Symptoms of Munchausen by Proxy (MSBP)

Munchausen by Proxy: Studying the Symptoms - Paradigm San Franscisco

One of the frightening things about Munchausen syndrome by proxy (MSBP) is that it’s a condition that causes symptoms in a person other than the one affected.

It’s a mental health illness, but it’s also a form of abuse – often abuse of children – and it can be deadly.

That means that it’s important to identify MSBP for the safety and health of everyone involved. But often, people who have MSBP are difficult to distinguish from loving parents and caretakers.

What are the symptoms of MSBP? How can physicians or others tell whether or not someone is suffering from MSBP, or whether there’s another illness at work?

Take a look at some things to know about MSBP, its symptoms, and how to recognize it.

What is Munchausen by Proxy?

First, it’s important to understand what Munchausen by proxy is.

In a case of Munchausen by proxy, one person – usually a parent or a caretaker – fabricates, exaggerates, or causes symptoms in another person, often a child, in order to gain attention and praise.

MSBP isn’t a case of a parent or caregiver abusing a child or vulnerable person because of frustration, anger, or cruelty.

Instead, what the parent or caregiver wants is to be seen by others as an exemplary caregiver. They often seem to be devoted to the person whose symptoms they’re causing, going out of their way to provide care and seek medical help for them.

This is what makes them difficult to distinguish from other parents or caregivers taking care of people who are truly sick. Most parents are devoted to their children and will go out of their way to seek medical care and provide comfort and support when their children are sick.

But most parents aren’t causing their children’s illnesses or exaggerating them to gain unnecessary treatments, as parents with MSBP are doing.

For an outsider, it can be difficult to tell the difference if no one knows that the parent or caregiver is the one creating or exacerbating the illness.

Symptoms of Munchausen by Proxy

One of the things that can make identifying Munchausen by proxy difficult is that the condition affects at least two people, so practitioners need to look for symptoms in both the caretaker and their victim.

Common symptoms in victims of MSBP include symptoms that don’t seem to fit any particular diagnosis, symptoms that improve during a hospitalization or period of monitoring by a medical professional, but worsen when the victim is at home or under the sole care of their parent or caretaker, test results that don’t match the symptoms presented, and a past history of injuries, illnesses, and hospitalizations.

The parent or caretaker may also have their own set of symptoms. They may:

  • Be overly involved with the medical staff taking care of their victim
  • Exhibit attention-seeking behavior
  • Seem to be working hard to appear self-sacrificing and devoted to their victim’s care
  • Seem to enjoy being in a medical facility or hospital environment
  • Refuse to leave their victim’s side
  • Exaggerating symptoms
  • Speak for their victim, even when their victim is capable of speaking for themselves

It’s common for people with MSBP to have some type of medical background or medical training, although they may also be self-taught.

In any case, caretakers with MSBP are often unusually knowledgeable about medical conditions and medical procedures.

Causes of MSBP

While Munchausen by proxy is certainly a memorable condition, it’s also relatively rare.

In addition, MSBP may be underdiagnosed because it’s so difficult to diagnose.

For these reasons, MSBP isn’t very well understood, and it’s not known exactly what causes the condition.

Often, people with MSBP were abused in some way during their childhood. In some cases, people with MSBP grew up in homes where they received love and attention for being sick, or where they witnessed someone else receive love and attention for being sick, which may cause them to associate illness with attention and care.

MSBP may also be triggered by some type of stress, like a traumatic event, a serious illness, or marital problems.

MSBP Treatment

A diagnosis of Munchausen by proxy requires treatment both for the caretaker and their victim.

Children or vulnerable adults who have been abused by a caretaker with MSBP must be removed from their care. This usually means involving Child Protective Services or the local Department of Children and Families.

They can place the victim somewhere safe and appoint a guardian who can be trusted to care for them.

Children or adults who haven’t been abused but who the person with MSBP is responsible for must also be protected. A mother with MSBP, for example, may only be making one of her children sick, but if that child is removed, then she may move on to another if they aren’t also removed.

Victims of MSBP may need medical treatment to treat injuries caused by their caretaker or by inappropriate medical treatments.

However, victims should also receive psychological counseling. Victims of MSBP often mistrust doctors, hospitals, and medical professionals, and even necessary and appropriate medical treatments can be traumatic for them.

Caretakers with MSBP will often face criminal charges for their actions. However, they should also receive psychological counseling in addition to their legal consequences.

People who have MSBP can be difficult to treat, because they often display manipulative behaviors, are skilled at deception, and may not be willing to admit what they’ve done. Once a caretaker with MSBP is willing to admit their actions, treatment is more likely to be successful.

When there are other family members in the mix, like siblings of the victim or a spouse of the caretaker, family or group counseling may be appropriate as well. MSBP is a condition that affects everyone in the family, not just the caretaker and victim.


At this time, there’s no way to predict who will develop MSBP or prevent the condition from occurring.

Therefore, it’s important for doctors, medical professionals, and family members to be alert to the signs and symptoms that victims and caretakers with MSBP display.

The sooner the condition is noticed and treated, the better the long-term outlook is for MSBP victims.

Dr. Nalin is a Licensed Clinical Psychologist, and Founder and Executive Director of Paradigm Treatment Centers, who has been a respected leader in the field of adolescent mental health for more than 20 years. He received his undergraduate degree from the University of Southern California, his Master’s degree from Loyola Marymount University, his Doctoral degree from Pacific University’s APA approved Clinical Psychology program, and completed his training at the University of California, San Diego’s APA approved psychology internship program.

Dr. Nalin has provided training and mentoring to students entering the field of psychology at institutions of learning including Pepperdine University’s Graduate School of Education and Psychology, UCSD, Pacific University, and Santa Monica College. He was also instrumental in the development of the treatment component of Los Angeles County’s first Juvenile Drug Court, which now serves as a national model.

Dr. Nalin has appeared as an expert on shows ranging from CBS News and Larry King, to CNN, The Today Show and MTV. He was also featured in an Anti-Drug Campaign for the Office of National Drug Control Policy (ONDCP).

Dr. Nalin is a Diplomate of the National Institute of Sports Professionals and a Certified Sports Psychologist as well as a Certified Chemical Dependency Intervention Specialist. He lectures and conducts workshops nationally on the issues of teen mental health, substance abuse prevention, and innovative adolescence treatment.

In 2017 Dr. Nalin was awarded The Sigmund Freud Foundation and Sigmund Freud University’s Distinguished Achievement Award in recognition of his work with youth in the field of mental health over the course of his career.

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