[Münchhausen syndrome by proxy: a challenge for medicine]

In Münchhausen syndrome by proxy, a subject, usually a mother, pretends her child has a serious medical disorder. After simulating ficticious symptoms, or even producing clinical signs such as convulsions, fever, bleeding, vomiting, diarrhea or skin eruptions, the mother repeatedly takes her child to different hospitals for care. During hospitalization, the mother shows great concern for the child and is highly cooperative with the health care team. The consequences may be unwarrented, often invasive, investigations and therapy with a very high risk of morbidity and mortality. The underlying psychopathological structure is difficult to apprehend. Narcissic fragility and borderline personality are the must frequent, but passive-dependent hysteric personality or sadomasochist behavior can be found and depression is often associated. The main, if not the sole, benefit for the mother lies in the leading role she plays during the repeated hospitalizations in front of the admizing medical staff. Rare cases of adult-adult Münchhausen syndrome by proxy have also been reported. Physicians should be aware of this syndrome in order to avoid unintentional participating in this morbid scenario by performing useless invasive examinations or by prescribing dangerous medication. Psychiatric treatment and sometimes legal action are required to avoid this particular kind of child abuse.