7 Things to Know About Munchausen’s Syndrome By Proxy

If you’ve been watching HBO’s Sharp Objects, heard of Gypsy Rose Blanchard, or seen The Sixth Sense, you’ve probably heard of Munchausen’s syndrome by proxy: Also known as factitious disorder imposed on another, it’s a pattern of behavior sometimes characterized as a mental illness seen in caretakers (typically mothers) who fabricate or induce physical and/or mental illness in a person (usually a child) they look after, according to MedlinePlus.

Those affected imagine, exaggerate, or actually cause symptoms. In some cases, they seek unnecessary, damaging, or potentially harmful medical care, according to The American Academy of Pediatrics, which describes the syndrome as “both physical abuse and medical neglect” as well as “a form of psychological maltreatment.”

Without getting into Sharp Objects spoilers, here’s what else you need to know about the mental disorder, which is widely referred to as factitious disorder, and is very real off screen.

1. Munchausen by proxy is just one manifestation of the syndrome.

Muchausen got its name in 1951 from British physician Richard Asher, who wrote that those affected by this condition tell dramatic and untruthful stories quite like Baron Munchausen, a fictional character in the 1785 book, Baron Munchausen’s Narrative of his Marvelous Travels and Campaigns in Russia. Therein, Munchausen, who was based on a real person who contested the association, claims to have performed absurdly impossible feats.

In Munchausen’s syndrome, a person deceives others by making themselves appear sick—either by lying about symptoms, tampering with test results, self-inflicting harm, or aggravating existing conditions, among other strategies, according to the National Health Service. Munchausen syndrome “by proxy” applies when a caretaker comes into play, and Munchausen “by internet” refers to people who pretend to be sick but only do so online.

2. The symptoms vary greatly.

In Munchausen’s syndrome by proxy, the severity of symptoms can range from nonexistent, like reports of frequent fainting that no one has witnessed, to very serious, like wound infection or poisoning, and can affect any part of the body including the mind, according to NHS.

3. The cause is unknown.

It may stem from experience with emotional trauma or childhood abuse, or from a personality disorder, according to NHS, which notes that generally, those affected seek attention. Munchausen by proxy sometimes involves people who have a history of faking personal illness, according to MedlinePlus.

4. It’s more serious than faking illness to miss work or school.

People with Munchausen by proxy go to great lengths to make sure a person is perceived as sick—and tampering with test results is just the half of it. To mimic disease, they sometimes cause injury via unnecessary use of medications or harmful substances, by opening old cuts, and so forth for the goal of inducing illness—not to make money or achieve another external reward, according to Cleveland Clinic.

5. Hypochondriasis is way different.

Now categorized as somatic symptom disorder (when a patient has at least one chronic physical symptom they’re excessively concerned about) or illness anxiety disorder (when a patient is intensely anxious about undiagnosed health condition), hypochondriasis involves people who worry they are sick. In contrast, caretakers affected by Munchausen by proxy know no one is sick—instead, they fabricate symptoms to give the illusion someone is unwell.

6. Its prevalence is anyone’s guess.

Because Munchausen syndrome (and by proxy) involves deception, it’s hard to say how many people have it. In making a diagnosis, psychologists and psychiatrists first have to rule out actual physical symptoms, then look for markers, like a patient’s dramatic but inconsistent health history, symptoms that mysteriously worsen or flare up when the person is alone or only with their caretaker, eagerness to opt into treatment or hospitalization, and extensive medical knowledge, according to Cleveland Clinic. The diagnosis tends to be qualitative rather than based on a certain number of symptoms.

While considered rare, according to Mayo Clinic, some estimates suggest Munchausen by proxy is more common among women and affects about 2 in 100,000 children.

7. Treatment typically involves therapy.

Although there’s no standard approach to treating Munchausen syndrome, psychotherapy and cognitive behavioral therapy can help, as can family therapy and getting to the root of psychological contributors, such as depression or other personality disorders with medication or psychiatric hospitalization, according to Mayo Clinic.

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