Among the common factitious disorders today, Munchausen syndrome is often encountered, which can be found in women and men of different age categories, regardless of social status. Significantly exaggerating or even artificially inducing any symptoms of the disease in themselves, people with this syndrome go to great lengths to get the desired attention and compassion from others.
What is Munchausen syndrome by proxy?
Munchausen syndrome is a mental disorder in which people invent or induce illnesses in themselves to attract the attention of doctors.
The syndrome is named after the “truthful” character in the book by Rudolf Erich Raspe. One type of SM is Munchausen syndrome by proxy (also known as FDIA, MSbP). People who have it do not “get sick” themselves, but cause symptoms of illness in children or adults who depend on them. Patients with Munchausen syndrome are often referred to by proxy as “MSbP individuals,” “perpetrators,” and their patients as “victims.”
The term “Munchausen syndrome” was coined in 1951 by physician Richard Escher, who studied the behavior of malingering patients. The term "Munchausen syndrome by proxy" was coined by pediatrician Roy Meadow, who described the strange behavior of two mothers in 1977. One of them deliberately poisoned her son with table salt, the other caused an inflammatory process in her child’s kidneys.
Most psychiatrists and psychologists believe that people with Munchausen syndrome do not pursue selfish goals. Their only motive is to receive attention, care and psychological support from doctors.
Regarding MSbP personalities, expert opinions differ. Some are sure that the motives of the performers are the same as those of people with Munchausen syndrome. Others believe they have two goals:
- emotional (to get the attention of doctors);
- material (receive social benefits).
Causes
The development of pathology is based on incompletely studied factors, as well as psychological aspects:
- dysfunctional and unhappy marriage;
- state of frustration ;
- cerebral dysfunction;
- having close relationships with medical professionals;
- experience working as a laboratory assistant or being hospitalized for a real illness in childhood;
- negative attitude towards doctors and medical institutions;
- lack of psychological support and attention;
- depression;
- different types of dependencies.
There is an opinion that faking an illness is a way to shift attention to the body and avoid painful emotions and hide the psychological trauma of childhood.
MSbP - violence in the guise of care
MSbP is not just a disease, but violence under the guise of care. People with this syndrome first cause severe symptoms in victims, and then work to save them. So they:
- feel needed (they won’t survive without them),
- receive the attention they need from doctors around them,
- realize their desire for fame (selfless people are always admired).
The performers are skilled imitators who mislead even professional doctors. Their patients are subjected to unnecessary hospitalizations, medical examinations, and surgical operations.
Most often, the victims of MSbP personalities are young children who do not know how to speak and cannot tell the truth.
Munchausen syndrome and MSbP are classified as borderline mental disorders. Those who have them are characterized by impulsiveness, low self-control, high anxiety, and desocialization. But they understand what they are doing. This is why many people with FDIA are criminally responsible for their crimes after being exposed.
Pathogenesis
Disturbances in Munchausen syndrome are behavioral, and they are not caused by external factors and are not logically motivated, for example, the disease is feigned in order to obtain a benefit, gain, or avoid punishment. Self-harm, the desire to receive care and attention are dictated not by consciousness and logic, but by emotions, neurosis , obsession , fear of loneliness, the desire to avoid responsibility, to be more significant, etc. Patients have a constant and irresistible desire to be examined, operated on, undergo various procedures and treatments, and feel superior to medical workers. Such people are also called “professional patients” and they like to play the role of a patient.
It all starts with the fact that they go to hospitals and talk about their fictitious diseases, if nothing can be found, then they begin to fake tests and symptoms, carefully collect a “medical history”, and then they can even go as far as self-harm, which is most often observed pathomimia is self-damage to the skin, especially if all other methods of simulation are impossible. In addition, iatrogenic consequences occur, allowing people to get their way and end up hospitalized and requiring care.
Who becomes the performer?
Munchausen syndrome by proxy still remains a big mystery for doctors: the exact causes of the disease are unknown. But a lot of research has already been done to determine the key characteristics of performers and understand the reasons for their actions.
In 1976, scientists David Rogers and John Tripp and co-authors published a paper detailing 6 cases of FDIA.
In all situations, the performers were young mothers. Most of them have faced traumatic factors in the past: abuse, death of parents, divorce, difficult pregnancy.
