Munchausens Syndrome by Proxy

What is Munchausen syndrome by proxy?

Munchausen syndrome by proxy (MSP), a type of factitious disorder, is a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick. The adult perpetrator has MSP and directly produces or lies about illness in another person under his or her care, usually a child under 6 years of age. It is considered a form of abuse by the American Professional Society on the Abuse of Children. However, cases have been reported of adult victims. (The term "by proxy" means "through a substitute.")

People with MSP have an inner need for the other person (often his or her child) to be seen as ill or injured. It is not done to achieve a concrete benefit, such as financial gain. People with MSP are even willing to have the child or patient undergo painful or risky tests and operations in order to get the sympathy and special attention given to people who are truly ill and their families. Factitious disorders are considered mental illnesses because they are associated with severe emotional difficulties.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Text Revision DSMIV-TR), which is the standard reference book for recognized mental illnesses in the United States, organizes factitious disorders into four main types: those with mainly psychological symptoms; those with mainly physical symptoms; those with both physical and psychological symptoms; and those that do not match the conditions for the other three types. MSP falls into the fourth category. Fortunately, it is rare (2 out of 100,000 children).

MSP most often occurs with mothers—although it can occur with fathers—who intentionally harm or describe non-existent symptoms in their children to get the attention given to the family of someone who is sick. A person with MSP uses the many hospitalizations as a way to earn praise from others for her devotion to the child’s care, often using the sick child as a means for developing a relationship with the doctor or other health care provider. The adult with MSP often will not leave the bedside and will discuss in medical detail symptoms and care provided as evidence that he or she is a good caretaker. If the symptoms go away in the hospital, they are likely to return when the caretaker with MSP is alone with the child or elderly parent.

People with MSP might create or exaggerate the child’s symptoms in several ways. They might simply lie about symptoms, alter diagnostic tests (such as contaminating a urine sample), falsify medical records, or induce symptoms through various means, such as poisoning, suffocating, starving, and causing infection. The presenting problem may also be psychiatric or behavioral.
What are the symptoms of Munchausen syndrome by proxy?

Certain characteristics are common in a person with MSP:

Often is a parent, usually a mother, but can be the adult child of an elderly patient
Might be a health care professional
Is very friendly and cooperative with the health care providers
Appears quite concerned (some might seem overly concerned) about the child or designated patient
Might also suffer from Munchausen syndrome (This is a related disorder in which the caregiver repeatedly acts as if he or she has a physical or mental illness when he or she has caused the symptoms.)

Other possible warning signs of MSP in children include the following:

The child has a history of many hospitalizations, often with a strange set of symptoms.
Worsening of the child’s symptoms generally is reported by the mother and is not witnessed by the hospital staff.
The child’s reported condition and symptoms do not agree with the results of diagnostic tests.
There might be more than one unusual illness or death of children in the family.
The child’s condition improves in the hospital, but symptoms recur when the child returns home.
Blood in lab samples might not match the blood of the child.
There might be signs of chemicals in the child’s blood, stool, or urine.

What causes Munchausen syndrome by proxy?

The exact cause of MSP is not known, but researchers believe both biological and psychological factors play a role in the development of this disorder. Some theories suggest that a history of abuse or neglect as a child or the early loss of a parent might be factors in its development. Some evidence suggests that major stress, such as marital problems, can trigger an MSP episode.
How common is Munchausen syndrome by proxy?

There are no reliable statistics regarding the number of people in the United States who suffer from MSP, and it is difficult to assess how common the disorder is because many cases go undetected. However, estimates suggest that about 1,000 of the 2.5 million cases of child abuse reported annually are related to MSP.

In general, MSP occurs more often in women than in men.
How is Munchausen syndrome by proxy diagnosed?

Diagnosing MSP is very difficult because of the dishonesty that is involved. Doctors must rule out any possible physical illness as the cause of the child’s symptoms, and often use a variety of diagnostic tests and procedures before considering a diagnosis of MSP.

If a physical cause of the symptoms is not found, a thorough review of the child’s medical history, as well as a review of the family history and the mother’s medical history (many have Munchausen syndrome themselves) might provide clues to suggest MSP. Often, the individual with MSP may have other comorbid psychiatric disorders. Remember, it is the adult, not the child, who is diagnosed with MSP. Indeed, the most important or helpful part of the workup is likely to be the review of all old records that can be obtained. Too often, this time-consuming but critical task is forgotten and the diagnosis is missed.
How is Munchausen syndrome by proxy treated?

