Munchausen Syndrome by Proxy: A Deadly Disorder

Some individuals fake illnesses, produce physical symptoms, or injure themselves in order to get attention. This is referred to as Munchausen syndrome.

Problems with Investigating Alleged MSBP

Any case of suspected Munchausen by proxy needs to be reported to child protective services and law enforcement.   Both agencies will need to investigate the situation.  They will need to use a multidisciplinary approach that also includes medical staff, social services, hospital administrators and prosecutors.  Charges may range from battery, child abuse, neglect of a dependent, child endangerment, attempted murder or sometimes murder.  Expect the following hurdles during your investigation:

  • Most of the victims are too young to talk
  • The suspect will appear unlikely: loving, attentive, concerned
  • The suspect is usually an experienced liar and will be in relentless denial
  • Suspects frequently move from doctor to doctor and/or hospital to hospital making it difficult to establish a pattern of the abuse.

The FBI has the following tips for investigating suspected Munchausen Syndrome by Proxy cases: 

  • Investigators assigned to work child abuse cases should investigate cases of MSBP as they do similar cases of abuse. In general, however, when confronted with possible cases of MSBP, investigators should:
  • Review the victim's medical records to determine condition and illness
  • Determine from contact with medical personnel the reporting parent's concerns and reactions to the child's medical treatment
  • Compile a complete history of the family to determine previous involvement with law enforcement agencies, medical facilities, and social and child protection services
  • Compile a detailed social history of the family, including deaths, injuries, and illnesses
  • Interview family members, neighbors, and babysitters
  • Use video surveillance in the hospital in accordance with State law, and
  • Use a search warrant for the family's residence when collecting evidence of the assaults.

False accusations do occur, but are rare according to research.  There are organized groups of mothers, such as M.A.M.A. (Mothers Against Munchausen Syndrome by Proxy Allegations) that actively claim that MBP is comparable to a witch hunt.


Abuse of a victim of MSBP is resolved in one of the three ways:  the child dies; the perpetrator is caught and brought into the justice system; the perpetrator moves on to a younger child within the family. Unfortunately, the consensus is that Munchausen Syndrome by Proxy is not that rare.  It does not respond to therapy, and has a very grim prognosis. Hopefully, the information presented in this article will alert the law enforcement community to the warning signs of MSBP so that they can better identify perpetrators and protect innocent victims.


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Pamela Kulbarsh, RN, BSW has been a psychiatric nurse for over 25 years. She has worked with law enforcement in crisis intervention for the past ten years. She has worked in patrol with officers and deputies as a member of San Diego's Psychiatric Emergency Response Team (PERT) and at the Pima County Detention Center in Tucson. Pam has been a frequent guest speaker related to psychiatric emergencies and has published articles in both law enforcement and nursing magazines.

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