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Graduate Student Journal of Psychology                                                                             Copyright 2009 by the Department of Counseling & Clinical Psychology  
2009, Vol. 11                                                                                                                        Teachers College, Columbia University                          
 
 

Effects of Munchausen Syndrome by Proxy on the Victim 
 

Kimberly Glazier 
Teachers College, Columbia University 

 
The perpetrators of Munchausen Syndrome by Proxy (MSBP) produce symptoms that often result in 
multiple doctor visits, hospitalizations, incorrect diagnoses, and unnecessary procedures for the victim. 
Immediate physical harm exists for all suffers of MSBP. However, growing research suggests that 
there are lasting adverse physical, psychological, and social effects for individual victims of MSBP. 
The mortality rate and risk of further abuse for children who are returned home after they receive a 
diagnosis of MSBP suggests greater consideration should be given before allowing a child to continue 
living with the perpetrator. Studies show that MSBP is not culturally dependent. The difficulty in 
diagnosing cases of MSBP indicates the prevalence rate may be underestimated. 
 

The term Munchausen Syndrome (MS) was first 
described by Asher (1951), who suggests that the main goal 
of individuals with MS was to trick healthcare professionals 
with false illnesses and to gain attention and care from 
providers. The deceptiveness of those with MS, in part, has 
caused a delay in the identification of the disorder; it was not 
classified until the 1950s. Twenty-six years after Asher 
coined the term Munchausen Syndrome, Meadow (1977) 
introduced the term Munchausen Syndrome by Proxy 
(MSBP).       

The two conditions are categorized in the Diagnostic 
and Statistical Manual of Mental Disorders IV-TR as 
factitious disorders (American Psychiatric Association, 
2000). The subcategory Factitious Disorder Not Otherwise 
Specified is where MSBP, also known as Factitious Disorder 
by Proxy, is classified. MSBP is diagnosed in cases where a 
caretaker intentionally produces or feigns illness for another 
individual. The motive for inducing symptoms results from 
the desire for attention and sympathy. These cases typically 
involve, but are not limited to, a mother as the perpetrator 
and her child as the victim.  

Due to the nature of the illness, the prevalence rates for 
MS and MSBP are difficult to determine. One study by 
Hamilton and Feldman (2006) reported a probable 
prevalence rate for MS of .2-1% for hospital inpatients, 
while another 2-year prospective study reported a prevalence 
rate of MSBP at  .00075% for children under the age of 16 
(McClure, Davis, Meadow & Sibert, 1996). The literature 
shows that the majority of individuals with MS tend to be 
white males between the ages of 30-50 years (Hamilton & 
Feldman, 2004). The majority of MSBP perpetrators tend to 
be white mothers of no specific age (Brannon & Carroll, 
2008). Little other demographic data is available, and 
research examining whether or not religion and 
socioeconomic status may be significant predictors of MS 
and MSBP would be helpful.     1

 
 
                                                 
Correspondence: Kimberly Glazier, kimberlyglazier@gmail.com  

Perpetrators of MSBP 
 
Bools, Neale, and Meadow (1994) examined 

characteristics of MSBP perpetrators. The medical files of 62 
families from the United Kingdom with a known history of 
MSBP were examined. Sufficient information on the 
mothers (the perpetrator of the MSBP cases) was gathered 
from 47 files and 19 mothers completed in-person 
interviews. The data showed that 19 of the 47 mothers had 
criminal records. A more detailed examination of mothers 
who completed in-person interviews found that 15 of the 
mothers reported childhood emotional neglect or abuse, 12 
had a history of self-harm, and 8 reported a lifetime history 
of alcohol or drug problems. Also, 15 met the diagnostic 
criteria for somatizing disorder, eight for histrionic 
personality disorder, five for borderline personality disorder, 
two for dependent personality disorder, and one for avoidant 
personality disorder. On the whole, the data suggest that as a 
group, MSBP perpetrators face adverse childhood 
experiences and suffer from a range of psychological 
disorders. 