The first concern in cases of MSP is to ensure the safety and protection of any real or potential victims. This might require that the child be placed in the care of another. In fact, managing a case involving MSP often requires a team that includes social workers, foster care organizations, and law enforcement, as well as the health care providers.

Successful treatment of people with MSP is difficult because those with the disorder often deny there is a problem. In addition, treatment success is dependent on the person telling the truth, and people with MSP tend to be such accomplished liars that they begin to have trouble telling fact from fiction.

Psychotherapy (a type of counseling) generally focuses on changing the thinking and behavior of the individual with the disorder (cognitive-behavioral therapy). The goal of therapy for MSP is to help the person identify the thoughts and feelings that are contributing to the behavior, and to learn to form relationships that are not associated with being ill.
What are the complications of Munchausen syndrome by proxy ?

This disorder can lead to serious short- and long-term complications, including continued abuse, multiple hospitalizations, and the death of the victim. (Research suggests that the death rate for victims of MSP is about 10 percent.) In some cases, a child victim of MSP learns to associate getting attention to being sick and develops Munchausen syndrome himself or herself. Considered a form of child abuse, MSP is a criminal offense.
What is the prognosis (outlook) for people with Munchausen syndrome by proxy?

In generally, MSP is a very difficult disorder to treat and often requires years of therapy and support. Social services, law enforcement, children’s protective services, and physicians must function as a team to stop the behavior.
Can Munchausen syndrome by proxy be prevented?

There is no known way to prevent this disorder. However, it might be helpful to begin treatment in people as soon as they begin to have symptoms. Removing the child or other victim from the care of the person with MSP can prevent further harm to the victim.

So purely hypothetically, say I have lost a child who had a sibling two years old when he/she disappeared. This sibling is now 7 years old and cannot remember what happened or indeed barely remembers anything from earlier than when he/she was 3 years old.

Doest the fact that I constantly remind him/her of a lost sibling and say a monster took him/her away from us, that I pretend they are getting presents from their sibling and cards and that one day we will find the monster - does all this too come under MSP?

I certainly think so.

Very interesting.

Quote: "MSP most often occurs with mothers—although it can occur with fathers—who intentionally harm or describe non-existent symptoms in their children to get the attention given to the family of someone who is sick."

So a key driving factor in MHP is attention seeking, any subsequent harm to the child is merely a symptom of such ttention seeking. Have I got that right?

2.5 million cases of child abuse reported annually in the US.......my God, what a world. I wonder what the figures are for UK? This is very interesting, though I am thinking, purely hypothetically, along the mental disorder of folie a deux, when two or more people share the same delusion.

From what I understand of this condition, a classic example of someone with it is the nurse Beverly Allitt who attacked children in her care in the early 1990s.

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The Tinning case in America may not be that well known in the U K - here we have a woman who revelled in the attention and sympathy that the death of a child brought.

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Personally I don't think that this condition is relevant to the McCanns.

No, I agree jean, personally, imo, I think a whole scenario has been invented, manipulated and put into play with implications and repercussions which could be quite scary if we were to be allowed to know the truth.

From Wiki - 'The syndrome name derives from Baron Münchhausen (Karl Friedrich Hieronymus Freiherr von Münchhausen, 1720–1797), a German nobleman, who purportedly told many fantastic and impossible stories about himself, which Rudolf Raspe later published as The Surprising Adventures of Baron Münchhausen.'

Have looked at folie a deux, interesting reading. Munchausens was just an idea which I thought might be worth pursuing, due to the withholding of medical records. Kate McCann from the outset looked to my layperson's eyes like a woman with a serious mental health issue, heavily medicated and I always wondered what was in those medical records of Maddie's.
There is something about the child that had at all costs to remain hidden it would appear, and I wondered could an array of reported medical conditions be the case.
Another thing I was thinking, as Maddie was such a problem child with colic in her very early years, and as Kate was a GP, did she as a GP diagnose Maddie herself rather than take her to the GP she would have been registered with? Could Kate have become so worried about her daughter's health, real or imagined problems, that she became neurotic, treated her appropriately or inappropriately out of anxiety, for health issues which possibly became either exaggerated in her mind, or became a reality when in fact they were non-existent and that any harm was with good intentions?
Maddie's health is a big issue imo, she did not look like a healthy child in many photographs. Just wondering might any problems have been created by a mother out of her depth with parenting 3 toddlers, low self esteem as a mother, feeling a failure when she had always been a high achiever, and a cry for help? Attention desperately sought, but via her child?

