Obstacles to the treatment of Munchausen by Proxy syndrome.

The Munchausen by Proxy Syndrome, in which a parent makes a child appear to be ill, was first reported in 1977. Although the features of this syndrome have been delineated and the psychodynamics are increasingly well understood, our experience with a new case, expanded review of the literature, and examination of certain follow-up data suggest that there exist important obstacles to the appropriate management of these cases. The obstacles include a failure to appreciate fully the relationship of this syndrome to that of nonaccidental poisoning; the striking symbiotic tie between parent and child that exists in these cases; the characteristic and highly persuasive denial on the part of parents when confronted with the situation; and the understandable skepticism on the part of legal authorities when asked to intervene on behalf of the child. The consulting child psychiatrist has an important role to play to assure that the children and parents involved in these cases (which are probably more numerous then previously recognized) receive appropriate medical and psychologic care and are protected from the apparently high child mortality rate of this serious disease.