 
Cases of MSBP 

 
One of the first investigations of MSBP was conducted 

by Meadow (1982). Nineteen cases of MSBP occurring in 
England were examined. Data were gathered on 19 children 
(10 boys and 9 girls), under the age of 7, from 17 families. 
The mothers of these children consistently presented false 
clinical histories and fabricated symptoms that resulted in 
unnecessary harmful medical investigations, hospital 
admissions, and treatment. The data were derived from 
physician’s medical records. The results showed that all of 
the children were subjected to hospitalizations. One subject 
missed 13 months of schooling, spent 5 months as an 
inpatient at a hospital, underwent 12 procedures, and was 
prescribed 27 medications. At the time of follow-up, which 
ranged from 1 to 4 years, two of the children in the study had 
died, and eight of the subjects were removed from their 
home environments. Records from two of the nine children 

70 



EFFECTS OF MUNCHAUSEN 
 

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who remained living with the perpetrator showed that 
frequent trips to doctors persisted. In seven of the 17 families 
with siblings, there were signs suggestive of similar practices 
with siblings. In one family, a sibling died under suspicious 
conditions. The findings of Meadow’s 1982 study helped 
spark an increase in the amount of attention and research 
devoted to MSBP. 

Rosenberg (1987) performed an extensive review (1966 
to 1987) of the existing literature on Munchausen Syndrome 
by Proxy. Rosenberg obtained 117 reported cases of MSBP 
and divided the symptoms of the victims into two categories: 
simulated or produced illness. Simulated illness was 
assigned to children when the mother did not directly cause 
harm to the child (e.g., infecting the child’s urine sample 
with outside contaminants). In produced illness cases, the 
mother physically caused harm to the child, such as inducing 
bone fractures or subjecting the child to sunlamp exposure 
that resulted in severe burns. The method of symptom 
induction was available for 72 of the cases. The findings 
showed that 25% were simulated illness only, 50% were 
produced illness only, and 25% were a combination of the 
two.   

Rosenberg further investigated the morbidity of MSBP 
by delineating short-term and long-term morbidity. Short-
term MSBP morbidity was defined as discomfort and/or 
illness that once resolved did not have a negative lasting 
impression on the overall health and development of the 
child. Long-term MSBP morbidity was defined as permanent 
adverse effects that resulted from the pain and/or illness. All 
of the cases met the criteria for short-term morbidity and 8% 
of the living subjects were determined to be affected by 
long-term morbidity. Ten of the 117 children in the study 
died, resulting in a 9% mortality rate. Also, 10 siblings of the 
117 MSBP victims died under unusual circumstances. 
Among the MSBP victims that died, 20% of the mothers 
were diagnosed with MSBP prior to the child’s death. 
Despite knowledge of the mother’s illness, these children 
were allowed to live with the mother, which resulted in the 
subsequent death of the child. Overall, 24% of the 
perpetrators were diagnosed with MS or possessed features 
of MS. Furthermore, 1% of the sample reported sexual 
abuse, and 1% reported physical abuse.  

Similar to Rosenberg’s review, Sheridan (2003) 
performed an extensive search for incidences of MSBP 
(1987-1999). The study showed that 57.2% of the cases 
involved physically produced symptoms. Sheridan also 
found a MSBP long-term morbidity rate of 7.3%, a 6% 
mortality rate, and a 25% mortality rate for siblings of 
MSBP victims. The data also showed that 61.3% of the 
siblings had documentations of suspicious illnesses or 
similar symptoms as the index subject. In 29.3% of the cases 
the perpetrator was diagnosed with MS or possessed features 
of MS; however, data on the number of perpetrators 
diagnosed with MSBP prior to the child’s death was not 
provided. Furthermore, rates of sexual and physical abuse for 
the victims of MSBP were not documented.   

Neither Rosenberg (1987) nor Sheridan (2003) 
examined whether the manner of fabrication significantly 
impacts the future well-being and adjustment of MSBP 
victims. Investigating such relationships would be an 
interesting area to explore.  
 
Victims Becoming Perpetrators 
 

According to Rosenberg (1987), it is possible that “child 
victims of MSBP grow into adults who perpetuate MSBP or 
who suffer from Munchausen syndrome or somatization” (p. 
557). Incidence rates for the evolution of victims to MSBP 
becoming perpetrators of MSBP are not currently known; 
however, if Rosenberg’s belief were true, one would expect 
most MSBP victims to be female given that the vast majority 
of MSBP perpetrators are female. In both Rosenberg’s 
(1987) and Meadow’s (1982) studies, all perpetrators were 
the mother of the child. In Sheridan’s (2003) study, 76.5% of 
the perpetrators were mothers and only 6.7% were fathers. In 
Rosenberg’s study, there were no significant gender 
differences among victims of MSBP (46% male, 45% 
female, and 9% unknown). In Meadow’s study, there were 
10 male and nine female victims. Sheridan showed similar 
gender rates among victims; 52% male and 48% female. 
This data suggests, that at least for males, being a victim of 
MSBP does not predispose the individual to become a 
perpetrator of MSBP later in life. More research is needed to 
determine whether or not a positive correlation between 
being a victim of MSBP and becoming a perpetrator of 
MSBP exists for females. 