russiandoll wrote:Have looked at folie a deux, interesting reading. Munchausens was just an idea which I thought might be worth pursuing, due to the withholding of medical records. Kate McCann from the outset looked to my layperson's eyes like a woman with a serious mental health issue, heavily medicated and I always wondered what was in those medical records of Maddie's.
There is something about the child that had at all costs to remain hidden it would appear, and I wondered could an array of reported medical conditions be the case.
Another thing I was thinking, as Maddie was such a problem child with colic in her very early years, and as Kate was a GP, did she as a GP diagnose Maddie herself rather than take her to the GP she would have been registered with? Could Kate have become so worried about her daughter's health, real or imagined problems, that she became neurotic, treated her appropriately or inappropriately out of anxiety, for health issues which possibly became either exaggerated in her mind, or became a reality when in fact they were non-existent and that any harm was with good intentions?
Maddie's health is a big issue imo, she did not look like a healthy child in many photographs. Just wondering might any problems have been created by a mother out of her depth with parenting 3 toddlers, low self esteem as a mother, feeling a failure when she had always been a high achiever, and a cry for help? Attention desperately sought, but via her child?

Excellent thoughts! I have often wondered if the reason why her medical records were kept back was because 'they' had treated her and prescribed her medication, which is surely against all medical ethics?!

monkey mind wrote:Very interesting.

Quote: "MSP most often occurs with mothers—although it can occur with fathers—who intentionally harm or describe non-existent symptoms in their children to get the attention given to the family of someone who is sick."

So a key driving factor in MHP is attention seeking, any subsequent harm to the child is merely a symptom of such ttention seeking. Have I got that right?

No, I believe the child's condition is a key determinant with MHP, not a mere symptom. It is a form of child abuse that involves the exaggeration or fabrication of illnesses or symptoms by a primary caretaker, in the large majority of cases the mother. They frequently insist on seeking medical attention for a child where there is no underlying illness to the symptoms presented, or for some injuries or illnesses actually caused by them.
I don't believe this applies to Kate McCann at all.

Ribisi.......could you give your reasons? I am unsure as to the relevance of MSBP, just thought it might be worth even a brief discussion.......there has to be a reason for not producing the child's health records.

I've copied this from 'Life before Portugal'

poppydog wrote:
snipped:
On another note, a friend briefly worked with Kate in a maternity hospital as Kate was completing her training. Apparantly the consultant in charge loathed her and her narcassistic tendancies even then. Friend said she was the least maternal woman she'd ever met.
Unquote

Interesting bit of info. That's how she's always struck me. The software just isn't there.
There are a few photographs of Kate carrying one of the twins, she carries them like a sack of shopping, leaning away from them and hardly holding them. Not at all safely imo.

I agree with Ribisi purely because this syndrome is primarily about seeking attention. If they treated her themselves there were no attention from anyone. (or close friends for that matter).

A mother having this syndrome will probably seek doctor after doctor to explain the illness, until she gets someone to feed her what she wants to hear, "that the child is ill". Someone who feels sorry for her, who will prescribed medicine, maybe even call to hear how the child is doing, one who will feel sorry for the mother.

Don't know if I am expressing me correctly here. To me this syndrome is all about complaining to the world what hell your life is with this sick child.

Just to add:

I see this the same as being a hypochondriac. The only difference its passing the illness on to the child. But with the primary objective of everyone should know how difficult life is with such an ill child. All about attention from the outside world "Poor mother, her life can't be easy with a child with such and such illness'

russiandoll wrote:Have looked at folie a deux, interesting reading. Munchausens was just an idea which I thought might be worth pursuing, due to the withholding of medical records. Kate McCann from the outset looked to my layperson's eyes like a woman with a serious mental health issue, heavily medicated and I always wondered what was in those medical records of Maddie's.
There is something about the child that had at all costs to remain hidden it would appear, and I wondered could an array of reported medical conditions be the case.
Another thing I was thinking, as Maddie was such a problem child with colic in her very early years, and as Kate was a GP, did she as a GP diagnose Maddie herself rather than take her to the GP she would have been registered with? Could Kate have become so worried about her daughter's health, real or imagined problems, that she became neurotic, treated her appropriately or inappropriately out of anxiety, for health issues which possibly became either exaggerated in her mind, or became a reality when in fact they were non-existent and that any harm was with good intentions?
Maddie's health is a big issue imo, she did not look like a healthy child in many photographs. Just wondering might any problems have been created by a mother out of her depth with parenting 3 toddlers, low self esteem as a mother, feeling a failure when she had always been a high achiever, and a cry for help? Attention desperately sought, but via her child?

What does a healthy child look like? I would be interested or at least pointed to exactly why Madeleine was not healthy. The only thing I see is eye bags which may indicate Hay Fever or similar.

All you who say Madeleine was ill, explain how.

