Monday, December 5, 2011

Munchausen Syndrome by Proxy

Today is an exciting (and also gruesome) day! I have banded together with the awesome Dr. Lydia Kang and the equally awesome Dr. Laura Diamond to discuss a really fascinating and (I strongly suspect) misunderstood ailment.

Lydia's post is about the medical aspects of Munchausen Syndrome and Laura's post is about the more psychological aspects. You might want to go read their posts to get a little background on this disorder. As for me: hey! I'm a child psychologist, so I am going to tell you all about Munchausen Syndrome by Proxy (MSP).

The basics: A caregiver (often a mother, but it could be a father) either feigns or induces symptoms in the person (often a young child, though it could also be an elderly parent) under her care. The caregiver does this for purely psychological reasons (e.g., not for financial gain).

MSP, which is considered very rare (like, 1 in 50,000), is not a formal disorder listed in the DSM IV, so it would be diagnosed as Factitious Disorder, Not Otherwise Specified (NOS). Factitious Disorder is a mental illness wherein the person feigns either physical OR psychological symptoms with the focus on assuming the "sick role" (not for external reasons like avoiding legal responsibility). MSP is usually considered a form of child abuse.

In MSP, we have a parent making a kid sick, solely for the purposes of gaining sympathy. They appear devoted, dedicated, tireless. They also tend to be really knowledgeable about the kid's symptoms and medical condition and very interested in having positive relationships with the medical professionals caring for the child. Warning signs include:
  • Multiple hospitalizations of the child. If the symptoms go away in the hospital, they usually come back when the kid goes home.
  • The parent reports the symptoms are getting worse (even when they aren't)
  • Reported symptoms don't match the lab tests
  • Some evidence of fakery in lab tests (the blood/urine isn't the child's)
  • Some evidence of weird chemicals in the lab tests
  • Siblings who have died under mysterious medical circumstances
  • The parent may have very similar symptoms, or a history of them
Examples:
  • Administration of excessive laxatives (or poison) to produce severe diarrhea, vomiting, or other symptoms
  • A mysterious skin condition produced by rubbing caustic substances on the child's skin

On a personal note, here's a pet peeve of mine: when professionals toss this label around casually. I find it really upsetting. Because as soon as a professional decides a parent is MSP, it's a recipe for nastiness. I'm not saying that parents don't sometimes contribute to children's conditions, but deciding it's happening with deliberate intention is a different thing entirely.

It's not that MSP doesn't exist, because it does. And it's not like we don't need to pay attention to the psychological processes that are active for a parent caring for a symptomatic child, because we do. But I get concerned when something this big and scary gets raised without very careful consideration of 1) all the other possible explanations for the parent's behavior and the child's symptoms, and 2) a great deal of knowledge about what MSP actually is (and is not--for example, I've heard professionals accuse a mom of MSP because she was desperate to get her kid on disability. That's financial gain, folks, which immediately eliminates MSP).

Parents of kids with rare medical disorders sometimes get accused of MSP, and it makes things so much worse. So. Just a note of caution. There's a lot of controversy about this disorder. For some solid, more detailed general information about MSP, go here.

What do you think of MSP? Horrifying, no? Somehow, I think it's even worse than Munchausen Syndrome, because with MSP, the person is inflicting symptoms on another, more vulnerable person. Now--if you haven't yet, go read Laura's and Lydia's posts!

23 comments:

  1. I suppose the most famous fictional case of this syndrome was in the movie The Sixth Sense, but I had read a book about this before that. I think it was probably an Alex Delaware mystery, although I wouldn't swear to it.

    A scary, horrifying disorder. And one that totally renders the victim (of the disorder) unlikable. Who could possibly have any sympathy for someone who does this?

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  2. It is horrifying but for more than one reason. Obviously, it's wrong and disturbing for the family and the patient. But how does a family member or friend see through the everyday actions of said caregiver and determine something is wrong? I'm sure it's a delicate and difficult situation. Great post, as always.

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  3. I remember this on ER a few years ago. I was shocked when I saw it because I couldn't understand why a parent would do that to their child. I'm glad to hear it's a rare condition.

