A:

In Munchhausen’s syndrome, patients either invent or cause illness in themselves. In Munchhausen’s syndrome by proxy (MBP), a caretaker produces or fakes illness in someone else.

In MBP, the perpetrator is usually a mother and the victim a small child. It is a form of child abuse. Consequences can range from minor to fatal.

In both illnesses, a person may demand intrusive procedures or surgery. Further complications can happen. Caretakers may tamper with lab tests. They may injure themselves or a child, or interfere with healing.

Münchhausen was an 18th-century German baron. He was known for telling wild stories. His stories were further exaggerated by other writers after his death.

The diagnostic manual in psychiatry calls Munchhausen’s syndrome a factitious disorder. The motivation is “to assume the sick role.”

People with factitious disorders deceive on purpose. They seem to want to appear ill and interact with the medical system. But the reasons are not clear. Patients seldom talk about their motivation.

The fakery is so good that MBP is nearly impossible to diagnosis. The child’s caregiver may object if a doctor calls for an evaluation. The caregiver may even express outrage. Child abuse and neglect laws may allow an inquiry. But it’s easy to be wrong. And investigations are always intrusive.

The doctor may only be able to make the diagnosis if the perpetrator slips up. During my training, I saw a person with a strange skin condition. Dermatologists could not explain it.

It turns out he had been burning himself repeatedly with cigarettes. Then he was scratching at the wounds to keep them open. A diagnosis of Munchhausen’s syndrome was made when a member of his family caught him doing it.