FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

MUNCHAUSEN BY PROXY: CHILD HAS SYMPTOMS BUT PARENT IS ILL

Question: A lawyer friend of mine mentioned recently that he had had a case involving a medical condition know as "Munchausen syndrome by proxy." Can you explain to me what this is?

Answer: Munchausen syndrome is named after Baron Karl Friedrich Hieronymus von Munchausen (1720-1797). He was a German traveler and soldier and the reputed source of numerous adventure stories that were wildly exaggerated and preposterous. This penchant for exaggeration and fabrication characterizes those who have Munchausen syndrome.

People who suffer from this condition have an emotional need to seek medical care. They travel from doctor to doctor and even from town to town seeking care for the ever-changing list of amazing and imagined medical problems.

The typical sufferer has repeated hospitalizations because of his or her imagined need to obtain medical care. It is not unusual for these people to prick a finger to drop blood into a urine sample to imitate kidney disease, or to inject saliva under the skin to mimic an infection. As a result of these antics, patients often undergo numerous and complex medical tests. They also often complain of severe pain. Surgeries, particularly abdominal surgeries, have sometimes been performed in an attempt to find the illusive cause of the reported pain.

Sufferers of Munchausen syndrome are not malingerers. A malingerer receives some benefit from their imaginary medical condition, such as back pain producing a disability claim or illness producing a few extra days off work. For the Munchausen patient, medical care is the underlying reason for his or her behavior. This is a very serious condition which is disruptive to the life of both the patient and his or her family. The sufferer's health is additionally threatened by the numerous unnecessary medications, surgeries and diagnostic procedures.

Now for the "proxy" part of your question. When a child is brought repeatedly to the hospital by a parent reporting problems which are not apparent after careful evaluation, it's possible the child has Munchausen syndrome by proxy. A few examples may be helpful.

Often, the accompanying parent -- usually the mother -- tells the doctor a story involving problems with seizures or similar neurological abnormalities that only the parent observed. In other cases, the parent will actually give the child a substance like syrup of ipecac to make him or her vomit. It's important to stress that it is the parent who is ill, even though the child has the symptoms or reported symptoms. The parent is acting out his or her emotional need for medical attention through the child. That is, the parent is using the child as a "proxy" or "stand in" for him or herself. That's why it's called "Munchausen by proxy."

Question: What can be done to treat Munchausen syndrome?

Answer: This condition is difficult to treat because it is so easy for an individual to seek the advice of another doctor. The Munchausen patient can be amazingly convincing when describing the alleged condition. Each new physician is obligated to do a thorough evaluation of these complaints. While the treatment for this condition is best given by a mental health care professional, these patients often refuse to see a psychiatrist or psychologist when one is recommended. Much coordinated effort from the patient, his or her family and the medical community is necessary to keep the Munchausen sufferer in the necessary psychiatric therapy.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.