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How To Spot Munchausen Syndrome By Proxy

By Tammy Ruggles, BSW, MA

A frantic Amanda carries her five-month-old baby, Ashley, into the
emergency room and reports that she has stopped breathing again. The baby
has undergone numerous tests and has been placed on an apnea monitor at
home. This is her tenth trip to the hospital in two weeks.
Two-year-old Billy has been hospitalized for chronic nausea, diarrhea,
and fevers. Numerous tests show no known cause, and the prescribed
medications do not appear to be effective. He is on an IV and is being
monitored closely. His mother, Lisa, is by his bedside and shows great
concern.
Nancy is an RN who has lost her third child to SIDS. The hospital staff
comforts her in an overwhelming show of support and kindness.

Definition: DSM-IV calls it Factitious Disorder, but it's commonly known as
Munchausen's Syndrome By Proxy. The word Munchausen originates from 18
(superscript: th) century's Baron von Munchausen, who was famous for
fabricating stories. Munchausen's Syndrome is a psychiatric disorder in
which patients fake illness for love and attention. They will even go so
far as to have multiple surgeries performed for medical conditions they
don't have. Munchausen's Syndrome By Proxy is a condition in which a parent
makes her child sick in order to gain this love, even to the point of
death. It is one of the most extreme forms of child abuse, and one of the
most difficult to diagnose.

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Statistics:

No one wants to think that a mother could smother her child, revive it,
smother it again, revive it again, and do it over and over and over.
No one wants to imagine that a father could put poison into his child's
bottle, IV tube, food, medicine, or syringe.
It once seemed like an obscure disorder. Now it seems to be gaining
national recognition and understanding.
In 1999, Kathleen Bush, a concerned, dedicated mother on the surface, was
convicted of child abuse in a Florida courtroom. This woman, nationally
recognized by Hilary Clinton before the allegations were made, caused her
eight-year-old daughter to have 200 hospitalizations and 40 surgeries, and
put feces in her feeding tube.
Texas mother Yvonne Padron was sentenced for suffocating her
twenty-one-month-old. The child lingered on life support for 3 months
following the suffocation. Padron confessed that she had suffocated the
child twice before--once when the child was hospitalized.
In 1998 Brian Stewart, a phlebotomist, was convicted of first-degree
assault after he injected his son with HIV-tainted blood.
98% of all Munchausen By Proxy perpetrators are female.
90% of all parents with Munchausen's have significant medical knowledge.
The mortality rate of MSBP is 9 %.
25% of MSBP cases involve more than one child.
Most cases begin in infancy, or before the age of 2.
Most victims are below the age of 6. School-age children are in the public
and are more likely to disclose.
8% of victims suffer long-term medical problems.
Emotional and cognitive effects of child victims can include hyperactivity,
fear, temper tantrums, withdrawal, aggression, and developmental delays.
Some of the ghastly methods of injury include:

--Laxatives to induce diarrhea.

--Blocking airways with food.

--Smothering with pillow, blanket, or hand.

--Nail polish remover.

--Salt or sugar poisoning.

--Oven cleaners or abrasive cleaners to cause rashes.

How to spot:

It is difficult to detect, for several reasons:

The perpetrator, usually the mother, appears to be the ideal loving,
concerned parent. What mother wouldn't rush her child to the hospital if he
or she is sick, as often as necessary? What mother wouldn't want to be
deeply involved with her child's treatment and medical care, to the point
of self-sacrifice?
The symptoms of the child victim are those common to children everywhere:
Fevers, diarrhea, vomiting, headaches, allergies, infections. Why would any
doctor attribute these symptoms to anything but normal childhood ailments?
Even the more severe symptoms such as seizures, failure to thrive, and
malnutrition don't ring the Munchausen alarm right away. Why shouldn't
doctors and nurses believe the patient histories provided by the parents?
Even though spotting MSBP is challenging, and one or two of the following
symptoms by themselves don't constitute the syndrome, here are some classic
signs to look for:

The child shows signs of poisoning or starvation with no identifiable
cause.

Lab tests that reveal unusual or unexpected results.

A child has multiple medical problems that reoccur and do not respond to
treatment and have no logical cause or explanation.

A mother who seems enamored with the hospital environment, who relates
well to staff, and who seems to enjoy interacting with staff and exchanging
medical information. She herself may even work in the medical field.

A mother who appears as needy as her child, and who offers little support
and comfort to the child outside the presence of medical staff.

A parent who angrily complains about the treatment her child is
receiving, who demands more or different tests, and who threatens to
transfer her child to a different doctor's office or hospital.

A parent whose spouse is distant, unsupportive, or absent during the
child's hospitalization.

The child's symptoms disappear when outside the care of the parent.

A parent who complains of unusual, unexplained symptoms similar to her
child's.

A parent who thrives on relating tragic events (fires, suicides,
accidents, etc) while her child is hospitalized.

Unexplained illness or deaths of child's siblings.

Family reports multiple cases of SIDS.

Why? An intelligent, caring mother fabricates her child's illness, or even
causes it. These mothers seek attention and love for themselves through
their child. They appear altruistic, but crave sympathy and recognition.
They want to be lauded as a martyr, and will sacrifice their child to get
it. In most cases they have an extensive knowledge of the field of
medicine, including symptoms, diseases, medications, treatment, etc.
Doctors and nurses are often impressed at the parent's level of knowledge,
competency, and concern surrounding the child's medical condition. Sadly,
this only feeds the perpetrator to continue her cycle of abuse. She has
deep, unmet emotional needs that can only be satisfied by her toxic
relationship with the hospital staff and her sick child. Perversely, the
attention boosts her self-esteem, and her drive to continue is
irresistible, intoxicating, and insatiable.

It is important to remember that MBP is more about the mother's emotional
tie to the hospital and staff than it is her child. Her child is just a
tool to have her childlike needs met by the parental figures of the doctors
and nurses.

If you suspect: If you suspect that a child is the victim of this disorder,
report your concerns to the police or child welfare agency. This disease
usually come to light when it's too late. In most cases it takes a court
order to videotape a suspected perpetrator without their knowledge or
consent. Unfortunately, only a fraction of these cases will be caught on
tape. But once evidence is obtained, a child can be placed in protective
custody, given proper medical treatment, and the mother can receive
psychiatric care. In the meantime, awareness and information are two of our
best methods of detection and intervention.

411: For more information on MSBP, visit: www.emedicine.com and www.vachss.com

Read Mary Bryk's experience as an adult survivor of a mother with MSBP in
July, 1997's Pediatrics journal. Article title: "My Mother Caused My
Illness".

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07/16/2005

07/16/05