Understanding MSBP for what it is: Abuse

Munchausen Syndrome

Recent TV show The Act highlights Gypsy Rose Blanchard, the falsely ill daughter of Dee Dee Blanchard, and magnifies the incredibly fascinating Munchausen syndrome by proxy. We decided we wanted to learn more. What really is this disorder? Yazhini Srivathsal, MD, psychiatrist at Banner Behavioral Health, is here to help answer all of our questions.

What is Munchausen syndrome by proxy?

What used to be called Munchausen syndrome by proxy is now called factitious disorder imposed on another. Factitious disorders are disorders in which an individual creates fake symptoms, either on themselves or another, and attempts to deceive medical providers with these fake symptoms. Munchausen syndrome by proxy or factitious disorder imposed on another is when someone (a perpetrator) produces symptoms voluntarily in another person (victim), with attempts to deceive the medical providers. The victim is made to assume the sick role, while the perpetrator acts as the caregiver. In factitious disorder imposed on another, the perpetrator does not have a clear secondary gain, like monetary or legal benefits, and instead is likely suffering from mental illness.

The most common perpetrator is a biological parent, usually the mother. The most common victims are children, usually younger than 4, with equal percentages of males and females. Other common victims include the elderly, people who are dependent on others for their medical care, people with disabilities and sometimes pets.

The perpetrator goes to the extent of fabricating stories about the victim’s medical history, changing details on the medical records, contaminating lab samples or doing acts that can directly injure the victim, such as injecting them with stool or physically hurting them.

Usually the perpetrators have some medical knowledge either due to their education/training or have a history of a similar illness themselves. With their knowledge, they can present a very convincing story, which can make us wonder if they are making these details up consciously, or if they actually believe that it is true. They seem to be so invested in taking care of the sick victims, that it is hard for them to focus on other activities, like other relationships, or even maintaining a job.

What causes factitious disorder imposed on another?

The cause of this disorder is unknown, but studies have shown that the perpetrators might have undergone abuse in their childhood. The perpetrators may have other mental illnesses present along with this disorder.

Can this disorder be treated?

This can be a challenge to both diagnose and treat. Diagnosis is very difficult unless someone directly witnesses the perpetrator hurting the victim. If diagnosed, the first thing to do is to protect the victim. Confronting the perpetrator might not be helpful, and the focus should be placed on management rather than cure. Therapy can be helpful, but this can be difficult too, since many perpetrators deny any ill-will or misdeed on their part.

How common is this disorder?

It is extremely rare. But, it is difficult to know how common this is as it is difficult to diagnose. It is not hereditary, as far as we know.

Can you have factitious disorder imposed on yourself? If not, what is that called?

Yes, and that is called factitious disorder imposed on self, previously called Munchausen syndrome. This is where the person assumes the sick role when they are really not sick, produces medical or psychological symptoms voluntarily, with attempts to deceive the medical providers, and do not have any secondary gains like monetary or legal benefits.

Factitious disorder imposed on another is abuse. If you suspect that someone has fallen victim to this, do not to confront the caregiver. Instead, speak with your local welfare agency or visit childhelp.org/hotline or napsa-now.org/get-help/help-in-your-area.

Blog written by: Yazhini Srivathsal, MD, psychiatrist at Banner Behavioral Health Hospital.

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