Munchausen Syndrome by Proxy, also known as MSP is a psychological disorder in which a caregiver seeks attention from health care professionals through those who are in his/her care. Munchausen Syndrome by Proxy is the worst form of child abuse that has a long lasting physical and emotional influence on a child. The caregiver alone is not the only individual responsible for harming his/her child, the parent convinces the professionals into delivering harm as well.
“MSP is now classified as a somatic symptom and related disorder. It is referred to as factitious disorder that is imposed by one individual on another or factitious disorder by proxy”. (Dryden-Edwards) MSP also known as, “medical child abuse,” is a mental illness which requires treatment from a medical professional. (Kids Health) Munchausen Syndrome by Proxy involves a caretaker, usually a mother, abusing a child by creating or faking symptoms in a victim. Most victims of MSP are preschoolers, although there have been cases in kids up to 16 years old. There are equal numbers of boys and girls affected by MSP. (Kids Health) Health care providers often overlook caregivers creating these symptoms due to the caregivers acting overly concerned and attentive to the victim. “Often, the perpetrator is familiar with the medical profession and knowledgeable about how to bring on illness or impairment in the child”. (Kids Health)
There are numerous theories regarding the cause of Munchausen Syndrome by Proxy. Caregivers may be experiencing marriage issues, or major stress that can trigger MSP. Often the
caregivers cause of MSP is believed to have been triggered in his/her past. Caregivers may have been abused, sexually or physically, as a child. Caregivers may have grown up viewing illness being the only way to receive love from others, which causes them to create an illness in his/her child believing they will be loved more. The caregiver may have his/her own personal needs that overcame their ability to see the child as a person with feelings and rights. (Kids Health) Overall the exact cause of MSP is unknown, but researchers are looking at biological and psychological factors and believe they strongly play a part in MSP. (WebMD)
“Munchausen Syndrome by Proxy is quite possibly one of the most difficult disorders to diagnose”. (Feurtado) When a medical professional suspects MSP in a caregiver they start by reviewing the victim’s medical records and figuring out what seems logical to have happened, noticing the victim is not responding to treatment the way he/she should, realizing an illness that only appears to worsen when the caregiver is present, or common symptoms that are found in the siblings of the victim. (Feurtado) “Common conditions and symptoms that are created or fabricated by parents or caregivers with MSP can include: failure to thrive, allergies, asthma, vomiting, diarrhea, seizures, and injections”. (Kids Health) It is common for children to have genuine symptoms from illnesses along with his/her caregiver exaggerating them which furthers the difficulty in diagnosing MSP. Medical professionals find it difficult to distinguish which symptoms are genuine and which are exaggerated. (Feurtado)
If Munchausen Syndrome by Proxy is suspected, like any form of child abuse, the health care professionals are required by law to report their concerns. (Kids Health) After the caregiver is charged, the victims symptoms may progressively become worse due to the attempts made by the caregiver to prove the illness. “In some cases, the parent or caregiver may deny the charges and move to another location, only to continue the behavior”. (Kids Health) If the child is returned to the caregiver while child-protective-services are involved, the victim may experience more abuse while the perpetrator avoids treatment for MSP. (Kids Health)
Diagnosing Munchausen Syndrome by Proxy is very difficult due to the dishonesty of the caregiver. Medical professionals must rule out any possible physical illness as the cause of the child’s symptoms before they can diagnose the adult with MSP. (WebMD) “A pediatrician who has experience and training in assessing and treating child abuse is often consulted and may be the primary professional working with the family”. (Dryden-Edwards) After ruling out illnesses that the child may possess, the medical professional then thoroughly reviews the child’s medical history, as well as family and the caregiver’s medical history. Reviewing the caregiver’s medical history may provide clues to consider MSP as a diagnosis. A strong piece of evidence to diagnose MSP is film, which is sometimes used to prove a child is suffering with a caregiver that possess MSP. “When cameras were placed in some children’s hospital rooms, some perpetrators were filmed switching medicine, injecting kids with urine to cause an infection, or placing drops of blood in urine specimens”. (Kids Health)
“Knowledge of how to treat Munchausen Syndrome by Proxy is limited”. (Feurtado) The caregivers may undergo extensive psychotherapy. In most cases the caregiver is fully aware of his/her behavior but yet refuses to openly acknowledge it which makes a good outcome of therapy more difficult. (Feurtado) Child-protective-services is called to maintain the safety of the child. Professionals, family members other than the perpetrator, and the community trying to maintain the safety of the child is strongly encouraged before removing the child from the home. (Dryden-Edwards) If treatment is noticeably becoming effective child-protective-services will slowly introduce the child and perpetrator into the same space. Psychiatric medications like antidepressant, anti-anxiety, mood stabilizer and antipsychotic may be prescribed to the caregiver and/or victim to help reduces the symptoms. (Dryden-Edwards)