Three had mental disorders, depression and suicidal behavior. One woman worked as a nurse.
There are also larger studies. For example, in 2017, British scientists analyzed 796 cases of Munchausen syndrome by proxy published since 1965. Here's what we found out:
- Almost all perpetrators were women (97.6%) and mothers of their victims (95.6%).
- Half of the patients were related to medicine.
- A third of performers experienced abuse as children.
- Many women with FDIA had comorbid psychopathologies: Munchausen syndrome (30.9%), personality disorder (18.6%), depression (14.2%).
Why do women become performers? The main factor in mental illness is domestic violence, and women are more likely to experience violence, including in childhood.
According to WHO statistics, every third woman in the world becomes a victim of physical or sexual violence.
Circumstances also favor women becoming performers. Society believes that a child is the full responsibility of the mother. As a rule, in families it is mothers who decide issues related to the upbringing and health of children. Therefore, women with a predisposition to FDIA are more likely to carry out criminal plans than men with the same mental problems.
Tests and diagnostics
There are difficulties in diagnosing true Munchausen syndrome, because the boundaries between factitious psychological disorder, malingering and somatization are blurred. Different conditions for the development of pathology necessitate the search for alternative names for them. To determine factitious disorder, the following criteria are used (source Wikipedia):
- identifying deliberately reproduced feigned symptoms, as well as self-harm to produce fake symptoms;
- implausibility of anamnestic data;
- lack of external motivation and benefits;
- the most important condition is laboratory confirmation of the feigning nature and the absence of the physical, organic nature of the symptoms.
The nosological system used in the USA - DSM-5 , identifies its criteria for Munchausen syndrome:
- identified falsification of psychological or physical symptoms and signs;
- in a person's understanding he is sick, weakened or injured;
- a false disease state is caused even in the absence of obvious benefit;
- the feigning state cannot be explained by other mental disorders - delusional or schizotypal .
To identify the fabrication of complaints, analyzes and an objective investigation are carried out to identify inconsistencies between the signs of the disease and the anamnesis data.
In some extremely dangerous cases, a psychiatric examination may be prescribed.
Manifestations of FDIA: good child - sick child
FDIA does not have typical manifestations; the actions of each performer are unique. At best, the guardian simply invents symptoms and forces the victim to pretend to be ill; at worst, he deliberately inflicts injuries on the ward (often incompatible with life).
John Stirling, MD, provides several real-life examples of FDIA in his article:
- The mother often takes the child to the doctor to be examined for sexual abuse, although there is no reason for this.
- The mother insists on treating the child for ADHD (attention deficit hyperactivity disorder), although there are no signs of the disorder.
- A parent puts their child on a severe diet to cope with a non-existent food allergy.
- The mother hits her child multiple times with a hammer. Doctors find it difficult to make a diagnosis and suspect that the child has a strange blood disorder.
- A child is hospitalized with a fictitious attack of apnea, his mother strangles and kills him.
MSbP individuals can invent and cause absolutely any disease. But they always use methods that leave no evidence. Suffocation with a plastic bag, hand, blows with a wet towel, injection of adrenaline, spoilage of medications prescribed by a doctor, failure to provide or untimely seeking medical help - all these are the methods of the perpetrators.
FDIA is one of the deadliest forms of child abuse. Scientists analyzed 451 cases of the syndrome, where the average duration of contact between children and Munchausen mothers was 22 months. By the time the mothers were exposed, 6% of the children were dead, 7.3% suffered serious complications.
Many victims had siblings who suffered from unknown illnesses or had previously died under strange circumstances.
Performers become especially dangerous when they do not receive the attention and sympathy they desire from doctors. In this case, they behave aggressively, take it out on their charges, and come up with new diagnoses and ways to imitate diseases.
Where is the line between caring and Munchausen syndrome by proxy?
There are mothers and grandmothers who do not cause any illnesses in their children, but literally smother them with their care and all-consuming love. They do not let the kids go even a step away from them, protect them from any possible dangers, do not allow children to play, walk, or overwork under the pretext that they have weak nerves/joints/health. At the same time, hypercaring adults actively declare and emphasize their dedication to others. And, as a rule, society admires them, but children in such relationships do not look happy and content.
