Which statement best distinguishes Munchausen syndrome from Munchausen by proxy?

• A. Munchausen syndrome involves the patient fabricating illness; Munchausen by proxy involves a caregiver causing illness in a child.
• B. Munchausen syndrome involves the caregiver causing illness in a child; Munchausen by proxy involves the patient fabricating illness.
• C. Munchausen syndrome is a form of phobia; Munchausen by proxy is a form of neurosis.
• D. Munchausen syndrome is treated with psychotherapy; Munchausen by proxy requires no treatment.

Answer: (B)

The key idea is who is fabricating or inducing the illness. Munchausen syndrome refers to a factitious disorder where the person themselves fabricates or feigns symptoms to assume the sick role and seek medical care. Munchausen by proxy is a factitious disorder imposed on another, where a caregiver—often a parent—causes or fabricates illness in someone under their care, typically a child, to gain attention or sympathy. So the distinction is self-directed deception versus caregiver-directed deception in someone else.

The statement you were given is reversed. Munchausen syndrome involves the patient fabricating illness in themselves, while Munchausen by proxy involves a caregiver causing illness in a child. (Note: the modern terms align with the same concepts—factitious disorder by self and factitious disorder imposed on another.)