Harvard Mental Health Letter

Questions & answers: Munchhausen's syndrome

Questions & answers

Q. What is Munchhausen's syndrome by proxy and why is it not in the DSM-IV?

A. A subscriber sent us this month's question after reading about a mother accused of child abuse. Her four children, who ranged in age from 6 to 14, had collectively amassed more than 500 doctors' visits during their lifetimes for symptoms including breathing problems, stomach distress, and seizures. California officials thought they had a case of Munchhausen's by proxy (MBP), suspecting the mother was either fabricating or inducing illness in her children. The family strenuously objected. Their experts thought the children's symptoms were the result of a rare familial disorder.

The story illustrates two conflicting impressions of MBP. Either it is a disorder that is difficult to detect and harder to confirm, or it is a diagnosis easy to make in error, and the basis for a "Kafka-esque" persecution, as one of the family's experts wrote. Probably it is both, and more.

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