False accusations of Munchausen by Proxy, The Truth Behind the Label: Part 1 – Diagnosing Munchausen by Proxy

[Alison J Stevens]

False accusations of Munchausen by Proxy, The Truth Behind the Label: Part 1 – Diagnosing Munchausen by Proxy

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(Part: 1 | Diagnosing Munchausen by ProxyMunchausen Syndrome by Proxy or MSBP is a diagnosis given to a mother or care giver to describe aspects of their behaviour. This behaviour usually includes subjecting what appears to be a previously
healthy child to unnecessary and often painful tests or medical
interventions i.e.: scans, x-rays and even surgical procedures to gain
attention from the medical profession.

Many theories exist as to why a woman may fabricate illness in her child. Common to most theories is a traumatic loss earlier in the mother’s life; such a loss may be represented by
maternal rejection and the lack of love and attention as an infant. It
may also be representative of the “loss of a parent, loss of a parent’s
love through neglect or abusive treatment, or loss of self through
childhood illness or traumatic disillusionment” (Bach, 1991).

The problem appears to be that many professionals describe MSBP as different things. There have been debates all over the world on the subject. Some have said it is a mental illness and some say that it
doesn’t exist, others question whether if it does, then can it even be
called MSBP, as Munchausen by Proxy is after all, just a term,
referring to a list of symptoms, named after a fictitious storybook
character Baron Munchausen, who enjoyed a series of fanciful adventures.

Dr Marc Feldman, thought to be a leading expert on the subject, believes that it does exist and describes what he believes to be the behaviour of a person thought to have MSBP on his website.

“They deliberately mislead others into thinking they (or their children) have serious medical or psychological problems, often resulting in extraordinary numbers of medication trials, diagnostic
tests, hospitalizations, and even surgery . . . that they know are not
really needed. In short, factitious disorder, Munchausen syndrome,
malingering, and Munchausen by proxy involve illness deception, or
“disease forgery.”

• They may feign illness – e.g., by faking a seizure or acting as if they have multiple personalities.

• They may falsify lab results – e.g., by adding blood or protein to a urine specimen.

• They may exaggerate a medical problem – e.g., by claiming occasional mild back pain is crippling.

• They may aggravate an existing ailment – e.g., by manipulating a wound so it doesn’t heal.

• They may induce an actual illness – e.g., by injecting themselves or their child with bacteria to cause a raging infection.

• They may “dissimulate” – e.g., by initially avoiding treatment so that a minor medical problem becomes serious”.

• 
  

He adds

“In variations of the root problem, some seek the HERO or VICTIM role, rather than the

SICK role”

In another article by Feldman Parenthood Betrayed, The Dilemma of Munchausen by Proxy he explains that MSBP mothers need to feel ‘special’ and ‘that virtually all have personality disorders.

Other professionals however, disagree with this opinion fiercely and in 2004, Earl Howe the Opposition spokesperson on children and health in the House of Lords, was reported to have said in the article Justice out of Balance that he believed that professionals were replacing the term MSBP with a diagnoses of Personality disorder, to assist arrest. .

In the article Munchausen by Proxy written by Ibrahim Abdulhamid MD he says:-

“Perpetrators are frequently described as caring, attentive, and devoted individuals. However, not all perpetrators fit this impostor parent profile. Some can be hostile, emotionally labile,
and obviously dishonest. Although they have no obvious psychopathology,
perpetrators can be deceiving and manipulative. Their ability to
convince others should not be underestimated. Their abuse is
premeditated, calculated, and unprovoked. The mother may have previous
health care knowledge or training, and she is often fascinated with the
medical field. In 1 study, 80% of the documented perpetrators, all
mothers, worked in health care or child-care facilities. She aspires to
establish close relationships with medical staff and frequently becomes
a source of support for staff members or the families of other
patients.”

Here we see that Abdulhamid’s describes a ‘profile’. The idea of a MSBP profile has built up over the years and has been used frequently to assist the diagnoses of MSBP abuse. The ‘profile’ is
a list of traits believed to be common in a MSBP type character,
unfortunately this profile also describes many innocent women as well
and this is concerning many professionals.

Dr Helen Hayward-Brown, one such professional is worried about the use of the ‘profile’ saying:-

‘It is a nightmare waiting on the step of every sick child’.

‘ordinary mothers and fathers are being accused of child abuse because their children have an illness that some pediatricians cannot diagnose, or the parents strongly question the
doctors over the child’s treatment’. Justice out of Balance

She goes on to say how parents are often trapped and uses the example that being an over protective parent is one part of the MSBP profile but then explains that equally so to is being a negligent
parent, putting parents into a no win situation.

