In Munchausen Syndrome by Proxy, a perpetrator assumes the sick role indirectly (i., by proxy) by feigning or producing illness in another person. The primary purpose of this behavior, some believe, is to gain some form of internal gratification, such as attention, for the perpetrator. Usually, the perpetrator is a mother who produces the symptoms or illness in her child of under six years of age (Kahan & Yorker, 1991). However, cases have been reported with adults as both perpetrators and victims. The syndrome is well known to veterinarians. In such cases, a pet's owner fabricates signs and symptoms in the animal (Sigal et al., 1989). MSBP is not uncommon; however its prevalence has not been established. Rosenberg (1987) considered 117 cases in a review. Schreier and Libow (1993) postulated that this syndrome is more common than previously believed, and that many of the cases are not diagnosed. MSBP ranges from diseases that are completely imagined to diseases that are fully induced in the child. The means by which MSBP mothers most frequently fabricate disease are suffocation, induced seizures, bleeding, chronic poisoning with ipecac (leading to vomiting), chronic poisoning with phenolphthalein (leading to diarrhea), and excrement injection. .
The psychological ramifications of Munchausen's Syndrome by Proxy are chronic and long-standing. They represent a real danger to the further development of society as a whole. These children who are victims may learn to view love from their mother as dependent on their being ill. Thus, they may help in the deception, or even use self-abuse, in order to protect themselves against fear of abandonment. Having learned to identify with illness and to use it as a means of expression and communication, many victims of MSBP become Munchausen patients. Thus, factitious illness may be perpetuated and an intergenerational cycle may develop. In older children, the school absenteeism that results from multiple hospitalizations brings with it loss of education and loss of social interactions with peers their own age.
