Munchausen syndrome by proxy (MSBP), more formally known as factitious disorder imposed on another, is a form of abuse in which a caregiver deliberately produces or feigns illness in a person under his or her care so that the proxy will receive medical care that gratifies the caregiver. Although well documented in the pediatric literature, few cases of MSBP with adult proxies (MSB-AP) have been reported. This study reviews existing literature on MSB-AP to provide a framework for clinicians to recognize this disorder. We searched Ovid MEDLINE, Ovid EMBASE, PubMed, Web of Knowledge, and PsychINFO, supplemented by bibliographic examination. We identified 13 cases of MSB-AP. Perpetrators were caregivers, most (62%) were women, and many worked in healthcare. The age range of the victims was 21 to 82 years. Most were unaware of the abuse, although in 2 cases the victim may have colluded with the perpetrator. Disease fabrication most often resulted from poisoning. MSB-AP should be included in the differential diagnosis of patients presenting with a complex constellation of symptoms without a unifying etiology and an overly involved caregiver with suspected psychological gain. Early identification is necessary so that healthcare providers do not unknowingly perpetuate harm through treatments that satisfy the perpetrator's psychological needs at the proxy's expense.

Munchausen syndrome by proxy is a persistent fabrication of illness done by a person to another. Renal and urologic forms of this syndrome are not as uncommon as can be thought; a review of all the cases of Munchausen-by-proxy syndrome reveals that 25% of the children had renal or urologic issues. This syndrome can result in a serious diagnostic dilemma for the physicians; knowing this entity can allow early recognition of falsification and limit the physical and psychological damages caused in the victim. In this study, we reviewed the pediatric nephrology cases of Munchausen syndrome by proxy, grouping them through the principal signs of presentation.

