.
Yep – it was.
In my mind it’s abuse, period. Unless there’s a psychotic break and the person has no idea what they’re doing. Of course, then it wouldn’t be FDIA, it would be whatever illness that caused the break.
I agree
I find this diagnosis really interesting! I think its definitely very real and I am not sure its that rare!
Yes I would imagine that a lot of times the diagnosis gets missed.
I knew someone whom I suspected had Munchausen’s. She needed a lot of attention, even getting upset if people didn’t reply to her within 5 minutes, She was always bragging about going to doctors and even about her and her mother bribing doctors with gifts so she could get medical leave she didn’t need. She really really wanted a schizophrenia diagnosis since she apparently “only” had depression and was always trying to undergo diagnostic procedures. She talked very fondly of the times she was ill enough to be in the local psych hospital because the nurses, doctors, and others in her life gave her a lot of sympathy and attention.
Oh that’s unfortunate.