From: pautrey on
AllPsych Journal
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Munchausen by Proxy Syndrome: A Deadly Disorder

Jessica Feurtado

May 15, 2004



Abstract

Munchausen by Proxy Syndrome (MBPS) is a deadly disorder of which
awareness must be increased. It is characterized by a parent, usually
the mother, who intentionally causes illness in her child. The
disorder was named after Baron von Munchausen. There are different
intensities and manifestations of this disorder. Symptoms of the
syndrome are hard to identify but are most prevalent when the child
only becomes sick in the presence of his or her mother. The mother
maintains a dynamic relationship with the physician, as the whole
disorder is centered upon her need for attention from the doctor. It
is most widely agreed that MBPS is caused by a need for attention and
compassion to placate self-doubt in the sufferer. The only plausible
treatment known for this disorder is extensive psychotherapy. If more
research is conducted on this syndrome, it will help to protect the
youth against abuse that is a by product of a psychologically sick
mother.

Introduction

When asked what Munchausen by Proxy Syndrome is, most
people will draw a blank. They are unaware of this form of abuse that
claims the life of nine percent of children that fall victim to it.
This paper will discuss the definition of Munchausen by Proxy Syndrome
(MBPS), the origin of its name, the subtypes of the disorder, the
symptoms associated with it, the dynamic relationship between the
sufferer of the disorder and the physicians caring for the sufferer’s
child, the causes of this syndrome, and the suggested treatment for
it. MBPS is extremely difficult to diagnose, which is why many
children die before doctors realize what was actually happening to
them. Treatment for this disorder is limited, as well as knowledge and
understanding of its causes. For this reason, it is extremely
important to raise awareness of Munchausen by Proxy Syndrome and to
work towards ensuring that no more children fall victim to illness and
death at the hands of their own parents.

Munchausen by Proxy Syndrome Defined

Munchausen by Proxy Syndrome, also called Factitious
Disorder by Proxy, is a psychological disorder characterized by a
pattern of behavior in which someone, usually a mother, induces
physical ailments upon another person, usually her child (“Munchausen
by Proxy Syndrome,” n.d., p. 1). The mother attempts to gain attention
and recognition for herself by putting on the public façade of
dedicated and loving mother. However, when alone with her child she
will subject them to abuse, both physical and emotional, as she tries
to deliberately make them sick. The website “Munchausen by Proxy
Survivors Network,” offers an extended definition for the disorder:

The child is a victim of maltreatment in which an adult falsifies
physical and/or physiological signs and/or symptoms in the child
causing this child to be regarded as ill or impaired. The perpetrator
who is usually a parent or caregiver intentionally falsifies history,
signs, or symptoms in the child to meet their own self-serving
psychological needs. Other member in the family may support and
participate in the deception (n.d., p. 1).


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. Parents with Munchausen by Proxy Syndrome do not
typically appear psychotic and, based on incidents caught on film, are
calm and collected when inflicting harm on their children. Victims of
Munchausen by Proxy Syndrome range greatly in age. The youngest case
known was of a mother intentionally harming her fetus. The older cases
involve people inducing illness in adults (Schreier & Libow, 1993, p.
6). With such a wide array of possibilities it is often too late for
the victim before the disorder can be diagnosed.

The Origin of the Name

Munchausen Syndrome, a disorder where people fabricate
illness in themselves, and Munchausen by Proxy Syndrome were named
after an 18th-century German dignitary named Baron von Munchausen.
Baron von Munchausen was known for telling “outlandish
stories,” (“Munchausen by Proxy Syndrome,” n.d., p. 1). The name was
first used in 1951 by Dr. Richard Asher to describe self-induced
illness. It is told that Asher came upon the name Baron Hieronymus
Karl Friedrich Freiherr von Munchausen in fictional accounts of his
stories published in 1785 (Schreier & Libow, 1993, p.6-7). Because of
the correlation between Baron von Munchausen’s fictional stories and
the exaggerated and made up symptoms of a person with this disorder,
the terms Munchausen Syndrome or Munchausen by Proxy Syndrome were
adopted as clinical terms describing the two main factitious
disorders.

