Munchausen syndrome by proxy: an adult dyad.

Munchausen syndrome by proxy (MSBP) is a form of abuse in which an individual deliberately produces or feigns clinical illness in a person under his or her care. Although well-documented in the child and adolescent literature, few case reports document MSBP with an adult proxy. We describe two patients: (1) Ms. A, a 21-year-old female, with recurrent episodes of polymicrobial bacteremia of unknown etiology, and (2) Ms. B, a 23-year-old female, with a history of a recurrent painful rash involving the pudenda. In the first case, medical staff found in the patient’s bed a syringe with an uncapped needle that contained a cloudy substance that grew the same organisms found in her blood. In the second case, the rash responded to topical treatment but dramatically worsened on the day of planned discharge. When the mother’s visitation was restricted and supervised, the rash immediately improved. Although typically reported in pediatric patients, MSBP should be considered in adult dyads when a patient’s medical problems do not respond as expected to therapy, and a caretaker appears overly involved or attention-seeking. Victims may suffer from “Stockholm syndrome,” holding the caretaker in high regard despite danger, even at risk of death. Munchausen syndrome by proxy (MSBP) is a mental illness characterized by a caregiver—the perpetrator—deliberately producing or feigning physical or psychological signs or symptoms in another person—the victim—who is under the perpetrator’s care. 1 The perpetrator’s psychological needs are met through the attention he or she receives during medical evaluations of their charge, even as induced conditions and iatrogenic complications can cause victims significant morbidity and even mortality. While MSBP is well described in the pediatric literature, 2 only seven cases have been reported with adult victims, 3‐9 and in three of these cases, the perpetrator was the same person. We believe that MSBP with an adult victim is underrecognized. We present two such cases with the objective