Earl Howe has also been extremely concerned about the use of the MSBP profile and in Oct 2001 said in a parliamentry discussion at the The House of Lords:-

”The danger of such a broad spectrum of behaviour being packaged into a single portmanteau term, MSBP, is that in the hands of those who are not sufficiently trained or experienced to know
better, it is a label that is all too easily applied without due care.
This is all the more true when one considers the so-called profile of
characteristics that are said to mark out a person suffering from MSBP.
These characteristics include such things as privation during
childhood, repeated bereavement, miscarriage, divorce and past health
problems. An over-intense relationship with the child and a desire to
be the perfect parent are other supposed markers. Regardless of the
fact that there are very many perfectly innocent, sane people around
who might have such characteristics, the very idea of a tell-tale
profile of this kind is an open invitation to apply the MSBP label
without properly looking at what may or may not be happening to the
child. Put at its simplest, there is all the difference in the world
between a Beverley Allitt, whose severe personality disorder led her to
murder young children, and a mother who invents reasons why she and her
child should visit the doctor. Yet under the all-embracing banner of
MSBP, and in the hands of the untrained, the two are treated as being
practically indistinguishable. It does not matter whether one calls the
condition “MSBP” or “factitious illness by proxy”, or by any other
name. The point remains the same. ”

Lisa Blakemore-Brown a psychologist, expert in Autism and an author agrees, she feels that parents become under attack and blamed, if they dare to question doctors, particlularly if they believe that their
child has become ill after a vaccine injury. She speaks of one
particular case in Omissions Prove What and she also made a comment in the Open House: Have Your Say: Measles ‘endemic’ in Britain The Independant in 2008 saying:-

“In the Sally Clark case, Professor Meadow accused her of killing two children who had just been vaccinated, one just 5 hours earlier. To my certain knowledge, as a Psychologist specialising in
Autism since 1993, and working as a generic Psychologist since 1984,
many parents whose children reacted to a vaccine have been wrongly
accused of MSBP. Known side effects have been morphed into child abuse.
Workers have been taught to view them this way and act accordingly.
Some have had their children taken from them, some were sent to prison
and Sally Clark lost her children and her life.”

Earl Howe the opposition spokesman on health, once accused a professor of inventing a “theory without science” and refusing to produce any real
evidence to prove that Munchausen Syndrome by Proxy actually exists. He
says-

‘It is important to distinguish between the act of harming a child, which can be easily verified (and there are plenty of cases to prove that it happens), and motive, which is much
harder to verify and which MSbP (controversially) tries to explain. For
example, a caregiver may wish to harm a child simply out of malice
(similar to domestic abuse by husband or wife) rather than in order to
draw attention and sympathy, in which case, harming the child is merely
incidental to the main purpose. In the former case, induced illness is
likely to be a means of avoiding detection of domestic abuse (a more
elaborate form of the excuse that the victim has “fallen down the
stairs”).

Blakemore-Brown believes that the use of the profile has encouraged professionals to think in a ‘ medieval manner’.

Lisa Blakemore-Brown’s Complaint

Re: Influence of Bruce Clark

”Since the introduction of the Clark guidelines, the warped MSBP thinking has performed much as one would expect. It has snaked right through the system.

It has encouraged workers and professionals at all levels to think in a medieval manner and misconstrue what is in front of them. It has fostered a misplaced belief that the road to
their suspicions is paved with robust science and indisputable medical
evidence. It has fostered a misplaced belief that they are protecting
children.”

Some professionals describe what they call some the ‘warning signs’ to watch out for when diagnosing a potential sufferer.

“The characteristic behaviour of the parent is pleasant, cooperative, and supportive of the medical staff; eager to be in the hospital, overly attentive to her child (takes temperature, administers
medication, attempts to exclude medical support staff); and able to
arouse sympathetic interest and involvement of hospital staff. In
addition, the mother may have a nursing or medical background, have her
own history of Munchausen syndrome, have a history of marital discord,
deny deception, lack the usual parental concern, and have suicidal
ideation or attempt suicide before or after discovery of the syndrome
(Meadow, 1982). The mother may thrive in the medical environment and
enjoy the attention and care she receives from the health care staff.
She may have a history of frequent use of emergency rooms and
ambulances”

However, if the parent has a disabled or frequently sick child, it is quite possible that they will be used to their local hospital as they may have been a frequent visitor with their child. If it is a good
hospital the parent will feel at ease. If this is so, they may feel
comfortable with the staff, even being on first name terms with many,
and feel that they are simply being helpful and saving work for the
busy staff. To many junior doctors and staff who are unfamiliar with
the parent and their situation, this may appear to be very much in line
with the above comments although I don’t know how a parent can be
”overly attentive to their child” and then to ”lack parental concern.”.