Münchhausen syndrome by proxy (MBPS), also commonly referred to as Medical Child Abuse (MCA), and now officially classified in the DSM-5-TR as Factitious Disorder Imposed on Another (FDIOA), is a severe condition that involves a caregiver who fabricates or induces signs and symptoms of physical, psychiatric, or developmental disorders in a child or other dependent victim. The primary motivation is the achievement of psychological gain—such as attention and sympathy—rather than obvious external benefits. Unfortunately this is frequently observed by health teams in clinics, hospital wards and emergency rooms and undoubtedly, these conditions generate high costs and unnecessary procedures in health care facilities and sometimes can evolve into the death of the child, depending on the gravity of the illness or the abuse. It is important for both physical and mental health of the children to diagnose as soon as possible this disorder and that’s why our team decided to write this review, in order to provide a complete and updated manuscript about such often misdiagnosed pathology so dangerous for children. Münchhausen syndrome by proxy (MBPS), also commonly referred to as Medical Child Abuse (MCA), and now officially classified in the DSM-5-TR as Factitious Disorder Imposed on Another (FDIOA), is a severe condition that involves a caregiver who fabricates or induces signs and symptoms of physical, psychiatric, or developmental disorders in a child or other dependent victim. The primary motivation is the achievement of psychological gain—such as attention and sympathy—rather than obvious external benefits. Keywords Münchhausen syndrome by proxy – MBPS FDIOA - factitious disorder imposed on another FDIA- paediatric condition falsification Medical child abuse Caregiver-fabricated illness Münchhausen by proxy syndrome - MBP pmc-status-qastatus 0 pmc-status-live yes pmc-status-embargo no pmc-status-released yes pmc-prop-open-access yes pmc-prop-olf no pmc-prop-manuscript no pmc-prop-legally-suppressed no pmc-prop-has-pdf yes pmc-prop-has-supplement no pmc-prop-pdf-only no pmc-prop-suppress-copyright no pmc-prop-is-real-version no pmc-prop-is-scanned-article no pmc-prop-preprint no pmc-prop-in-epmc yes pmc-license-ref CC BY-NC-ND issue-copyright-statement © Società Italiana di Pediatria 2026 Introduction Münchhausen syndrome by proxy (MBPS) is a form of child abuse, that typically occurs when a caregiver abusively and compulsively falsifies physical, psychiatric or developmental disorders in a child or adult victim in order to satisfy the psychological need to gain attention. Table 1 Diagnostic criteria of FDIOA (DSM5 - TR) Diagnostic criteria of FDIOA (Munchausen syndrome by proxy) 1. Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another, associated with identified deception. 2. The individual presents another individual (victims are generally children or elders or pets) to others as ill, impaired, or injured. 3. The deceptive behavior is evident even in the absence of obvious external rewards. 4. The behavior is not better explained by another mental disorder, such as delusional disorder or another psychotic disorder The diagnosis is received by the perpetrator, not the victim of the abuse. Another psychiatric disorder that has been reported in FDIOA is for example the catatonia: a picture of immobility/stupor, mutism, staring, verbigeration with hypernasality and slurred speech, rigidity, aggressive and stereotypic speech, mutism and withdrawal, which has been described in a 12-year-old female with a history of concerns of child abuse and Munchausen by proxy imposed by the mother [ 49 ]. Eating disorders by proxy are also reported in literature, such as bulimia or anorexia Conditions that may mimic Munchausen syndrome by proxy and which must be considered in the differential diagnosis: Deception to avoid legal liability. Caregivers who fabricate or exaggerate injuries in dependents solely to shield themselves from legal repercussions are not classified as having factitious disorder imposed on another. This is because their motivation stems from external incentives, such as avoiding liability, which are evident even without overt external rewards (Criterion C). It is important to note that the presence of factitious disorder does not rule out the coexistence of genuine medical or mental health issues. For instance, a person manipulating blood sugar levels to mimic symptoms of diabetes may also genuinely have diabetes [ 4 ]. The treatment of FDIOA The treatment for the perpetrator Understanding the psychopathology of individuals who perpetrate Munchausen by Proxy (MBPS) is crucial when addressing the needs of affected families. Psychological interventions such as narrative therapy, trauma-focused cognitive-behavioral therapy, dialectical behavior therapy, and family therapy can be beneficial. These approaches aim to develop a comprehensive care plan for the child, involve parents actively in the treatment process, and enhance the family’s overall well-being. Special attention should be given to siblings and the father of the victim, as they may have been neglected or affected during the abuse. Fathers may require individual therapy to process their emotions and feelings of guilt related to their lack of awareness. Prolonged, unnecessary hospitalizations and the focus on illness often lead to significant gaps in education, socialization, and age-appropriate play, hindering developmental milestones and contributing to difficulties with academic and social integration (Phase III C). On the other way, others victims having been subjected to continuous medical intervention, harbor a profound distrust of and fear toward the healthcare system. This can lead to delaying or refusing necessary medical care later in life [ 100 – 104 ]. Conclusion Münchausen syndrome by proxy is a very dangerous pathology often underdiagnosed or misdiagnosed.

<h4>Background</h4>Factious disorder imposed on another (FDIA) is a severe yet often undetected form of abuse and mental disorder in which a caregiver recurrently falsifies a disease in another person to obtain medical and secondary benefits. We conducted this review to summarize the characteristics of both the perpetrators and the victims, as well as the interventions and outcomes.<h4>Methods</h4>Seven electronic databases were searched for FDIA case reports and series published from the establishment of the database to August 20, 2024. Our search yielded 314 studies covering a total sample of 455 perpetrators and 469 victims. Information extracted included demographic and clinical characteristics of perpetrators and victims, in addition to interventions and outcomes.<h4>Results</h4>Most of the victims were children (28.36%) and adolescents (27.93%), with slightly more males (56.50%) than females (43.50%). Most perpetrators were female (92.75%), married (52.09%), literate (30.33%), employed (26.59%), and with stable economic status (20.44%). Both the victims and perpetrators had physical, psychological, and behavioral problems. The most common intervention for FDIA was medical treatment, which was received by 25.49% of perpetrators and 40.51% of victims. The most common outcomes were victims being raised by foster care or social authorities (14.50%) and perpetrators being accused of a crime (29.67%).<h4>Conclusion</h4>Our review opens the possibility of creating international multicenter databases of abuse cases in the FDIA context, which requires a multidisciplinary and transcultural approach to include all single case reports or case series to enrich the understanding of FDIA.