A striking example of a toxic guardian is the grandmother from Pavel Sanaev’s story “Bury Me Behind the Baseboard”: she completely controls all the actions of her grandson, considers him not a person, but a living, obedient doll. Yes, she loves the child, takes diligent care of his health, and constantly takes him to doctors. But for the boy, his grandmother’s house has become a real prison, where he feels unhappy, unprotected, sick, suffering, and dying.
If guardians do not heal children, but poison their lives with tyrannical love, and even do this for the sake of feeling their own importance, these are also manifestations of FDIA.
A child surrounded by a toxic adult cannot develop normally. He does not have the opportunity to learn independence, he is afraid to make decisions and simply live.
Ganser syndrome
This syndrome is reminiscent of Munchausen syndrome, since a person’s internal anxiety is transformed into demonstrative, defiant, inappropriate behavior that is directed at others. Another name for it is hysterical psychosis. It was first described by the German psychiatrist Ganser in a person who was under investigation. The disorder is still more common when something threatens a person’s social status—for example, a trial. But this could be mobilization into the active army, or even a sudden break in relations.
With this syndrome, a person behaves like a child - sits on the floor, “plays” with surrounding objects. Answers simple questions incorrectly (for example, confuses left and right), cannot get dressed, forgets how to eat. What’s strange is that a person understands speech addressed to him, but says or does everything as if “by.”
Sometimes it gets to the point of “running wild” - a person gets on all fours, laps up water from a bowl, barks, howls and tries to bite people around him.
After an attack, a person does not remember what happened to him. This syndrome is incredibly rare. It is almost never mentioned in movies or feature films. On the other hand, maybe we just have a bad idea of what happens to a person facing prison.
Diagnosis and exposure
It is difficult to identify FDIA: the syndrome has not been sufficiently studied, and there are no clear diagnostic criteria. However, the American Professional Society on Child Abuse has compiled a list of common signs that can provide a starting point for doctors. Here are some of them:
- The child does not have the symptoms reported by the mother.
- Fictitious symptoms do not correspond to the real medical history.
- The results of the child's examination are clinically impossible or implausible.
- In the hospital, the child's symptoms disappear when the mother is not around.
- Other children in the family also have unknown illnesses.
Exposing MSbP personalities is complicated by the fact that they behave cautiously. If the doctor has suspicions, the executor can take the child from the hospital contrary to medical recommendations, change the specialist, hospital, or place of residence.
Is FDIA treatable?
The performers do not consider themselves sick and do not seek treatment. Imitating diseases in victims becomes for them the main meaning of life and the foundation of existence. Admitting crimes to yourself and others means ruining your life.
According to Dr. Mark Feldman, most mothers stubbornly deny their crimes, even when presented with videos of child abuse. An MSbP person can only be cured if she admits her illness. But this is very rare.
The most resonant cases of Munchausen syndrome by proxy
Healed my son to death: the story of Garnett and Lacey Spears
Lacey Spears was a single mother, housewife and popular blogger. True, her blog looked strange: in it she talked in detail about the endless illnesses of her son Garnett. The boy actually had health problems, but his mother herself provoked them. Lacey regularly poisoned him with salt, and turned the results of cruel experiments into stories for the blog.
Source
The shocking truth was revealed on January 19, 2014, when Lacey's 5-year-old son was taken to a New York hospital with acute abdominal pain. At first, doctors were inclined to believe that the cause was a virus, but after examination it turned out that the boy had an overdose of sodium. Soon the child fell into a coma and died.
During the investigation, the mother's guilt was established. Even before arriving at the hospital, she injected a huge amount of salt through a tube into Garnett's stomach.
At the hospital, Lacey continued her experiments: she took her son to the restroom and poisoned him with salt.
In April 2015, Lacey was sentenced to 20 years in prison. During the announcement of the verdict, the judge noted that the woman suffered from delegated Munchausen syndrome, and that was the only reason she managed to avoid life imprisonment.
13 surgeries and 323 hospitalizations in 8 years of life: the story of Christopher and Kaylin Bowen
After the birth of her son Christopher, Kaylin Bowen broke all records for the number of visits to doctors. It’s hard to believe, but over the course of 8 years of his life, Christopher was hospitalized 323 times and underwent 13 operations.
Photo from open source
The first alarm bells appeared immediately after the birth of my son. Kaylin constantly told her husband that if Christopher fed on her milk, he would certainly vomit. At two months old, the child was given the first “diagnosis” - gastric reflux disease. Kaylin claimed that the baby could not eat on his own, and he was fed through a tube.
