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What Is Munchausen Syndrome By Proxy Disorder?

Munchausen syndrome by proxy (MSP), according to the National Institute of Health, is “a mental illness and a form of child abuse.”

teen who engages in risky behaviorsThis is a psychological disorder that is marked by attention-seeking behavior that is taken out on the people in the care of the individual. A caretaker of a child fabricates symptoms and/ or causes real symptoms to make the child in his or her care appear sick. Munchausen syndrome by proxy is listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), but is clinically referred to as Factitious Disorder Imposed on Another (FDIA). Although the adult with MSP is suffering from a mental illness, the way the illness affects his or her dependents results in child abuse. The constant seeking of medical care for a fictitious disorder that is imposed on a child can result in attention for the adult, while simultaneously causing severe physiological damage to the child. 

Risk Factors

The precise cause for why an individual develops Munchausen syndrome by proxy disorder remains unknown. Certain risk factors have been identified as increasing one’s susceptibility for developing MSP, which include the following:

  • Psychological risk factors
    • Personal history of child abuse
    • Personal history of sexual abuse
    • Personal history of physical abuse
    • Personal history of emotional abuse
  • Biological risk factors
    • Family history of mental health disorders
    • Serious illness
  • Environmental factors
    • Growing up in a family where illness was the primary way to receive love and attention
    • Stress 

It is of course, not a forgone conclusion that an adult that has any combination of the above risk factors will go on to develop Munchausen syndrome by proxy. Studies have shown that is it most commonly seen in mothers of children under the age of six. MSP can, however, affect anyone.

Warning Signs

There are distinct warning signs that may present in the child as well as the caretaker when it comes to Munchausen syndrome by proxy disorder. Certain MSP warning signs that may be exhibited by the caretaker can include any combination of the following, as provided by the Mayo Clinic:

  • Will not leave the child’s side
  • Constantly speaks on behalf of the child
  • Consistently exaggerates his or her child’s symptoms
  • History of being in and out of hospitals

Warning signs that a child may exhibit include the following examples:

  • Nausea
  • Vomiting
  • Inability to gain weight
  • Diarrhea
  • Failure to thrive
  • Infections
  • Allergic reactions
  • Breathing difficulty
  • Seizures
  • Fevers 

A child that is in a MSP dynamic will likely have a history of frequently being in and out of hospitals. The symptoms a child may have will not necessarily match those belonging to any single disease. It is also highly common for the symptoms to worsen when the child is alone with the caregiver. 

Diagnosis Challenges

When there is a sick child involved, it is highly common for a medical professional to initially overlook the possibility of MSP. In situations where a child is repeatedly brought in for medical treatment for unexplainable illness and/ or injuries, a physician may begin to suspect child abuse. In these cases, it is a doctor’s responsibility to protect the child and report the suspicion to authorities. An adult struggling with Munchausen syndrome by proxy disorder is blindingly selfish, as he or she has a deep-seated need for attention, regardless of the pain they inflict on helpless children. The adult must admit to abuse and agree to psychiatric treatment in order to be diagnosed with MSP. 


In order to properly treat Munchausen syndrome by proxy disorder, the adult as well as the child must undergo treatment. The safety of the child is paramount, and he or she will likely be removed from the custody of his or her abuser. While under the care of the medical professional, the child involved will be treated for any existing illness, injury, and/ or emotional trauma. It is also recommended for the child to continue treatment with psychological counseling. The caretaker may face criminal charges, and will require significant, long-term treatment and psychiatric counseling for MSP. 

For Information and Support 

Seeking help is never easy, but you are not alone! If you or someone you know is in need of mental health treatment, we strongly encourage you to reach out for help as quickly as possible. It is not uncommon for many mental health difficulties to impact a person for the long term. The earlier you seek support, the sooner you and your loved ones can return to happy, healthy and fulfilling lives.

Our admissions team is available to answer any general questions regarding mental health issues, treatment, and/or specific questions about the program at Pacific Teen Treatment and how we might be able to help your family. 

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