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Herman Kagan Ph.D.

Munchausen Syndrome: A Difficult Disorder to Detect

How to diagnose the rare syndrome "Factitious Disorder Imposed on Another."

The basic unit of the body is the cell and the basic unit of society is the family. Cells that make up the different organs in our body have to function properly. Families have to do the same to maintain a viable society. The children raised by families eventually take on the leadership and jobs in their society.

Parents who help raise their children have to give love and take pride in watching their children grow. These basic ingredients must be ingrained in the makeup of the parents. It’s ingrained in many other animal species like lions, elephants and dolphins who protect and help their offspring grow and mature.

However, some mothers, and very rarely fathers, seem to lack these basic ingredients of giving love and taking pride in their children. Instead, these mothers possess a basic need to label their children as sick. They try to convince doctors, social workers and others that their children are sick even when their children are healthy. They can be very convincing.

They will make up false stories, exaggerate the condition of their children and even do harm to their children. They deceptively present themselves as caring mothers and can get sympathy from others. It seems to take on the form of an obsessive-compulsive disorder, so the mothers don’t even enjoy the health and maturation of their children. Their false stories indicate that they know their children are not sick.

These mothers have a psychological disorder first known as Munchausen Syndrome by Proxy, named after Baron von Munchhausen, a German military officer who was known for telling exaggerated stories about his life and military episodes. This disorder is now termed “Factitious Disorder Imposed on Another” in the DSM-5 psychiatric manual (Frieden 2014). Their motives don’t include getting money, avoiding legal issues, obtaining a job or getting their children into a special school.

When their deceptive behavior is not detected, these mothers can get lots of sympathy and attention. If confronted, they deny abuse and claim caring behavior. While medical examinations may not back up a mother’s contention that her child is sick, physicians tend to rely on a mother’s report about the symptoms she presents regarding her child. So, detecting the deceptive nature of the mother is not an easy task.

Mothers with this disorder may do harmful things to their child to create medical symptoms. Poisoning them, suffocating them or starving them have been used. Studies have shown a mortality rate of between 6 and 10 percent, making these actions the most lethal form of abuse (Sheridan 2003).

One of the worst cases of this Factitious Disorder syndrome was filed against Marybeth Tinning in 1985 (Fisher 2016). Mrs. Tinning was born in 1942 and married Joe Tinning in 1965. They had eight children of their own and adopted one child. The children were: Barbara, Joseph, Jennifer, Timothy, Nathan, Michael (adopted), Mary Francis, Johnathan, and Tami Lynn. While Mrs. Tinning was implicated in the death of her children, her husband, apparently, never suspected anything.

The first child to die was Jennifer who was only 8 days old. She was diagnosed as having hemorrhagic meningitis and multiple brain abscesses. Seventeen days after Jennifer’s death, Mrs. Tinning took her 2-year-old son Joseph to the Ellis Hospital emergency room because he wasn’t breathing. He died with the diagnosis of cardiopulmonary arrest. Several weeks later, she rushed her 5-year-old daughter to the hospital because she was having convulsions. Barbara died the next day with the diagnosis of having Reye syndrome.

The hospital staff did become suspicious and notified the police but the pathologist identified the death as cardiac arrest and that stopped any chance of an investigation. Then Timothy, a month after he was born, was brought to the hospital dead. Mrs. Tinning told the doctors that she found him lifeless in his crib.

His death was listed as sudden infant death syndrome (SIDS).

Nathan, the fifth child, died in the Tinning car six months after he was born. After Nathan, Mary Francis, their seventh child, was taken to the hospital in full cardiac arrest, was put on life support but died two days later. Their eighth child, Jonathan, also in cardiac arrest and put on life support, died four weeks later after taken off life support. Then Michael, their adopted child, was taken to the hospital at age 4 after falling down a flight of stairs and was pronounced dead at the hospital.

The hospital staff then discarded their long-suspected theory that death in the Tinning family had a genetic origin. Their ninth and last child, Tami Lynn, 4 months after birth was pronounced dead after being smothered. The Police Department and Social Service both visited the Tinning home and took both Joe and Marybeth in for questioning. During intense police interrogation, Marybeth confessed to the murders of Tami Lynn, Timothy, and Nathan (Lovitt 2016).

Marybeth Tinning was arrested and charged with second-degree murder only in the death of Tami Lynn. She was convicted in 1987 and given a sentence of 20 years to life. She was imprisoned and paroled in 2018 at age 76 after spending 31 years behind bars. Joe was there to greet her.

This story shows how bad and how sad Factitious Disorder Imposed on Another can get and how difficult it can be to detect. Doctors can render a diagnosis if there are vague and inconsistent details about the child’s medical history, continual approval of medical staff is sought and no believable reason exists for an illness or injury.


Fisher, Jim (2016). Marybeth Tinning: America’s Worst Munchausen Syndrome by Proxy Case. Jim Fisher True Crime.

Frieden, Joyce (2014). Munchausen by Proxy, A Case Study of Abuse. Medpage Today, Oct 29, 2014.

Lovitt, Bryn (2016). Beyond Gypsy Blancharde: When Mothers Harm Their Kids for Attention. Rolling Stone, Aug 31, 2016.

About the Author

Herman Kagan, Ph.D., is a retired Clinical Psychologist who specialized in treating abused children and their families.