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Clinical Child Psychology and Psychiatry
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Munchausen Syndrome by Proxy: A Narrative Approach to Explanation

Peter Loader

Guy's and St Thomas' Hospital

Ciaran Kelly

Great Ormond Street Hospital for Children

Munchausen Syndrome by Proxy (MSBP) is generally categorized as an unusual variant of child abuse, and one where the mother is the usual perpetrator. Explanations of this extraordinary condition focus on characteristic features of the mother and the family. This article attempts to complement these findings with a narrative approach, viewing MSBP as the outcome of a particular human story. A detailed case history is presented and linked to clinical and research findings in an attempt to track the evolution of the behaviour we categorize as MSBP. This view suggests that MSBP is best seen as a process, and one in which the key relationship is between the mother and the child's doctor. Such a view has important implications for the detection and management of this increasingly recognized problem.

Key Words: case study • factitious illness • Munchausen Syndrome by Proxy (MSBP)

Clinical Child Psychology and Psychiatry, Vol. 1, No. 3, 353-363 (1996)
DOI: 10.1177/1359104596013005
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M. J. Sanders
Hospital Protocol for the Evaluation of Munchausen by Proxy
Clinical Child Psychology and Psychiatry, July 1, 1999; 4(3): 379 - 391.
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