Munchausen syndrome by proxy (MSBP), also known as factitious disorder imposed on another, is a psychological disorder in which a caregiver fakes or induces medical symptoms in a person under her care.
The term “Munchausen syndrome by proxy” was first used in 1977 by a doctor named Roy Meadow who suspected a patient’s mother of poisoning the boy with salt. Many people simply consider this condition to be child abuse in a clinical setti
MSBP was named after Baron Munchausen, a fictional character somewhat based on the real-life Karl Friedrich von Munchhausen who lived in the 18th century and was a renowned storyteller. A writer later “embellished” these tales to include impossible but entertaining stories of Baron Munchausen, the literary character, traveling to the Moon and riding a cannonball. That’s how the name Munchausen became associated with fantastic or exaggerated tales.
After being depicted on hit televisions shows like Scrubs, Law & Order, and Body of Proof, MSBP exploded into public awareness. However, while you probably have heard about MSBP, the following facts are guaranteed to shock and disturb.
10The Victim Is Not Always A Child
MSBP is often assumed to be abuse of a child by that child’s parent (or parents). Sometimes, this is not the case. MSBP can also take the form of an adult child or friend harming or feigning illness in an elderly person for whom they are a caregiver.
Medical professionals N.J. Smith and M.H. Ardern described a case in which a 69-year-old male was repeatedly brought to the doctor for an extensive list of constantly changing symptoms. The individual bringing him to doctors and hospitals was a 55-year-old female friend of the patient.
Within a period of four years, the patient had gone to 14 different specialty medical units and visited multiple GPs. Despite having seen doctors specializing in everything from dental work, psychiatric disorders, orthopedics, dermatology, and urology, the man didn’t receive a single positive diagnosis.
Meanwhile, doctors who had treated the patient had made notes that his lady companion was “oversolicitous,” harassing the attending physicians with demands for treatment or offering suggestions as to possible diagnoses. In fact, every time the patient appeared to be on the mend, doctors were presented with another new and concerning symptom, often conveniently noticed only by his so-called friend.
In this case, the symptoms were incorrectly reported rather than induced.[1]
9MSBP Can Be Fatal . . . For The Child
While some cases of MSBP may manifest as a caretaker simply claiming symptoms exist where they don’t, others are much more disturbing. Statistics for the MSBP fatality rate are hard to quantify due to the difficulty of diagnosing this condition. However, experts estimate that 9–31 percent of children subjected to MSBP may die as a result of symptoms inflicted upon them.[2]
This high mortality rate is caused by the harm done to the child by the parent as well as exposure to invasive and unnecessary medical procedures like surgeries. Some children have been known to undergo more than 100 completely unneeded procedures to treat fictitious conditions.
8The Abuser Is Usually The Mother
Most of us think of mothers as nurturers, a source of constant protection in their children’s lives. Not so true when a mother suffers from MSBP.
This disorder can be hard to diagnose because the caregiver typically appears to be deeply concerned about the victim’s health. This makes it hard for doctors to get accurate data and statistics for the condition. However, the medical community agrees that MSBP is much more common in females. In at least one study, the percentage of victims abused by their mothers was estimated to be between 90–98 percent.
Another study found that 1 percent of all children with asthma had been subjected to MSBP.[3] Still another found 5 percent of the children they studied with food allergies had also been subjected to MSBP. In both cases, the mother was overwhelmingly the person with MSBP.
7We Don’t Know What Causes MSBP
Although doctors have many theories as to why a mother would make her child sick or falsely report that he is, nobody knows the true cause. Some suggest that this behavior is a way for somebody who has experienced loss to receive attention and support from friends, family, and medical professionals. Other possibilities include an as-yet-unidentified brain dysfunction.
Many therapists suggest that childhood abuse may also lead a person to develop MSBP later in life. However, we do know that all patients with MSBP exhibit one specific trait: pathological lying.[4]
6MSBP Can Take Years To Discover
MSBP can be almost impossible to diagnose early. After all, most mothers are highly concerned about their children being sick. It is difficult for a doctor to know when that concern is a facade for something more sinister—a desire for attention so deep that the mother will hurt her own child.
Some specialists estimate that the average time to diagnose MSBP is approximately 4.5 years.[5]
What may start as a lie about a child having a fever can grow into something truly terrifying over time—a child being actively harmed by his mother to continue the ruse.
5Surveillance May Be The Key
If a doctor is suspicious that a child patient may be suffering at the hands of a parent with MSBP, what options are available? Parents with MSBP are known to falsify results of lab tests or interfere with samples given by their children. They seem concerned about their child’s welfare to the point of being overbearing. Unfounded accusations are certainly not the best option.
Sometimes, the best option is video surveillance. Numerous cases exist where a doctor, suspicious of a parent but not certain enough to act, has been able to gain proof through use of covert surveillance cameras. Such cameras have recorded parents intentionally suffocating, poisoning, strangling, and even fracturing the bones of their children.
Of course, there are privacy concerns associated with video surveillance of a child without his parents’ permission.[6] Sometimes, though, the ends may justify the means if the life of an abused child can be saved.
4One Is Not Always Enough
We know that MSBP can be difficult to diagnose, usually taking years. Even more disturbing is this: Children who are abused by a parent diagnosed with MSBP often have deceased siblings.
In one study, 15 out of 83 children whose parents had MSBP also had siblings who had died. Some of those families had more than one deceased child. A common “cause of death” for these dead children was sudden infant death syndrome. Many of these families also had older, living children who were known to have been physically abused.[7]
3Victims May Play Along
Children targeted by a parent with MSBP are usually not more than five years old. This is probably because a child of that age is less likely to ask questions or inadvertently betray the situation to medical staff. So what happens when the child gets older?
Older children who are victims of MSBP have been witnessed voluntarily playing along with their parents’ deceptions. This may be due to fear of the consequences if the kids tell the truth.
It is also possible that the child has been told he is sick for so long that he truly believes it. Either way, this makes a doctor’s role in uncovering the deception more difficult and makes it possible for the fabrication to continue.[8]
2Medical Knowledge Is A Must
Doctors who have interacted with MSBP sufferers have repeatedly noted their tendency to have above-average knowledge of the medical field. This information may have been gained through employment in a medical field, experience as a patient, or just a lot of time spent on WebMD.
This knowledge serves two purposes. First, the mother appears to have “done her homework” and is furthering the appearance of her extreme concern for the child. Second, the mother is able to draw on this information to create or mimic symptoms that keep the child unwell and evoke more sympathy.
In 85 percent of the MSBP cases researched in one study, one or both parents of the child in question had some level of training in health care or childcare.[9]
1Like Mother, Like Child
Some research shows that a child who survives abuse inflicted by a parent with MSBP may repeat that abuse on his or her own children later in life. One possible reason is that children may learn that positive attention can be gained when they or someone close to them is sick. In fact, the more unwell a person is, the more attention and sympathy they may receive.[10]
This can manifest in the child continuing to feign illnesses in themselves as they grow older to feed their emotional needs. When they finally have children of their own, it is all too easy to repeat their parents’ horrifyingbehavior.
By: Mahmoud Alomda
