Judith A. Libow

Munchausen by proxy victims in adulthood: A first look

Very little is known about the long-term impact of Munchausen by Proxy abuse on children, as many victims probably are never identified and most have been lost to follow-up soon after termination of protective services supervision. This exploratory study examined the childhood experiences and long-term psychological outcomes for 10 adults, ranging from 33 to 71 years of age, who were self-identified victims of illness fabrication by a parent. Subjects completed a 33-item questionnaire including demographic and open-ended questions and a checklist of PTSD symptoms, supplemented by telephone interviews. Subjects described a range of experiences from poisonings and induced bone fractures to symptom exaggeration. Subjects generally felt unloved and unsafe in childhood; a few were directly aware of their parents deceptions. They made limited attempts to alert others, with little success. Subjects reported significant emotional and physical problems in childhood, and problems in adulthood including insecurity, reality-testing issues, avoidance of medical treatment and posttraumatic stress symptoms. Most of their siblings were also abused, physically or medically. Some subjects express considerable residual anger towards the abusing mothers, but a surprising degree of sympathy for the fathers who passively colluded or failed to protect. Some of the MBPS parents have continued fabricating their own medical illnesses or harassing their adult children with fabricated dramas even decades later.

Position Paper: Definitional Issues in Munchausen by Proxy

In 1996, a multidisciplinary task force of experts was created to develop working definitions for the constellation of behaviors currently described as Munchausen by proxy (MBP). The aim of the task force was to develop a synthesis of the most current thinking in pediatrics, psychiatry, psychology, child protection, and law and to articulate the current consensus among professionals to facilitate the identification and treatment of this complex clinical problem. The term Munchausen by proxy was first used by Roy Meadow (1977), a British pediatrician, to describe illness-producing behavior reminiscent of adult Munchausen syndrome but using the child as a proxy. Adult Munchausen syndrome, described in 1951 by Asher, is a psychiatric disorder in which an adult intentionally induces or feigns symptoms of physical or psychiatric illness to assume the sick role. MBP was initially described as “the intentional production or feigning of physical or psychological signs or symptoms in another person who is under the individual’s care for the purpose of indirectly assuming the sick role” (American Psychiatric Association, 1994, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. [DSM-IV], p. 475). The fact that Munchausen syndrome and MBP share the same name has resulted in considerable confusion. Although once thought to be quite rare, most experts now believe that MBP is fairly common. Using the results of a careful but conservative British study (McClure, Davis, Meadow, & Sibert, 1996), we estimate that a minimum of 600 new cases of just two forms of MBP (suffocation and nonaccidental poisoning) will present in the United States each year. Given the wide spectrum of pediatric conditions that have been known to be feigned, the problem is far from trivial. Furthermore, experts now agree that MBP

Further Thoughts on “Beyond Munchausen by Proxy: Identification and Treatment of Child Abuse in a Medical Setting”

To the Editor .— This letter is in response to an article by Dr Stirling and the American Academy of Pediatrics Committee on Child Abuse and Neglect titled “Beyond Munchausen Syndrome by Proxy: Identification and Treatment of Child Abuse in a Medical Setting.”1 We were pleased to see the article published to remind pediatricians of this unusual but potentially fatal form of child abuse. We are writing today with 2 comments. First, the authors indicated that the motivation of the suspected parent is unimportant when evaluating for possible illness falsification and, later in the article, that treatment options vary depending on the motivation of the parent. We can see how this might be confusing to readers (see ref 2). We agree that abusive illness falsification must be …