Munchausen Syndrome by Proxy left untreated may result in the victim growing up to be medically, emotionally or functionally disabled adults. Dryden-Edwards states that “People who were the victim of MSP as children are more likely to develop weight problems (including anorexia or obesity) and chronic pain as adults”. (Dryden-Edwards) Other conditions may become an issue when the victim ages these illnesses include, depression, anxiety, anger problems, posttraumatic stress disorder, and mood swings. Victims of MSP are more likely to not complete his/her education and often avoid seeking medical attention when a medical issue arises in his/her life. “It can be fatal in more than 5% of cases, and more than 7% may have long-term or permanent injury as a result. Survivors of this disorder are sadly at a higher risk of becoming perpetrators of this and other forms of child abuse as adults”. (Dryden-Edwards)
“In the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnosis of factitious disorder imposed on another includes the disorder originally known as Munchausen Syndrome by Proxy”. (Brannon) In DSM-5 factitious disorder is separated into 2 types, one of which is Factitious disorder imposed on another (Munchausen Syndrome by Proxy) and the other Factitious disorder imposed on self (Munchausen Syndrome). (Brannon) When an individual forces or makes up an illness that his/her child has, the diagnosis is factitious disorder imposed disorder (MSP). The DSM-5 criteria for MSP are as follows: “Falsification of physical or psychological signs or symptoms, or induction of injury or disease, in another associated with identified deception. The individual presents another individual to others as ill, impaired or injured. The deceptive behavior is evident even in the absence of obvious external rewards. The behavior cannot be better explained by another mental disorder, such as delusional disorder or another psychotic disorder”. (Brannon)
A case of Munchausen Syndrome by Proxy resulting in the murder of the perpetrator was made into an HBO documentary in 2017. “Mommy Dead and Dearest” the murder of Deedee Blancharde by her daughter Gypsy Rose is explored, as well as the circumstances leading up to the event. “The film tells the story of Gypsy Blancharde, a 24-year-old woman who was convicted of killing her mother. Yet she was sentenced to only 10 years in prison due to her claims that she was a victim of something called Munchausen by Proxy perpetrated by her mother”. (Brayson) Deedee was giving her daughter, Gypsy Rose, seizure medication that caused her teeth to fall out, forced Gypsy to sit in a wheelchair and shaved her head. (Staff) Jim Arnott, the sheriff in the documentary states, “Gypsy can walk without a wheelchair and she can do that very well” as Gypsy walks into the court room due to the involvement in her mother’s murder. (HBO) It was proven that after the murder of Deedee nobody, not even Gypsy, knew Gypsy’s birthdate due to her mother using different birthdates over a period of time. In the HBO documentary Gypsy is asked in an interview “What illnesses did your mom say you had?” Gypsy responds, “Asthma, Epilepsy, hearing impaired, vision impaired, fed with a feeding tube, paralyzed from the waist down, retardation, and among other things, I just can’t remember them”. (HBO) Later in the documentary Gypsy speaks again stating, “All I knew was I could walk, I was blinded by faith, I thought mothers know best”. (HBO)
Another Munchausen Syndrome by Proxy case is one of the most unbelievable cases, 23 year-old mother, Blanca Montano, who infected her children with fecal matter and bacteria which resulted in her two children having positive results for E. Coli. (Allen) One of the two children went on to heal normally. The second child continued to stay in hospitals and later the doctors discovered additional bacteria in her blood, which is when they believed that is was a Munchausen Syndrome by Proxy case. They installed camera’s in the child’s hospital room, and caught Blanca contaminating her child’s IV. It is believed that in this case the mother deliberately poisoned her children to gain attention from the children’s father in hopes he would come back to her. Blanca was sentenced to thirteen years starting in 2011 after being caught. (Allen)
When asking individuals about Munchausen Syndrome by Proxy, often times they draw a blank. So many individuals are unaware of this form of abuse. “Claims the life of nine percent of children that fall victim to it”. (Feurtado) Munchausen Syndrome by Proxy is a difficult disorder to diagnose which is why many victims die before medical professionals realize what had happened. The knowledge of this disorder is very limited, therefore it is extremely important to raise awareness, so less children fall victim to Munchausen Syndrome by Proxy and leave their death in the hands of their own parents. (Feurtado)
Munchausen Syndrome by Proxy is the worst form of child abuse that has a long lasting physical and emotional influence on a child. The caregiver alone is not the only individual responsible for harming his/her child, the parent convinces the professionals into delivering harm as well. Munchausen Syndrome by Proxy, the relatively rare, medical child abuse forces harm, fabricates harm, and often convinces medical professionals to harm a child. If left untreated permanent damage as well as fatality may occur.