Munchausen by Proxy (MBP) Maltreatment Manifesting as Child Sexual Abuse

MBP is sometimes called Munchausen Syndrome by Proxy, Munchausen by Proxy Syndrome, or Factitious Disorder by Proxy. All of these terms apply to a well-established variant of maltreatment (abuse and/or neglect) in which caregivers deliberately feign or produce ailments in others. The perpetrator deliberately misleads others knowing that there is no reason to believe the victim has an underlying physical and/or psychological-behavioral problem. The signs and symptoms perpetrators falsify or create are usually physical. For instance, a mother might repeatedly suffocate a child in secret, then claim to doctors and family members that these respiratory arrests were spontaneous. Less frequently, the problems are mainly psychological or behavioral. For example, a mother might falsely allege that a child is suicidal. Physical and psychological-behavioral "problems" may occur in the same case. Regardless, the victim typically then undergoes unnecessary physical or mental health examinations, tests, medications, and/or surgeries. These activities can not only be painful, frightening, and embarrassing, they may also place the child at emotional and/or physical risk in the present and the future. Individual cases of MBP may incorporate physical abuse, emotional abuse, medical neglect, and/or sexual abuse.

The perpetrator's principal motivation is usually to attract attention, sympathy, care, and concern as the parent of a child with problems. She may be motivated by other "internal" goals as well, such as the desire to control and manipulate others, including a spouse or a high-status medical professional. For example, in a troubled marriage, the perpetrator may create "problems" intended to avert the spouse's leaving home or finding a new partner. In this example, the perpetrator may intend to gain the spouse's attention, interfere with the new relationship, or obtain revenge. When MBP presents in the context of divorce or custody dispute, those very situations may be a part of the motivation or provide "triggering events" for the MBP maltreatment.

The victims are usually infants or toddlers, but older children, adults, and the elderly can be victimized as well. In this piece, we will discuss only cases that involve child victims. Also, because the vast majority (75 to 95 percent) of known perpetrators are mothers, we will be using the terms "mother" and the pronoun "she" to refer to them.

MBP perpetrators typically bring the child to health care settings such as hospitals, emergency rooms, and clinics, but conceal their own role in the problem(s). Sometimes they mobilize the sympathy and attention of others but do not actually access medical or mental health care. MBP is usually diagnosed through the accumulation of solid circumstantial evidence. Investigative techniques such as secret video surveillance (i.e., filming the mother abusing the child in the hospital room) may provide direct confirmation of MBP-like behavior but do not necessarily "prove" that the behavior constitutes MBP maltreatment. As mentioned above, direct evidence can be very important but may not usually be necessary to prove that MBP maltreatment is involved.