As a medical professional I have come accross this disorder a few times and from what I know of it I don't think it fits with this case.
Sufferers tend to be obssessed with medical professionals and crave attention from them. As doctors KM and GM would have knowledge of this disorder and how easily it can be detected. Also I do not think Beverley Allitt was a sufferer as the ill children did not gain her attention (she was just a very sick bunny).

I do agree that not providing MBM's medical records was strange and I'm surprised that permission was needed in a case of this sort. Surely now that MBM is a ward of court their permission is not required???

russiandoll wrote: Ribisi.......could you give your reasons? I am unsure as to the relevance of MSBP, just thought it might be worth even a brief discussion.......there has to be a reason for not producing the child's health records.

Munchausen syndrome by proxy is so diagnosed when a mother fakes or causes symptoms or illnesses in her child in order to seek medical attention for the child, thus by proxy the mother herself receives attention she desires, if I understand correctly. Kate's behaviour is typically narcissistic but I do not believe she abused Madeleine in this way. She would abandon her in the apartment to seek pleasure in a bar, she would leave her in the creche all day during a family holiday so she can jog and play tennis. She perhaps was not a most caring and sympathetic mother, she might slap her or shout at her, but I do no believe she would harm her in a premeditated way.

I do agree with you that Madeleine's health is significant in this whole case because they made such a big deal about her colic and much more importantly because of their refusal to hand over her medical record. One naturally speculates what did they have to hide from the police? Did she have some illness that resulted in her death? Or was she regularly given medication to sleep or even to calm down, a practice they knew to be unethical as medical doctors? Was there some congenital disorder she suffered from which they as parents did not want the whole world to see?

It was Kate writing about Maddies fear of pain which got me thinking she might have been ill and had painful medical procedures performed.
MSBP offenders are uncharacteristically calm in view of the victims baffling medical symptoms, and they welcome medical tests that are painful to the children. They also maintain a high degree of involvement in the care of their children during treatment and will excessively praise the medical staff. They seem very knowledgeable of the victims'' illnesses, which may indicate some medical study or training. They may also have a history of the same illnesses being exhibited by their victims. [why medical records were important]

Victims of MSBP can be of either gender. They are often immature for their age, due to their forced dependency on the abusing parent, and female victims may assume multiple roles. For example, they may take on a motherly role as they imitate their closest role model--the offender--and then regress to the role of a sick, weak, dependent child.

"She wouldn't have left the twins, she was like a wee mother figure to them. "

isolation
Munchausen Syndrome is an attention-seeking personality disorder which is more common than statistics suggest. Munchausen Syndrome, named after a German soldier renowned for exaggerated tales, is a predominantly female disorder in which an emotionally immature person with narcissistic tendencies, low self-esteem and a fragile ego has an overwhelming need to draw attention to herself and to be the centre of attention

In Munchausen Syndrome, this is achieved by capitalising on, exploiting, exaggerating or feigning illness or injury or personal misfortune. [ The opportunities for being centre of attention can be increased if feigning victimhood through alleged victimisation,isolation , exclusion or persecution is added to the equation; the Munchausen person can then depict another person (often a family member) as a victimiser or persecutor and herself as the victim. Presenting herself as a false victim is also a Munchausen trait.[b]

Imo the above fits KM.
capitalising on and exploiting an event or [non event if we disbelieve abduction]
feigning victimhood [child snatched], Maddie soon became not central .
isolation.....foreign police not helpful, they were the only ones looking for Maddie.
persecution....... foreign.police fitting her up, public would be kinder were she fat and frumpy or words to that effect.

behaviour profile and history of attention-seeking behaviour including manipulation and deception, at which Munchausen cases excel.

russiandoll - I enjoy many of your theses because you are an original thinker with an imaginative mind. But here I honestly think you are mislabelling Kate's personality traits.

I wish you would label KMs personality traits...I would like to consider all opinions differing from my own !

tigger wrote:So purely hypothetically, say I have lost a child who had a sibling two years old when he/she disappeared. This sibling is now 7 years old and cannot remember what happened or indeed barely remembers anything from earlier than when he/she was 3 years old.

Doest the fact that I constantly remind him/her of a lost sibling and say a monster took him/her away from us, that I pretend they are getting presents from their sibling and cards and that one day we will find the monster - does all this too come under MSP?

I certainly think so.

I agree with the implication here although I would call it emotional abuse (the stuff of children`s nightmares) rather than MSP. This is a highly contentious label that has been used widely in child protection services in order to justify the removal of babies and young children from their mothers, and suspected cover-ups by medical practitioners. See Lisa-Blakemore Brown.