The history of an older child victim of Munchausen by proxy (MBP) is described. He was referred for evaluation after repeated sinus surgeries for recurrent sinus infections believed to be related to a falsified history of an immunodeficiency. The perpetrator was the mother of this 14-year-old victim, consistent with the majority of such cases. This case prompted a review of cases of MBP in older children reported in our hospital as well as a literature search for other cases in older children. This study was a chart review of children over 6 years of age who had been evaluated by social services at the Children's Hospital at the Cleveland Clinic and reported as cases of Munchausen by proxy to Child Protective Services between January 2001 and June 2003. Also, an OVID, Psychline, and Pubmed literature review of published cases of Munchausen by proxy were identified, and cases occurring in the older child were selected for review. Older children who are the victims of Munchausen by proxy may have an induced illness, but falsified reports of symptoms and medical history to coerce the child to undergo medical procedures may be more common. Collusion of the victim with the perpetrator may also become a factor as the child ages and adopts the deception. Given the complex relationship that exists between the parent and child, it is difficult to predict whether the victim either will assist the caregiver in maintaining the factitious illness or be able to recognize the falsification. Older children who are the victims of Munchausen by proxy may fear consequences of revealing the factitious illness. Physicians must consider the possibility of this diagnosis whenever there are discrepancies in a child's illness that makes a factitious illness a consideration.

Munchausen syndrome by proxy: recognizing the victim. Munchausen syndrome by proxy is a serious and potentially lethal form of child abuse in which a parent deliberately induces or reports physical symptoms in a child. The child not only suffers from parent's action, but he or she is subjected to an extensive battery of invasive medical and radiological testing that are unnecessary and painful. All health care professionals must work together to ensure that the syndrome is discovered in time and the child is protected. The child's psychological and physiological welfare are in danger. Published in Pediatric nursing

Munchausen syndrome by proxy: a review. Munchausen syndrome by proxy is a form of child abuse in which a parent or caretaker simulates or produces illness in a child. Case reports of Munchausen syndrome by proxy document a wide and confusing spectrum of symptoms. The children who are the victims of this syndrome suffer morbidity linked to numerous unnecessary hospital admissions and diagnostic procedures, severe psychological morbidity, and a significant risk of mortality. Because of these extreme consequences, all health-care professionals must be able to recognize its warning signals. Published in Texas medicine (1991)

Munchausen by proxy syndrome: the triad of abuse, self-abuse, and deception. The Munchausen By Proxy Syndrome (MbPS) is a complicated phenomenon whereby a peculiar threefold relationship between perpetrator, victim, and medical staff develops. This triad is based on abuse of the child, deception of the doctor, and, in many cases, self-abuse or passivity of the victim towards the perpetrator's deeds. We have analyzed the interrelationship between the perpetrator, the victim, and the medical authority, in light of the mother's pathology. Published in Comprehensive psychiatry

Psychologic morbidity of children subjected to Munchausen syndrome by proxy. Munchausen syndrome by proxy is being recognized and reported with increasing frequency, which suggests that it is more common and occurs with a wider spectrum of severity than was previously suspected. In past reports, the difficulties of detecting and documenting the syndrome have been emphasized, as well as its physical morbidity and mortality. The psychologic morbidity of Munchausen syndrome by proxy in six children is described. The children reacted with developmentally appropriate behavior problems ranging from feeding disorders in infants, withdrawal and hyperactivity in preschool-aged children, to hysterical disorders and personal adoption of Munchausen syndrome behavior in adolescents. Parental psychologic and behavioral styles, family dynamics, and responses from legal and children's protective services systems make protection of the child within the home difficult, if not impossible. Even with protection from further physical injury, severe psychologic trauma remains likely. Extreme caution is suggested in allowing these children to remain in the family. Published in Pediatrics (1989)