"Munchausen by proxy syndrome": not only pathological parenting but also problematic doctoring?

Jon N Jureidini, Allan T Shafer and Terence G Donald
Med J Aust 2003; 178 (3): 130-132. || doi: 10.5694/j.1326-5377.2003.tb05104.x
Published online: 3 February 2003


  • Certain social expectations of medicine combine with characteristics of subspecialised technological paediatrics to facilitate the form of child abuse labelled "Munchausen by proxy syndrome".

  • Examining this form of child abuse highlights possible shortcomings of medical practice.

  • The primary medical tasks of diagnosing and curing illness and of preventing suffering are sometimes overridden by other motivations of which doctors may not be fully aware.

  • More open discussion of what motivates health professionals in their work may improve medical practice and lead to a reduced incidence of Munchausen by proxy syndrome.

The label "Munchausen by proxy syndrome" is best applied to cases of child abuse in which a caregiver, usually the child's mother, fabricates symptoms or induces illness in a dependent child, and the doctor mistakenly believes that a naturally occurring illness is present.1 Thus, an active interaction between the caregiver-perpetrator and medical professional is required for the syndrome to occur.

There is an increasing expectation that medicine will cure all ills and end all suffering, and an ensuing societal hostility towards the profession for its consequently inevitable shortcomings in diagnosis and management. We believe that social expectations of and the nature of modern medical practice lead vulnerable doctors, when exposed to Munchausen by proxy syndrome (MBPS) perpetrators, to become unwittingly complicit in the cruel mistreatment of children. We suggest that MBPS may arise when doctors are unable to accept, on behalf of our society, our limitations in dealing with undiagnosable illness or abusive mother–child relationships.

Psychological theories of organisational dynamics have been used to examine society's reliance on medical systems to help manage and avoid anxieties about illness and death.2 In keeping with this tradition, we propose that MBPS demonstrates that doctors' primary tasks might not conform to the role allocated by society, but might be distorted or corrupted by organisational and other pressures.

Clinical practice: contributing characteristics

What characteristics of the medical system allow situations of misdiagnosis and unnecessary investigation of MBPS to develop? Some, such as increased consumer involvement, subspecialisation and risk management, are relatively new; others, such as professional standing and rivalries with colleagues, are longstanding.

Recent trends
Doctor: innocent bystander or guilty party?
Essential to the drama

In cases of MBPS, the doctor may not be an innocent bystander in the deceptive process: MBPS abuse doesn't properly start until a doctor becomes actively engaged in the process;4 and MBPS perpetrators create dramas of medical interest. The enthralling excitement of life-and-death activities and decisions is an aspect of work that engages many doctors. The heroic, last minute, life-saving intervention, as exemplified in Jane's case, is too commonly the standard of the medical genre. Doctors' personal and professional lives may be compromised by their inability to put aside such excitement in favour of their own parental, marital and clinical responsibilities.

  • Jon N Jureidini1
  • Allan T Shafer2
  • Terence G Donald3

  • 1 Department of Psychological Medicine, Women's and Children's Hospital, Adelaide, SA.
  • 2 Perth, WA.
  • 3 Child Protection Service, Women's and Children's Hospital, Adelaide, SA.



JJ's contribution is supported by an Australian Research Council grant.

Competing interests:

None identified.

  • 1. Donald T, Jureidini J. Munchausen by proxy syndrome: child abuse in the medical system. Arch Pediatr Adolesc Med 1996; 150: 753-758.
  • 2. Obholzer A. Authority, power and leadership: contributions from group relations training. In: Obholzer A, Roberts VZ, editors. The unconscious at work: individual and organizational stress in the human services. London: Routledge, 1994: p39-47.
  • 3. Jureidini J, Donald T. Child abuse specific to the medical system. In: Adshead G, Brooke D, editors. Munchausen syndrome by proxy. Current issues in assessment, treatment and research. London: Imperial Press, 2001: 39-47.
  • 4. Greenacre P. The imposter. Psychoanal Q 1958; 27: 359-382.


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