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I agree with Jean that MSP is not relevant to the McCanns and is in fact too controversial to be useful.

As to why Madeleine`s medical records were withheld that does raise the big question. Why ?

Ribisl wrote:

monkey mind wrote:Very interesting.

Quote: "MSP most often occurs with mothers—although it can occur with fathers—who intentionally harm or describe non-existent symptoms in their children to get the attention given to the family of someone who is sick."

So a key driving factor in MHP is attention seeking, any subsequent harm to the child is merely a symptom of such ttention seeking. Have I got that right?

No, I believe the child's condition is a key determinant with MHP, not a mere symptom. It is a form of child abuse that involves the exaggeration or fabrication of illnesses or symptoms by a primary caretaker, in the large majority of cases the mother. They frequently insist on seeking medical attention for a child where there is no underlying illness to the symptoms presented, or for some injuries or illnesses actually caused by them.
I don't believe this applies to Kate McCann at all.

Now I have no idea whether this applies to the delightful Kate or not. But, to use your words.....

"It is a form of child abuse that involves the exaggeration or fabrication of illnesses or symptoms by a primary caretaker, in the large majority of cases the mother. They frequently insist on seeking medical attention for a child where there is no underlying illness to the symptoms presented, or for some injuries or illnesses actually caused by them"

So I had it right the first time. 1. The parent craves attention, this is the root, the dis-ease itself. 2. The child is the visible presented symbol of the dis-ease, just like a visible sore, wound, lesion, hacking cough, foul breath or whatever is the sign of some underlying problem. For instance, the visible smallpox simply points to an underlying greater lethality. To dab cream on the pox achieves little. In MHP, it seems the child's imaginary illnesses or inflicted illnesses are simply a projection, a manifestation of the root dis-ease, which lies in the parent, and according to the above, appears to be attention seeking. I'm not at all saying MHP has anything to do with this case, but I did find that attention seeking being obviously a root cause, well I did find that interesting. Very interesting.

I'm not sure about MSBP in this case, but of course I agree that MSBP is definately all about the parent/carers' needs being met.

As I remember, (personal experience from my ward days !) another frequent feature of Munchausens is the parents'/carers need to be hailed a hero/heroine for saving their childs life - for reviving them, in the nick of time. Giving the parent/carer immense status and praise as well as lots of attention from the medics.

As I also recall Ms Allitt was present at such a moment.

jmac wrote:

tigger wrote:So purely hypothetically, say I have lost a child who had a sibling two years old when he/she disappeared. This sibling is now 7 years old and cannot remember what happened or indeed barely remembers anything from earlier than when he/she was 3 years old.

Doest the fact that I constantly remind him/her of a lost sibling and say a monster took him/her away from us, that I pretend they are getting presents from their sibling and cards and that one day we will find the monster - does all this too come under MSP?

I certainly think so.

I agree with the implication here although I would call it emotional abuse (the stuff of children`s nightmares) rather than MSP. This is a highly contentious label that has been used widely in child protection services in order to justify the removal of babies and young children from their mothers, and suspected cover-ups by medical practitioners. See Lisa-Blakemore Brown.

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I agree with Jean that MSP is not relevant to the McCanns and is in fact too controversial to be useful.

As to why Madeleine`s medical records were withheld that does raise the big question. Why ?

Thank you for that. Yes emotional abuse but the suffering reflecting on the parent.

Kate in particular seems to revive like a watered plant the moment she is in the spotlight. I've seen this on several videos, she hates having to sit there and anwer stupid questions - but starring in her own TV drama, promoting her book, the Expresso interview - she's the centre of attention and she loves it.

Getting back to promoting the emotional suffering (missing their sibling) of the twins, I've seen this sort of thing happen in my own family. Some people simply don't have very interesting lives and these tricks make them more so.
As you and others pointed out: the attention for the parent and their suffering is the main factor in these manupilations.
If it goes over a certain limit, then the MSP becomes a factor.

quote jmac
I agree with Jean that MSP is not relevant to the McCanns and is in fact too controversial to be useful

Possibly not, there is no evidence. Just some indications imo that this might have been what was going on. Health appears a major issue due to Maddie's withheld records. We do not know if these would reveal numerous or hardly any visits to her GP or hospital[s].
There is evidence of Kate McCann's ego and narcissism, and a lack of bonding with her eldest daughter. Her "truthful" book for sure is one source.
I agree this discussion might reach a dead end very soon, however its controversial nature should not be a reason why.
I have read more than one post on this forum with the very controversial opinion that Maddie was taken on a planned family holiday in order for her to disappear because she was " surplus to requirements" !