Mathilde – Hello to all listeners, and welcome to our podcast show ! Today we have decided to talk about a very particular and unknown syndrome, which has nevertheless serious repercussions. Let’s not keep the suspense going, today we are going to focus on Munchausen Syndrome By Proxy, once an obscure medical term. But I’m not alone today, we have Romane Drault, child protection psychologist:
Romane – Hello everyone! Thank you Mathilde for the invitation, I am delighted to be able to take part in this program, and to teach you a little more about this serious form of abuse.
Mathilde – First of all, I think it is important that I explain to the audience what is the Munchausen syndrome : This is a psychiatric disorder characterized by simulated symptoms and/or a non-existent illness. The patient with Munchausen syndrome pretends to be ill without being ill and has certain symptoms without having any. People suffering from this syndrome do not actually have any real illness from a clinical point of view. So, now can you tell us more about the Munchausen syndrome by proxy more specifically ? Also known as factitious disorder imposed on another, or MSBP.
Romane – Sure, MSBP is where you act like the person you’re caring for (a child, a disabled individual, or an older person, for example) has a physical or mental illness while the person is not actually sick. This is a form of child or elder abuse. Most professionals differentiate two forms of the syndrome : passive with invention of symptom and active with ingestion of drugs or toxic substances.
Mathilde – Yes, thank you Romane, just to complete it’s important to remember that MSBP can involve any vulnerable person who has a caregiver. Today we will focus on a parent who abuses his child through MSBS, because it is the most common form.
Romane – Yes, you are right
Mathilde – So what characterizes the caregiver with MSBP?
Romane – The caregiver with MSBP may lie about the child’s symptoms, change test results to make a child appear to be ill, or physically harm the child to produce symptoms, for example. Victims are most often small children. They may get painful medical tests they don’t need. It could take a toll, in fact the child may even become seriously ill or injured or may die because of the actions of the caregiver. Most of the time, the parent who produces the illness in his child is looking for recognition. They are looking for recognition and support in their role as a protective parent. The feeling of compassion he feels from the medical profession and those around him leads him to maintain his deviant behaviour towards the child.
Mathilde – Yes exactly, by the way, children who are victims of MSBP can have lifelong physical and emotional problems and may have Munchausen syndrome as adults. Furthemore, one of caregiver characteristics is that he is in denial about the origin of his child’s symptoms. As a child welfare worker, how often do you encounter this syndrome?
Romane – One incidence study from Great Britain found that 2.8 per 100,000 children younger than 1 year of age are affected by MSBP. So you can’t say that I am often confronted with this form of abuse. But still, the mortality rate is 6% to 33%, and 25% of victims’ known siblings are dead. These numbers are huge, it is important to raise awareness among health professionals and the general public about this form of abuse which has terrible repercussions.
Mathilde – I am personally impressed by the numbers you just shared with us !… So, can you tell us what are the signs that can alert a professional or even the family to this type of syndrome ?
Romane – So, first of all, it’s difficult to notice very specific signs of this syndrome and that’s why it makes it a highly dangerous disease. BUT, when there is medical wandering regarding the illness from which the child has been suffering for a long period of time, when the parent seems to demand too much attention compared to the norm and seems to experience the illness of his child more as a way to be the center of attention and to be recognized as a parent than as an anguish regarding the child, then we can begin to be suspicious.
Mathilde – Ok, I see what you mean… I read also in an article that a too fusional relationship between the parent and the child can emphasize the MSBP diagnostic. For example, a mother who would be pathologically present at all medical appointments even if it means not allowing the doctors to do their job properly, in other words who interfere in the doctor’s attempt to diagnose. Or a parent who would control all areas of his child’s life: not allowing him to eat anything other than what he prepares for him, not allowing him to go out and play with friends for fear that he will hurt himself etc…
Romane – Yes, you’re right ! That’s why it’s important to be attentive and to take the child apart. First, you have to speak with him to learn more about his symptoms and in what kind of context they appear. So, the exchange with other professionals (nurse, doctor, social services etc…) is also crucial at this point. In fact, cross-referencing of information about the child and his family can lead us to the good diagnostic. For example, if on calling the former doctor handling this case, he informs us that when he had a suspicion of a factitious disorder the parent decided to move his child to a different hospital,I think we can be suspicious. Then, if we, or others, find that the illness or symptoms are no longer present when the child is separated from the parent concerned, then this can lead us to MSBP diagnostic.
Mathilde – Great, thanks for these information. And, regarding the child’s behavior, are there any specific signs that can be noted ?
Romane – Like you said before : a strong link to his parent. But as a child in a hospital it could be normal to need to be very close to his parent, to be reassured. It could be strange only when the child’s behaviour and dependence are not consistent with his age.
Mathilde – So, I suppose that this syndrome requires a double care : both the child and the parent ?
Romane – Yes, concerning the child, he needs to know the truth about his health and we have as a psychologue to work with him on the rupture of this toxic link with his parent, on his capacities of discernment, on the emotions and the impact that this syndrome has had on his life. And finally, we must accompany the child in his return to reality. About the parent it’s more complicated : first of all we have to make a report to child welfare practice to assure the security of the child. Then, it depends of the case but several therapy could be proposed : psychotherapy, medical treatment, hospitalization in psychiatry… But there is no magic treatment like for others troubles.
Mathilde – Thanks you Romane for all these explanations about the MSBP ! For people who want to learn more about this syndrome I recommend you the book “Sickened : The true story of a Lost Childhood” written by Julie Gregory. And if you’re more of a movie person than a book person, there are several movies about this subject. In particular the series “The Act” and the movie “Love you to death” telling the famous story of the murder of Dee Dee Blancharde, mother of Gypsy Rose. This mother had Muchausen’s syndrome by proxy. She had been telling her daughter since she was 8 years old that she had leukemia, muscular dystrophy, and that she was going blind and deaf. Gypsy was forced to use a wheelchair and was fed through a tube.It wasn’t until she was 24 years old that she really realized her mother’s mental illness and decided to kill her in order to get out of the vicious circle she had been trapped in since childhood. This case is particularly tragical but it shows us the dramatic impact that could have MSBP on a child and the hardness, the difficulty for him to feel betrayed by the one he thinks wants his good. So, thank you all for your listening, I hope that will have interesting you. See you soon for a new podcast, have a nice day !