   
Potential Complications for Victims of MSBP 

 
Psychological conditions have not been assessed in the 

majority of the MSBP subjects. Schreier and Libow (1993) 
noted that out of the 178 articles found on MSBP, 143 were 
located in medical journals, while only 19 were in 
psychiatric or psychological journals. However, Rosenberg 
(1987) noted three cases of psychological disturbances for 
MSBP victims. The symptoms included severe withdrawal, 
preoccupation with being poisoned, emotional disturbances 
specifically related to fear of blood and death, fixation with 
bodily integrity, and aggression. The lack of data on 
psychological disturbance and MSBP highlights the need for 
future work examining whether or not the onset of certain 
psychological disorders are positively correlated with MSBP 
victimization.  

Schreier and Libow’s (1993) study identified the 
mortality rates associated with MSBP. Questionnaires 
assessing for MSBP were mailed to 1,258 pediatric doctors 
(870 neurologists and 388 gastroenterologists). The response 
rates for the two groups were 22% and 32%, respectively. 
The results showed 273 confirmed and 192 highly suspected 
cases of MSBP. Furthermore, in 25.8% of the cases, siblings 
of the victim were also believed to have been subjected to 
MSBP. In total, the mortality rate was 9.7% for children 
suffering from MSBP and 4.8% for their siblings. These 



GLAZIER 
 

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studies showed the immediate consequences of MSBP and 
support the notion that more protection needs to be provided 
to victims of MSBP as well as other children living in the 
home. 

Davis et al. (1998) conducted a follow-up study to 
McClure’s 1996 study of the epidemiology of MSBP, non-
accidental poisoning, and non-accidental suffocation. 
Questionnaires were sent to the pediatricians who 
participated in the earlier study to assess the outcome of the 
cases previously submitted to the British Paediatric 
Association Surveillance Unit (BPASU). The response rate 
for completion of the surveys was 93%. Excluding deaths, 
91 cases of MBSP were identified. Physical harm was 
identified in 52 cases. Thirty of the 39 MSBP victims with 
no physical harm were returned to live at home. During the 
follow-up period, five cases of further abuse were reported, 
resulting in a 16.7% re-abuse rate. Two children suffered 
further instances of MSBP and three were victims of 
emotional abuse. Excluding cases involving suffocation or 
poisoning, 13 cases of MSBP with physical harm were 
documented. Nine of those children were returned home and 
one case of further mistreatment was found, which 
constitutes an 11.1% re-abuse rate. The 2-year prospective 
study combined with the 1-year follow-up study provides 
further support for harm associated with MSBP and the 
danger of returning victims to live with the perpetrator. 

Few studies have specifically examined the impact 
MSBP has on its victims after receiving an MSBP diagnosis. 
A follow-up study conducted by Bools, Neale, and Meadow 
(1993) included a follow-up assessment of individuals 
diagnosed with MSBP. The initial study, which identified 56 
MSBP cases occurring between 1976 and 1988, examined 
methods used to fabricate illnesses and the symptoms 
induced by the perpetrators were reported (Bools, Neale and 
Meadow, 1992). The follow-up study sample was comprised 
of 54 cases (26 males and 28 females). Two children died in 
the lapse between studies. The duration between detection of 
MSBP and follow-up ranged from 1-14 years with a sample 
mean of 5.6 years. Clinical interviews were conducted with 
the parent or current guardian of the victim if researchers 
determined that potential adverse effects for the child were 
minimal.  

Upon follow-up, 30 of the 54 children remained living 
with the mother, who was also the perpetrator. In 10 cases 
the mother was still feigning sickness in the subject. No 
fabrication of illnesses was found in the children living with 
foster or adoptive parents. This data suggests the importance 
of permanently removing MSBP victims from the home 
environment.  

