In a playgroup I attend, the mothers often talk about one woman. She seems to always have a crisis and has told many stories over the years -- about having been attacked, having a brain tumor, being infertile, being stalked, having miscarriages. None of these stories hold up, and people who have tried to help have found no any evidence of these crises (no hospital records or police reports, etc.). Now, in the few months since her baby was born, she has been rushing the infant to the hospital with one ailment or another. The hospital never finds anything wrong with the child. One woman in our group tried to talk to a family member and was dismissed angrily, so she called the child abuse hotline. Now the state is intervening on behalf of the child. This whole thing seems unbelievable to me. Have you ever heard of this type of disturbing behavior? Are there books that an average layperson can read to learn more about it?

R.

The behavior you describe sounds like what has traditionally been known as Munchausen's syndrome and Munchausen's syndrome by proxy. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (or DSM-IV), the current "Bible" of psychiatric diagnosis, the conditions are called "factitious disorder" and "factitious disorder by proxy."

Munchausen's is characterized by seeking medical attention or the sympathy of others through phony illnesses and the creation of illnesses. Some people with Munchausen's syndrome, for instance, inject themselves with substances to create fevers and infections. Others may report physical symptoms that lead physicians to perform exploratory surgery in which no disease or injury is discovered. Some may shave their heads and purposefully lose weight to pass themselves off as cancer patients receiving chemotherapy or radiation treatments.

People with Munchausen's syndrome by proxy do similar things to their children. They may smother their infants in order to facilitate a dramatic resuscitation, or poison their children to mimic infection or disease. The parents will, of course, vehemently deny harming their children and may appear to be model caregivers during the subsequent medical crises. As you can understand, the children of people with Munchausen's syndrome by proxy are in danger of being seriously injured or killed by their parents' behavior.

Experts suspect that the conditions are a form of attention-seeking behavior gone out of control. The "Munchausen" name comes from the legendary teller of tall tales Baron von Munchausen. The "by proxy" part refers to the individual's creating tales (or crises) about another person -- usually a dependent child -- in order to get attention and praise for good caregiving.

The diagnosis of Munchausen's syndrome does not apply to individuals who are conscious frauds and are faking their own or a child's illness for some secondary gain, such as disability payments or a lawsuit. Rather, there appear to be deeper psychological reasons for this behavior. You can read more about Munchausen's syndrome and Munchausen's syndrome by proxy in the book Patient or Pretender: Inside the Strange World of Factitious Disorders, by Marc D. Feldman and Charles V. Ford.