Subtypes of Munchausen by Proxy Syndrome

Though difficult categorize, Munchausen by Proxy Syndrome
manifests in a plethora of different forms. This section will discuss
the most commonly recognized subtypes. Factitious Disorder by Proxy
can range in frequency or intensity. Chronic Munchausen by Proxy
Syndrome is characterized by the constant pursuit of attention through
the harming of another individual. People suffering from this degree
of the disorder are compulsive and allow the syndrome to consume most
of their lives. The episodic form of the disorder occurs in bouts.
There are intervals in which the sufferer experiences symptoms of
Munchausen by Proxy Syndrome followed by a hiatus where he or she can
conduct a normal life. More intense degrees of symptoms can cause the
caregiver to put the child in immediate jeopardy of dying. These
parents resort to measures such as “suffocation, inducing vomiting,
poisoning, or removing the blood from a child.” In less extreme cases,
the caregiver may withhold treatment for an already sick child, or
simply lie about the child having symptoms that they aren’t truly
exhibiting (Schreier & Libow, 1993, p. 9). In extreme cases of this
disorder, a mother can induce severe symptoms in her child, but appear
cooperative, compassionate, and concerned in the presence of a
physician. Schreier and Libow call these sufferers “active inducers.”
Milder cases have shown mothers that forge medical histories of their
child and lie about the child being sick rather than actually causing
sickness by active means. They do this for the emotional gratification
they feel from receiving the attention of a doctor. These individuals
are defined as “doctor addicts,” (1993, p. 10).

Symptoms of Munchausen by Proxy Syndrome

Munchausen by Proxy Syndrome is quite possibly one of the
most difficult disorders to diagnose. For this reason, an unfortunate
nine percent of victims to this abuse die (Feldman, 1998, p. 1).
Indicators that a parent may be suffering from Munchausen by Proxy
Syndrome include but are not limited to a discrepancy between the
child’s medical records and what actually seems logical to have
happened, the child exhibiting symptoms that do not respond to
treatment as they were expected to, an illness that only appears or
becomes more grave in the presence of the parent, symptoms that
disappear in the absence of the perpetrating parent, sickness that
resumes once the caretaker is informed that the child is recovering,
or similar symptoms found in siblings or family members of the victim
(Lasher, 2004, p.1). The induced illness can range anywhere from
diabetes to diarrhea. The possibilities are endless, as individuals
with this disorder do not conform to feigning any particular illness.
Because of the seemingly infinite sicknesses people with Munchausen by
Proxy Syndrome have to choose from, it is impossible for doctors to
single out Munchausen Syndrome based solely on the ailment of the
patient. This makes it particularly important for medical personnel to
recognize the behavioral patterns that individuals with Munchausen by
Proxy Syndrome display. A single child suffering from many different
illnesses in a short span of time is usually an early indicator that
something is not right. Unusual responses to treatment are also
factors that can indicate a problem (Schreier & Libow, 1993, p. 15).
It is common for victims of this syndrome to exhibit genuine symptoms
of illness along with the exaggeration and fabrication of other
symptoms. This furthers the difficulty in diagnosing Munchausen by
Proxy Syndrome because it makes it difficult for physicians to
distinguish the real ailments from the ones which were made up.
Another sign that is common among parents with Factitious by Proxy
Disorder is their “righteous indignation” when confronted by a doctor
about their fictitious accounts of the child’s medical history, or of
inducing symptoms in their child. Often the parent will threaten to
file a malpractice lawsuit, or may even cause the child to become
deathly ill to prove to physicians that she was right about the
child’s poor health (Schreier & Libow, 1993, p. 40)

Dynamics of the Mother-Physician Relationship

When a mother (or caregiver) suffers from Munchausen by
Proxy Syndrome, she is in a constant effort to mask the life
endangering child abuse she commits behind closed doors. Schreier and
Libow call this process “mother imposturing.” They define it as a
clinical condition that is “a form of relating (here, to a physician)
in which lying is the essential mode of interaction,” (1993, p.
84-85). The mother attempts to portray an outward image of perfection.
She shows compassion and devotion to her child by giving up much or
all of her time to constantly take them to the hospital (Feldman,
1998, p. 1). Though the abuse on the child is the most prevalent
aspect of Munchausen by Proxy Syndrome, the real focus of the disorder
is on the relationship between the doctor and the parent. When the
pediatrician withholds some attention from the mother and her ill
child, the symptoms further escalate, as the mother tries harder to
gain the attention of the doctor. It is clear that the mother thrives
off of any sympathy or attention given to her, especially by a
physician.

