The Narcissist's Seriously Ill child and Munchausen by Proxy Syndrome

By Sam Vaknin
Author of "Malignant Self-love: Narcissism Revisited"

Narcissistic parents of seriously ill children derive narcissistic supply from onlookers, friends, family, colleagues, and community by attracting attention to their role as saintly caretakers. They are demonstratively and ostentatiously patient, compassionate, suffering heroically, and dedicated to the child, its welfare, and ultimate healing. They flaunt the child's sickness as a kind of a hard-won but well-deserved medal, down in the trenches with their tortured offspring, doing desperate battle with a pitiless enemy: the disease. It is an intoxicating part in the unfolding film that is the narcissist's life.

But this irresistible craving for attention should be demarcated from the sinister affliction colloquially known as Munchausen by Proxy Syndrome.

Patients afflicted with the Factitious Disorder colloquially known as "Munchausen Syndrome" seek to attract the attention of medical personnel by feigning or by self-inflicting serious illness or injury. "Munchausen by Proxy Syndrome" (Factitious Illness or Disorder by Proxy, or Imposed by Another, or FII - Fabricated or Induced Illness by Carers) involves the patient inducing illness in or causing injury to a dependent (child, old parent) in order to gain, in her capacity as a caretaker, the attention, praise, and sympathy of medical care providers. Both syndromes are forms of shared psychosis (folie a deux or a plusieurs) and "crazy-making" with hospital staff as unwilling and unwitting participants in the drama.

Superficially, this overwhelming need for consideration by figures of authority and role models (doctors, nurses, clergy, social workers) resembles the narcissist's relentless and compulsive pursuit of narcissistic supply (which consists of attention, adulation, admiration, being feared or noted, etc.) But, there are some important differences.

To start with, the narcissist - especially the somatic variety - worships his body and cherishes his health. If anything, narcissists tend to be hypochondriacs. They are loath to self-harm and self-mutilate, let alone fake laboratory tests and consume potentially deleterious substances and medications. They are also unlikely to seriously "damage" their sources of supply (e.g., children) as long as they are compliant and adulating.

As opposed to narcissists, people with both Munchausen Syndromes desire acceptance, love, caring, relationships, and nurturing, not merely attention: theirs is an emotional need that amounts to more than the mere regulation of their sense of self-worth. They have no full-fledged False Self, only a clinging, insecure, traumatized, deceitful, and needy True Self. Munchausen Syndrome may be comorbid (can be diagnosed with) personality disorders, though and the patients are pathological liars, schizoid, paranoid, hypervigilant, and aggressive (especially when confronted.)

While narcissists are indiscriminate and "promiscuous" when it comes to their sources of narcissistic supply - anyone would do - patients with the Munchausen Syndromes derive emotional nurturance and sustenance mainly from healthcare practitioners.