Exaggeration of Symptoms or Psychiatric Munchausen’s Syndrome by Proxy?

By Fiona McNicholas, Vicky Slonims and Hilary Cass, Child Psychology and Psychiatry Review, (2000) 5 69-75.

The authors would like to present three cases presenting with symptoms suggestive of autism, where local professionals considered a diagnosis of Munchausen's syndrome by proxy (MSEP). MSEP, also known as Factitious Disorder by Proxy, is a form of child abuse, usually by the mother, in which there is a deliberate production of physical or psychological signs or symptoms in a child, in the absence of an external incentive. The child is often of pre-school age.

The underlying motivation is assumed to be a psychological need by the perpetrator to assume the “sick role” by proxy.

“Psychiatric” Munchausen's syndrome by proxy refers to the presentation by the mother of signs and symptoms suggestive of a psychiatric disorder in the child - for example, Attention Deficit Hyperactivity Disorder (ADHD), autism, tics ete., in which the main presenting complaint is psychological.

Three cases are presented in which there were real concerns by professionals locally that the mother was fabricating the presentation in the child. In each case child protection services had already been involved. In two cases it was felt that an alternative diagnosis to MSBP accounted for the difficulties presented (PDD).

Diagnosis of a rare condition, particularly those such as PDD, where there is no suitable confirmatory medical0psychological test is difficult and requires careful assessment by clinicians. When trying to differentiate true cases from MSBP an unbiased and full assessment by the appropriate multidisciplinary team is required.