Christopher's subsequent life was like a bad dream: he was hospitalized with sepsis, was confined to a wheelchair, and even spent some time in a hospice. He was suspected of having cancer and was diagnosed with rare degenerative diseases. Kaylin even tried to put him on the list of patients in need of a lung transplant.
Surprisingly, for a long time not a single doctor suspected Kaylin or doubted the boy’s illness. The woman was exposed only in 2022, 8 years after the abuse began.
The mother once again brought her son to the clinic, claiming that he was having a seizure attack. The examination showed that the child did not have any seizure. Christopher's other diagnoses were also refuted.
In 2022, Caitlin was sentenced to 6 years in prison. The prosecution insisted on a maximum 20-year sentence, but the judge, for unknown reasons, chose a more lenient sentence. After her arrest, Christopher finally got rid of the tube, began to eat normally and live a full life.
Revenge for bullying: the story of Gypsy Rose and Dee Dee Blanchard
Dee Dee Blanchard was considered by neighbors and friends to be the best mother in the world: she alone raised her terminally ill daughter Gypsy and devoted all her time to her. According to Dee Dee, Gypsy had a whole bunch of serious illnesses: asthma, leukemia, epilepsy, food allergies, muscular dystrophy, digestive problems, vision and hearing problems, and mental retardation.
When neighbors met Gypsy on the street, they had no doubt that she was sick. The girl moved in a wheelchair, wore wigs and hats to hide her lack of hair, and was very thin. However, these were not signs of illness.
Dee Dee regularly shaved her daughter’s head to simulate oncology, and fed her baby food through a tube. Gypsy took a bunch of medications, slept with a breathing tube, and endured beatings.
Photo from open source
Gypsy tried to escape several times, but her attempts to break free were unsuccessful. At the age of 21, the girl met a young man, Nicholas Godejohn, via the Internet. After two years of correspondence, they plotted to kill Dee Dee so they could finally be together.
On June 14, 2015, Dee Dee was found dead in her home. The cause of death was multiple stab wounds. Her daughter was nowhere to be found, although all life support machines and wheelchairs remained in place. The next day, Gypsy and Nicholas were detained. To the surprise of those around her, Gypsy did not move in a wheelchair, but on her own legs.
It turned out that Nicholas inflicted the puncture wounds, and Gypsy was hiding in the bathroom at that time. During the investigation, the girl was examined by doctors and no diseases were found in her. Her medical records contained notes from more than 150 doctors, and each one included the notes: “Mother reported,” “Story from mother.”
Gypsy was sentenced to 10 years in prison, Nicholas to life imprisonment. In prison, Gypsy gave an interview in which she said: “I feel freer in prison than living with my mother. Because now I’m allowed... to just live like a normal woman.”
Source
After Dee Dee's death, many doctors opined that she had delegated Munchausen syndrome. For example, Professor Mark Feldman was sure of this. He called the story of Dee Dee and Gypsy unprecedented in his practice. In 24 years of working with FDIA perpetrators and victims, he has never seen a child kill their abusive parent.
"You made me sick"
Not long ago, an accusation book called “You Made Me Sick” was published in the United States. This book immediately became a bestseller and was published in 18 countries around the world. Unfortunately, it has not yet been translated into Russian. In this book, a 35-year-old woman named Julia remembers her childhood, which was filled with hospitals, pills, doctors, various tests, procedures and diets. Julia's mother, Sandi Gregory, dragged her from hospital to hospital, asking the same question to doctors: “My daughter feels very bad! What with her?" Of course, after everything they did to her, the girl looked terrible. Doctors looked for the cause, constantly took blood tests, sent Julia for x-rays, examined her internal organs using catheters, but could not find anything. Without receiving a diagnosis, Sandi took the girl to another hospital and there everything started all over again. Young Julia was treated for everything from sore throat, migraines, dizziness, various allergic reactions, shortness of breath, even heart disease and heart rhythm disturbances were suspected. The girl was prescribed strict diets, various medications and unnecessary procedures, although she was in fact absolutely healthy, only the “treatment” weakened her body. Fortunately, Julia survived everything that her parents and doctors did to her without serious consequences, however, she could not forgive her mother for her poisoned childhood...