Sufficient data to determine current psychological 
functioning of the individual was obtained for 38 children. 
Twenty-seven of these children were considered to have 
significant disorders and 10 of these subjects, although 
significantly impaired, were beginning to display signs of 
slight improvement. The children suffered from a range of 
symptoms that affected their physical, psychological, and 
social wellbeing, including: somatic symptoms, nocturnal 

enuresis, developmental delay, irreversible brain damage 
leading to quadriplegia and severe learning disabilities, 
coordination issues, emotional problems, specific phobias, 
conduct disorder, hypochondriacal behavior, nightmares, 
concentration difficulties, social development delay, theft, 
school non-attendance, and school suspension. These studies 
indicate the short-term consequences of MSBP, while Bools, 
Neale, and Meadow (1992, 1993) also demonstrate that 
many victims continue to suffer even after a diagnosis of 
MSBP was determined.  

        
Adult Survivors of MSBP 

 
To research the lasting impact that MSBP has on child 

victims, Libow (1995) conducted a retrospective study that 
examined the adult lives of 10 MSBP survivors. The subjects 
completed a questionnaire and were offered an optional 
follow-up interview. The reports found that the perpetrator 
was the mother in nine cases and the father in one case. In 
response to a question regarding his or her childhood years, 
most participants reported emotional disturbances and two 
reported serious physiological problems. One respondent 
told of dramatic weight issues: being anorexic as a young 
child and 50 pounds overweight in her adolescence. Another 
suffered from significant growth problems, weighing 47 
pounds and standing 47 inches tall as a freshman in high 
school. Half of the subjects reported suffering from a variety 
of depressive symptoms. Four individuals experienced 
difficulties in school that resulted from physical or 
psychological factors. One child missed 8 years of schooling 
due to the mother’s insistence of her illnesses. Another 
reported difficulty concentrating in school due to the 
constant anxiety that her mother’s abuse would recommence.  

With regard to the victims’ adult lives, two reported not 
being significantly affected by their childhood abuse; 
however, both of these subjects reported avoiding visits to 
doctors and ignoring health and medical issues. While these 
individuals did not consider their behaviors problematic, 
significant adverse consequences could result from ignoring 
potential health concerns and avoiding doctor appointments 
(e.g., early detection of cancer). The remaining subjects 
reported a range of lasting and damaging psychological 
symptoms, which included trouble sustaining relationships, 
inability to separate one’s identity from that of being a 
victim, and difficulty distinguishing reality from fantasy 
especially regarding bodily symptoms and the need to seek 
medical attention. Furthermore, decreased feelings of self-
worth, doubt, searching for maternal love, generalized rage 
toward family members, suicidal ideation, and feelings of 
anxiety and depression were all described as long-term 
consequences due to the MSBP abuse. Subjects were also 
given a 27-item questionnaire that screened for 
Posttraumatic Stress Disorder (PTSD). Nine adults 
completed the questionnaire and results found that six of the 
subjects had at least four symptoms of PTSD. Also, seven of 
the adults had received psychiatric or psychological 
counseling and one patient reported having a clinical 



EFFECTS OF MUNCHAUSEN 
 

 73

diagnosis of Bipolar Disorder. These findings suggest that 
victims of MSBP can endure lasting negative psychological 
effects.   

Out of the eight MSBP parents still alive at the time of 
the interview, only four participants reported having some 
contact with the parent. These adults expressed ongoing fear 
of the perpetrator. Furthermore, none of the eight parents 
admitted to the abuse, even when confronted by the 
participant. The direct effect of not receiving proper 
acknowledgement from the perpetrator cannot be determined 
from this study. However, in future studies it would be 
helpful to examine the parent-child relationship and the 
effect of proper acknowledgment of the abuse from the 
parent perpetrator.  
 
Limitations 

 
One limitation of MSBP research is the reliance on 

participants’ retrospective memory of childhood. However, 
retrospective self-reports are used in the majority of research 
that examines the effects of childhood physical and sexual 
abuse on later life development (e.g., Libow, 1995).  A study 
conducted by Bernstein et al. (1994) explored the validity 
and reliability of the Childhood Trauma Questionnaire 
(CTQ; Bernstein, 1995), a retrospective instrument used to 
assess childhood abuse. The results found an internal 
consistency ranging from .79 to .94 and a test-retest 
reliability of .88. The high validity and reliability of this 
measure supported Libow’s decision to use the self-reporting 
method (1995).  