Causes of Munchausen by Proxy Syndrome

There are various theories regarding the cause of
Munchausen Syndrome. Dowdell and Foster theorize that a mother may
feel that a sick child can bring her closer to her spouse. It is more
likely, however, that mothers suffering from this disorder “have had
an emotionally deprived childhood with a high probability of a history
of physical abuse,” (n.d., p. 1). The women are most likely depressed
and insecure, and channel their personal inadequacies into abusive
behavior, which in turn produces gratifying attention for themselves.
The environment of a hospital also gives the mother a chance to rid
herself of parental responsibility while medical personnel tend to her
child. It is common for mothers with this disorder to wander the
hospital and speak with other parents. Their sick child helps them
establish a common bond with other mothers in the hospital and thus
makes the mother feel as if she fits in. According to Schreier and
Libow, “longed-for but absent” fathers appear quite often in clinical
data (1993, p. 98). If a mother realizes an increasing detachment from
the family in the father of her child, she may resort to hurting her
child in order to restore cohesiveness in the family. An absent spouse
also leaves the mother plenty of time alone with her child to inflict
injuries and sickness that she otherwise may not be able to inflict in
the presence of her husband.

Treatment of Munchausen by Proxy Syndrome

Knowledge of how to treat Munchausen by Proxy Syndrome is
limited. Feldman relays about mothers with MBPS that “virtually all
have personality disorders that lead them to behave in odd and even
destructive ways, especially when they feel under stress,” (1998, p.
1). It is even more important, then, for these mothers to undergo
extensive psychotherapy. In most cases, the mother is fully aware of
her behavior but reluctant to openly acknowledge it. She is unaware of
the its cause and feels she has no control over her own actions. “The
therapist’s task was described as ‘uncover[ing] and interpret[ing]
these fantasies and behaviors to the patient’,” (Schreier & Libow,
1993, p. 153). Parents suffering from Munchausen by Proxy Syndrome are
highly unlikely to voluntarily attend psychotherapy. It is important
for the court system to mandate visits for the sufferer, or the
problem will not be assessed and treated. Unfortunately, “very little
encouraging data is y available on successful therapeutic work with
MBPS mothers,” (Schreier & Libow, 1993, p. 162).

Conclusion

Munchausen by Proxy Syndrome is extremely difficult to
characterize and diagnose. It manifests in so many different forms
that it often goes undetected. It is often difficult for physicians to
believe that a mother would intentionally hurt or even kill her own
offspring, as it is a mother’s job to protect and ensure that her
children are protected from all harm. Symptoms of this disorder are
often near impossible to distinguish, however, with raised awareness
among doctors and nurses, it can be spotted and treated before a child
is put in life-threatening jeopardy. There is not nearly enough
research on the syndrome to completely understand or pinpoint why some
parents suffer from it. It is crucial that in the future some measures
for prevention of Munchausen by Proxy syndrome, and more effective
ways of treating it are developed. The medical and psychological
community must become more aware of the problem and help children to
be set free of the abusive hands of their own mothers.

References

Dowdell, RN, PhD, E.B., & Foster, RN, K. L. (n.d.). Munchausen
Syndrome by Proxy: Recognizing a Form of Child Abuse. Retrieved April
6, 2004 from http://nsweb.nursingspectrum.com/ce/ce209.htm.

Feldman, M.D., Mark D. (1998). Parenthood Betrayed: The Dilemma of
Munchausen Syndrome by Proxy. Retrieved April 1, 2004 from
http://www.selfhelpmagazine.com/articles/parenting/hsmun.html.

Lasher, Louisa J. (2004). MBP Basics. Retrieved March 29, 2004 from
http://www.mbpexpert.com/definition.html.

Munchausen by Proxy Survivors Network. (n.d.). Retrieved April 3, 2004
from http://www.mbpsnetwork.com.

Munchausen by Proxy Syndrome. (n.d.). Retrieved April 3, 2004 from
http://www.kidshealth.org/parent/system/ill/munchausen.html.

Schreier, H.A., & Libow, J.A. (1993). Hurting for Love: Munchausen by
Proxy Syndrome. New York: The Guilford Press.




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