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  4. When my daughter was a baby and was sick for so long, and they couldn't find the underlying cause of the problem (milk fat of all things) this disorder was bandied about on more than one occasion. I, naturally, went ballistic, and accused all her doctors, specialists, and nurses, it wasn't me, it was them. Irate mothers are not fun. Unfortunately every test they ran came back with negative results, and it wasn't until a blogger said, "try switching her milk". Five years of pain and suffering, lost school months (yes months) and all it was was her milk. So a good outcome for her, but having that "label" on me, even for that short amount of time, really did a number on my own psyche. It wasn't something I would wish on anyone. People do treat you differently when you are pinned with a "label".

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  5. wow. The MSP is horrifying. I can understand vigilence on the medical community's part when all the elements seem to point towards MSP, but I think hospitalization and clearing out all other possibilities would be really important before accusing someone. Scary stuff!

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  6. Recently, while listening to a song by Eminem, "I'm Sorry Mama" he mentioned he was subjected to MSP. http://www.youtube.com/watch?v=F-yZgJygcZM

    His lyrics are brutally honest so I have to believe he was a victim. The video is upsetting because it seems to be what he actually experienced as kid.

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  7. It's a big deal to accuse someone of Munchausen's or Munchausen's by proxy--not to be thrown around without careful considerations. So true.

    Great post! This was fun and I learned a lot too!

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  8. Um, I don't mean Munchausen's is fun, but doing a triple post. Gah. You knew that, though, right? ;P

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  9. Wow, this has always been a fascinating topic to me. Thanks for the wealth of info. I was a very sickly child, but I remember my mom stopped taking me to the doctor for a while because of the rudeness we would receive from the staff. I even walked around on a broken ankle for DAYS because of that, until my mom finally said enough was enough. I definitely think we need to be careful with labelling patients as this.

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  10. Definitely worse than regular Munchausen's.

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  11. This is a terrible thing, and it's hard to believe that people actually do it. Raising awareness about it is a good thing. Thanks for the info.

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  12. The Sixth Sense and House are about as close as I've ever come to this. Sad stuff.

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  13. This is such a sad disorder. Attention seeking to the point of pretending a loved one is sick (or actually making that loved one sick) is a tragedy to me, but I understand why it's difficult to diagnose.

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  14. Fantastic posts from all three of you, thank you! And I love your pet peeve, Sarah. From a writer's pov, it's an excellent plot twist in an already fascinating, tragic and complicated arc--I hope you're using it in one of your books!

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  15. Ugh. I knew about the disorder, but I never REALLY thought about what it means. I feel ill thinking about poisoning or hurting a child. I'm a mother and OMG I could start crying right now. But you're right, I think it's really important not to jump to conclusions or misdiagnose something like this.

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  16. Yeah, this one makes me so sad (esp. from a parent's pov)and you're right, different than a parent trying to get their child on disability which occurs way more and for different reasons!

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  17. hi miss sarah! i read miss lydia and miss lauras posts. wow! its just way sad that a mom or dad could make a kid sick on purpose. im wondering what could cause them to be that way. for sure they could need some help.
    ...hugs from lenny

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  18. There is an Alex Delaware novel (Devil's Waltz by Jonathon Kellerman) that features MBP. That was how I learned about the syndrome. The Sixth Sense was horrifying, and I just read Nearer Than The Sky by T. Greenwood which is also about MBP and a very good read. I hope no one accuses me of this because my kids are sick a lot and my younger has some more serious health issues, one of which is constant stomach ache. We just did a lactose intolerance test, but I'm thinking it might be milk fat. Glad I read the comment section today! Thanks Anne.

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  19. Thanks for explaining the disorder from other issues a mother may be having.

    I like seeing this illness from different perspectives.

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  20. This is more horrifying than what was described in Lydia's post. Oh my! I have no words (a rare occurence.) Christy

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  21. Love that the three of you tackled different aspects of the same disorder! It's been very informative. I totally agree with you that in cases like this, where things can be so unclear, it's important to be thorough with the research before diagnosis. And yes, MSP definitely scarier.

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  22. I first heard of this about 20 years ago. There was widespread press interest in a killer named Beverley Allit here in the UK. The press bandied this about a lot as an explanation for her crimes.

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  23. Someone I knew at school developed Munchausen Syndrome when she started her nursing course and I always thought it was a desperate cry for recognition. MSP seems far worse to me because the child is put through so many unnecessary investigations while the parent is suffering dreadfully from the need to be noticed. What is worse than that is to have a disorder or for the child to have a disorder that is not diagnosed and the sufferers are accused of Munchausen or MSP. Fascinating subject, though.

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