History of Munchausen
In the 18th century, Karl Friedrich Hieronymus also known as Baron von Munchausen (1720-1797) was known for his highly unlikely stories of adventure and escapes and being one of the most notorious liars in the century. In 1737 as a German soldier, he served in the Russian–Turkish war and returned with exaggerated stories of adventure. Every evening after supper in the banqueting-hall he would gather his friends and those in attendance and tell stories of his past. He loved the attention he received from the stories he would tell.His stories were so extreme and extravagant that an author named Rudolph Erich Raspe, who was seeking refuge in England from the German law, decided to write about the adventures of Munchausen.The first edition of Munchausen's tales that was attributed to him appeared anonymously in 1785 and was called Baron Munchausen's Narrative of his Marvelous Travels and Campaigns in Russia. Gottfried August Burger edited the first German version the following year. Rudolph Erich Raspe never claimed his rights over the success from his books. Some still debate whether Raspe or Burger actually published the first book about the tales of Baron von Munchausen. Munchausen’s tales are so outrageous; many of the stories attributed to him have appeared in French, Spanish, Welsh and Greek literature. (Heritage, 2013) Today his name is known for boasting, fabrications and exaggerated stories.
Definition
In 1951the name Munchausen made its way into healthcare by Dr. Richard Asher. Because of the correlation between Baron Munchausen’s fictional stories and the exaggerated and made up symptoms he used the term "Munchausen Syndrome" to characterize patients who fabricate illness and subject themselves to unpleasant and potentially harmful medical procedures. In 1977 an English pediatrician Dr. Roy Meadow created the term "Munchausen Syndrome by Proxy" (MSBP) after discovering that several of his epileptic patients' mothers had fabricated the children's symptoms. (Karlin,N 1996). "By proxy" indicates that a parent or other adult is making up or exaggerating symptoms in a child, not in himself or herself.
Munchausen by Proxy syndrome is a pattern of behaviors in which a caregiver fabricates, exaggerates an illness, or induces mental or physical health problems in those who are in their care. In most cases of children, the mother is the perpetrator. The victims are usuallychildren under the age of 6. Some cases have been reported of victimized children up to the age of 16. The perpetrators are usually women between the ages of 20-40 and white men between the ages of 30-50. These people are usually in the medical field such as nurses or medical technicians or have so kind of medical knowledge.
There are three types of MBPS perpetrators:
1) Help seekers- these motherswant attention and know they are able to get it by having an ill child. But really they seek medical treatment for their own anxieties, depression, exhaustion or inability to care for the child. There is usually domestic violence in the home, marital problems, unwanted pregnancies or single parenthood.They are generally responsive to counseling. 2) Doctor addicts- these mothers are obsessed with medical treatment for nonexistent illnesses in their children. They believe their children are ill and refuse to believe the contrary even when presented with physical evidence such as lab reports. The mothers are usually distrustful, angry and paranoid. The child is usually older than 6 years old. 3) Active inducers- these mothers induce illnesses upon their child by dramatic methods. They are depressed and anxious and often paranoid. They treat the doctors and medical staff as great and outstanding caretakers. (Mateolli, 2009)
Research has found the drivefor MBPS is a need for attention and sympathy from doctors, nurses, and other professionals. However, some experts believe that it isn't just the attention that's gained from the "illness" of the child that motivates this behavior, but also the satisfaction in deceiving individuals whom they consider to be more important and powerful than themselves. (Lyness, 2015)MBPS is a serious and psychiatric condition. In some cases, the perpetrators were themselves abused, physically and/or and sexually, as children. They may have come from families in which being sick was a way to get love or attention.
Diagnosing Munchausen by Proxy
Diagnosis is very difficult, but could involve some of the following: * a child who has multiple medical problems that don't respond to treatment or that follow a persistent and puzzling course * physical or laboratory findings that are highly unusual, don't correspond with the child's medical history, or are physically or clinically impossible * short-term symptoms that tend to stop or improve when the victim is not with the perpetrator (for example, when the child is hospitalized) * a parent or caregiver who isn't reassured by "good news" when test results find no medical problems, but continues to insist that the child is ill and may "doctor shop" to find a professional who believes that * a parent or caregiver who appears to be medically knowledgeable or fascinated with medical details or seems to enjoy the hospital environment and attention the sick child receives * a parent or caregiver who's overly supportive and encouraging of the doctor, or one who is angry and demands further intervention, more procedures, second opinions, or transfers to more sophisticated facilities (Lyness, D2015)
In some cases hospital staff has even placed hidden cameras in the child’s room for definitive evidence. MBPS is not only a psychiatric condition but also child abuse and a criminal offense.
The Effects of Munchausen by Proxy on Children
Children who fall victim to a parent suffering from Munchausen by Proxy Syndrome quite often require extensive emergency medical care, and undergo several unnecessary procedures such as painful surgeries and physical testing. They can suffer short term and long term physical and psychological effects. Cases have been reported where children developed destructive skeletal changes, limps, mental retardation, brain damage and blindness.Ten percent die from their injuries.Younger children may believe that they are responsible for their illness and they are being punished for their behavior. Older children suffer aloss of education and loss of social interactions with peers their own age due to multiple hospitalizations and absenteeism from school. The child must be protected and usually involves being removed from the perpetrator by child protective services. Some reports have even shown victims of MBPS to become Munchausen patients themselves as adults.

Treatment for the Perpetrator
The mother or perpetrator will most likely face criminal charges.It is important for the court system to mandate psychotherapy for the sufferer, or the problem will not be assessed and treated. Perpetrators of MBPS suffer from various types of personality disorders, depression and anxiety. Mothers suffering from Munchausen by Proxy Syndrome are highly unlikely to voluntarily seek treatment. The person may need therapy for years to come or even a lifetime and most of the times will not regain custody of their child. There is no known specific cause for the condition but many perpetrators were abused themselves and for reasons not fully understood, never developed a healthy relationship with their child.It is a very difficult to treat this condition effectively. Knowledge of how to treat Munchausen by Proxy Syndrome is limited.

Abstract
Munchausen by Proxy Syndrome is a condition named after a German soldier who was known for telling exaggerated and fabricated stories to get attention from friends and anyone who would listen. His stories were so far-fetched that an author in England decided to write and publish a book about the extravagant stories of Baron von Munchausen. Many years later a doctor by the name Richard Asher noticed certain patients who were making themselves ill to get attention, and used the correlation to develop the term Munchausen syndrome. Later a pediatrician in England naned Roy Meadows discovered some of his epileptic patients were having seizures caused by their mothers. He developed the term Munchausen by Proxy Syndrome. This is a condition whereas the caregiver causes psychological or physical symptoms in a person in their care. The cause is usually for attention.

References
Mateolli, R 2009,The Munchausen Complex: Socialization of Violence and Abuse
Karlin, N 1996 Munchausen Syndrome by Proxyhttp://earthops.org/munchausen/munchausen.html
Lyness, D 2015 http://kidshealth.org/parent/general/sick/munchausen.html http://www.heritage-history.com/index.php?c=read&author=raspe&book=baron&story=_front Dubowitz, H, Lane WG. Factitious disorder by proxy (Munchausen syndrome by proxy). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics 2013
Vesalius. 2002, http://www.ncbi.nlm.nih.gov/pubmed/12422889
Feurtado, Jessica May 15, 2004http://allpsych.com/journal/munchausen/#.Vh6rVflViko
Schreier, H.A., &Libow, J.A. (1993).Hurting for Love: Munchausen by Proxy Syndrome. New York: The Guilford Press.