The mother of a 2-year-old boy says that he won't stop vomiting. The child looks happy and normal, his vital signs are normal, and his physical examination reveals no pathology. The mother insists that the child is very ill and needs to be hospitalized “again.” You ask for old records and find five prior admissions with similar complaints, but no organic diagnosis has ever been uncovered. In addition, no one other than the mother has ever seen the child vomit. You expect the mother:
To depart immediately when the child is admitted.
To demonstrate frank psychosis.
To have a background in health care.
To have antisocial personality disorder.
To ignore the child.
The caretaker in Münchausen syndrome by proxy is the biologic mother in 98% of cases. Many have a background in health professions or social work. Depression, anxiety, and somatization are common, but frank psychotic behavior is atypical. The perpetrators of Münchausen syndrome by proxy are typically pleasant, cooperative, and appreciative. They often will stay in the hospital with their child and cultivate close relationships with hospital staff.