Another shortcoming associated with MSBP research 
relates to the complexity of uncovering MSBP cases. A 2-
year prospective study looked to examine the epidemiology 
of MSBP, non-accidental poisoning, and non-accidental 
suffocation among children under the age of 16 (McClure et 
al., 1996). Pediatricians from the UK and the Republic of 
Ireland reported all diagnosed or suspected incidences of 
MSBP, non-accidental poisoning, and non-accidental 
suffocation that occurred from September 1992 through 
August 1994 to the BPASU. The results showed 97 cases 
involving MSBP (55 MSBP only; 26 MSBP and poisoning; 
14 MSBP and suffocation; and 2 MSBP, poisoning, and 
suffocation). The Office of Population Census and Survey 
reported a population of 12,725,936 during the time period 
of the study. From these statistics the prevalence of MSBP 
was found to be .75/100,000; however, this percentage only 
included cases detected by the pediatricians.   

Other factors help make determining the true prevalence 
of MSBP difficult. Meadow (1995) listed the following 
differential diagnoses for MSBP: unrecognized physical 
abuse, overanxious parents, mothers with delusional 
disorder, masquerade syndrome, hysteria by proxy, doctor 
shopping, and mothering to death. There have also been 
multiple instances when the victim had informed 
professionals of the perpetrators’ production or simulation of 
the symptoms and the child was not believed (Libow, 1995). 
Another aspect that may make diagnosing cases of MSBP 

even more challenging results from blended cases, which 
Libow (2002) described as the collusion of symptoms 
between caregiver and child. In these cases, the intentions of 
both parties coincide. Consequently intentional revealing of 
the deceit could make subsequent diagnosis more difficult 
for practitioners. Detecting and properly labeling cases of 
MSBP has been proven difficult. These challenges 
undermine accurate reporting of prevalence, and suggest that 
current rates of MSBP incidences are underestimated.   

 
An International Look at MSBP 

 
While most research of MSBP has been conducted in 

western societies, the universal presence of MSBP should 
not be ignored. Feldman and Brown (2002) searched 
multiple databases, articles, chapters, and books to 
investigate the existence of MSBP in countries excluding 
Australia, Canada, New Zealand, Ukraine, and the United 
States. The results found a total of 129 cases of MSBP from 
24 different countries. Gender information was available for 
81 cases (54% male and 46% female). In the 93 reports 
where the perpetrator was identified, 86% were the mother, 
4% were the father, 4% were spouses unrelated to the child, 
2% were the grandmother, and 4% were other. While 
information documenting the detrimental effects and 
mortality rate for the victims was not provided, the study did 
show that MSBP existed throughout developed, developing, 
and underdeveloped countries.   

Another international study reported on cases of MSBP 
throughout Japan (Fujiwara, Okuyama, Kasahara, & 
Nakamura, 2008). In 2004, 11 leading Japanese physicians 
specializing in child abuse were asked to identify confirmed 
or suspected cases of MSBP they encountered from 1995 to 
2004. Twenty one cases were reported, consisting of 10 male 
and 11 female victims. Incidences were categorized as either 
having predominantly physical or psychological symptoms 
(16 and 5, respectively). Eighteen of these cases were 
reported to the Child Guidance Center and eight of the 
children were returned home to live with the abuser. Two of 
the victims who returned home died; both of the victims 
were classified as having predominately physical symptoms. 
This study provides further proof that MSBP also occurs in 
non-western cultures, with similar negative outcomes for 
victims. The findings also note the risk of returning victims 
of MSBP to the home environment. Lastly, another avenue 
for future exploration may be potential differences between 
perpetrators who produce physical versus psychological 
symptoms in the child, and more specifically predictive 
outcomes based on the four types of symptom feigning (i.e., 
physical, psychological, simulated, and produced). 
 

Conclusion 
 
Significant literature and research has been conducted 

since the introduction of MSBP in the 1970’s. However, 
more attention and study needs to be given to the disorder. 
The literature currently shows the damaging short-term and 



GLAZIER 
 

 74 

long-term risks that may arise due to MSBP victimization. 
The harmful complications compounded by the mortality 
rate for victims and siblings suggest that more consideration 
needs to be given to removing children from homes when 
MSBP has been diagnosed. Future research should more 
thoroughly address psychological issues among those 
exposed to MSBP. An increase in knowledge surrounding 
psychological complications will help provide appropriate 
services to care for victims of MSBP. Furthermore, the 
prevalence of MSBP and its signs and symptoms need to be 
made more publically accessible across all countries and 
cultures. Greater awareness regarding MSBP will hopefully 
decrease the duration between the onset of MSBP and its 
diagnosis 

 
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