The family systems of Munchausen syndrome by proxy.

Munchausen Syndrome by Proxy describes a parent who fabricates the appearance of physical illness in a child. Previous descriptions of the syndrome have focused exclusively upon medical or psychiatric assessments of the involved child and perpetrating parent. The family evaluations of two cases presented here suggest that Munchausen Syndrome by Proxy may be a systemic syndrome generated when a mother already possessing a somatoform or factitious disorder joins an enmeshed, authoritarian family system possessing a systemic history of exploitation of children. We suggest that measures instituted to protect the abused child must take into account the systemic function of the Munchausen by Proxy behavior in maintaining family stability, lest such measures be rendered ineffective by family members. When there is ongoing victimization of perpetrating parents in a similar pattern of dominance/submission within their own family of origin, disruption of these intergenerational patterns of exploitation may be a necessary component of treatment.