Shirah Vollmer MD

The Musings of Dr. Vollmer

Munchausen By Proxy

Posted by Dr. Vollmer on September 27, 2010

Some folks lie about their symptoms. Since all psychiatric diagnoses are based on historical information, along with a mental status examination, a patient can skillfully convince a doctor that he/she has a particular syndrome. When this process is done to obtain a secondary gain such as federal disability or an insurance settlement, we call this Malingering. When a person does it for unconscious reasons, then we call it factitious disorder. When a parent creates an illness in a child,  and then denies that she does this, we call this Munchausen by Proxy; I call it heart-stopping child abuse.

Anna’s eight year old son, Don, has ADHD. Although all psychiatric diagnoses are open to suspicion, Don has problems focusing, problems sitting still, and problems with impulsivity, in all settings: home, friends and school. Anna did not cause Don’s ADHD, but she acts as if Don’s disability has given her a focus (pun intended) that has long been missing in her life. Anna worked as a corporate attorney for ten years before she had Don and her second son Anthony. Her husband, also an attorney, suggested that she stop working to take care of her kids. She, without much thought, agreed. Anna works out, she has friends, but ever since she stopped working, she has felt that a gaping hole in her mental well-being. She had a hard time explaining this feeling to her husband, to her friends and to her family, since to them, Anna’s life was the dream life. She had time to herself; she had time to be there for her kids, her husband and her friends. Anna’s quiet sense of emptiness persisted until Don started having behavior problems at school. Suddenly, Anna was mobilized into action. She needed to mobilize a team to help Don. She needed to investigate the best schools, the best professionals, the best doctors. This “project” as she called it, quickly made her feel like she was using her research skills, her interviewing skills and her management skills.

Anna is not abusing Don; she is helping him. At the same time, she is exhibiting the same characteristics of mothers who are guilty of Munchausen by Proxy. These mothers go from what they perceive to be a mundane existence, to one where they have to deal with doctors, physical therapists, occupational therapists and nurses. Their child is “sick” and no one knows what is wrong with him/her. This puzzle creates a challenge; a secretly needed challenge.

Maybe if we, as a society, recognized the challenges of parenting, the need in some parents, to explore many aspects of their brain in parallel, the need to multi-task, then perhaps we could help parents accept that raising children may not feel like “enough” to keep them satisfied. I wonder if accepting how brains need to be satisfied, mother’s brain and baby’s brain, then maybe we could decrease child abuse. I wonder.

9 Responses to “Munchausen By Proxy”

  1. Shelly said

    Interesting piece. Are you distinguishing Anna’s behavior (Munchausen by Proxy-like) from normal parental behavior (ensuring our children receive the best care, etc…) because Anna seemed fulfilled by the mothering/nurturing/active role she needed to take to get her son treated? While many stay-at-home parents find fulfillment being the caretaker, highly successful professionals like Anna might not find being a full-time mother stimulating enough. Why then the mention of Munchausen by Proxy in this blog? Is Anna searching for sympathy and being the center of attention? Is that what constitutes Munchausen by Proxy? How is this different than narcissism?

    • I think I was not clear. I was trying to describe how some parents build their self-esteem on managing the disabilities of their child. Sometimes this is a win-win, as with Anna. Other times it is a win-lose as with Munchausen by Proxy. The dynamics are similar though. Managing medical care comes with an invisible excitement, for some. As you say, being the center of medical attention can feel good, even in the face of illness or disability. I agree that all of this is about narcissism, but in particular, this is the kind of narcissism which flourishes from meeting a challenge.

  2. Suzi said

    I have heard the mention of the ‘hole’ that one feels in their lives as perhaps a type of ‘despair’. It’s not really a grief (though grieving would seem to be happening), it’s not really depression, or anxiety (though it perhaps it could feel that way) and apparently can be diagnosed as such.

    Sometimes, slowing down from a fast paced life can feel a bit like it might feel to slam into a stationary wall while traveling along at over 100 km per hour.

    It will mess with all the physical, mental, emotional and practical life type things.

    It could leave you feeling as though you’re dead but interacting and functioning right along with the living. Numb, empty, worthless – dead but other people think one is still alive.

    Any kind of stimulation – anything to do… anything. I guess just to find out if one is actually dead or what if, perhaps, these other people are right and one is still alive or… something… anything.

    Poor Don. Anna is lost in it. I hope someone can help Don though.

  3. Kristin said

    Is it still Munchausen by Proxy if you can find a diagnosis for your kid’s personality in the DSM-V? With the ever-broadening roster of diagnoses, pretty soon everyone will be covered and M-b-P parents won’t have to make up illnesses any more!

    • Shirah Vollmer said

      Munchausen by Proxy is a term to describe a mother who actively causes her child to have an illness (physical or mental). For example, a mother might give her child laxatives and then tell the doctor that the child has unexplained diarhea. M-b-p for psychiatric diagnoses is more complicated, since there are no diagnostic tests.

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