Munchausen syndrome by proxy: Early recognition and management

“Munchausen Syndrome by proxy” is a factitious disorder wherein the medical attention-seeking behavior is transposed to individuals (often children) cared for by the perpetrator. The person induces symptoms and signs on the dependent individual who she/he is in charge of. It is a variation of factitious disorder where in assumption of sick role is placed on the victim instead of self. There are several red flag signs that should raise the suspicion of confirming this diagnosis. Psychiatric healthcare professionals should ensure utmost scrutiny in considering and evaluating the possibility of such a diagnosis particularly when the red flag signs are noticed. The focus should be on child neglect and maltreatment rather than the controversial issues of motivation and intentionality of the caregiver. Medical professionals should also be aware of the challenges encountered such as denial of diagnosis and refusal of or nonadherence to treatment. It also requires liaison with the interdisciplinary team for effective management.