Prof Meadow mentions suicide attempts before and after diagnoses of MSBP. “have suicidal ideation or attempt suicide before or after discovery of the syndrome (Meadow, 1982).”

Again, for some parents with a disabled or ill child there is a total lack of help and support locally and it is possible that this lack of support will have a detrimental impact on a mothers
mental health. She may well become suicidal or be driven to attempt
suicide. This was highlighted in the news story regarding a couple who
had a daughter with Asperger’s syndrome who felt unable to cope with
the pressures.

Suicide pair’s girl Heartbroken

The article describes the lengths the parents’ of a disabled child resorted to as a result of a total lack of support by the system. Their daughter who had Aspergers
syndrome had ran up huge debts. The family had no support and no where
to turn. So in sheer desperation they decided they could no longer cope
and decided to end their lives. Tragically the mother died but the
father did not. In their suicide note it read

“There is still no attempt to provide any form of help, therefore we have chosen that the only way out is to end our lives.

“…We came to Tenerife on a cheap one-way flight and have been sleeping on the beach for the last three nights while we pondered the situation, but we realise that we will have to
end our lives as there is no help whatsoever.”

More recently a young mother felt she was forced to end hers and her daughters life in -

Bullied by gang of youths: mother kills herself and daughter

This is yet another case where the system failed a mother and a child who were in desperate need of help. This sadly can be the reality of a life with a disabled child. Leaving vulnerable families feeling
that death for them is the only way out.

Other classic warning signs depicted include separation anxiety in the child and parental over-protectiveness.

“The child may cling to the mother and not demonstrate age-appropriate behaviour (Crouse, 1992). The child may initially display fear, negativism, and anxiety, and later progress to a passive,
helpless state”

This equally can be normal behavior. A hospital can be a scary place for a child with many unfamiliar people. There may be a need for blood tests and examinations and this may make a child appear
clingy or anxious This in turn may send a parent into overdrive, making
them appear over protective. A child who is ill or in pain can also
display fear, negativism, and anxiety.

Louisa J Lasher another said expert on the subject of Munchausen Syndrome by Proxy in her article Smothered with Something That Looks Like Love but Isn’t says:-

“The main thing these mothers are after,” says Louisa J. Lasher, MA, an international expert on the subject, “is the attention that they get from having a child with problems.” Commonly,
these mothers will receive sympathy from friends and family. Sometimes
church groups or community groups praise these mothers for their
selfless duty to their sick child. Of course, to keep the praise
coming, the lies must continue. Thus, the children suffer.

Lisa Blakemore-Brown has a differing opinion which was described by Jamie Doward in his Guardian article.

Guardian 2004 Ministers are told child harm theory was flawed :-

‘Between 1996 and 2002 Blakemore-Brown also raised her concerns in a series of letters to, among others, Tony Blair, health secretaries Frank Dobson, Alun Milburn and Health
Minister Jacqui Smith. In each case she received a reply observing only
that her concern had ‘been noted’. She also wrote to the Psychologist
magazine, warning: ‘I cannot establish a robust scientific base and am
aware of a number of cases in which mothers have had children removed
on the basis of this diagnosis to discover later that their children
had real illnesses or disorders which were missed when the notion of
MSBP loomed large.’

See the copy of her letter here

Letter published in Psychologist

MSBP is often described as a mental illness, this is probably because its counterpart Munchausen Syndrome is listed in both ICD 10 and DSM IV (the psychiatrist’s bibles) We have also seen Dr Marc
Feldman and. Ibrahim Abdulhamid MD describe it as a personality
disorder.

Both of these sites show references to Munchausen Syndrome being listed but not MSBP.( Munchausen Syndrome is when a person falsifies their ‘own’ illnesses to gain attention.)

ICD-10 – ICD-10:

and

Wikipedia

However FDBP or Factitious Disorder by Proxy which is now a name sometimes used, is listed as a personality disorder and is in DSM IV and has been since 1994

In 1985 Sir Roy Meadow states:-

‘that as a rule mothers with MSBP appeared normal on psychological tests with no disorder apparent to the psychiatrist and Rosen et al describes a case where a mother he knew
fell within normal limits and showed no sign of psychopathic tendency,
however a psychodynamic interpretation of her data later resulted in a
diagnoses of narcissistic personality disorder.’

Again this indicates that MSBP is a personality disorder but is it? Many professionals disagree as we have seen. If it is then why is it not just called a ‘personality disorder’ .in the same
way as ‘narcissistic personality disorder’ is? For example ‘MSBP
Personality disorder’.

Since 2002, MSBP has also been known as FII which is Fabricated or Induced Illness. FII is listed as a mental illness which is maybe why it is being more frequently used as
the listing would give the diagnoses more weight.

All in all serious caution is required when making a diagnosis of MSBP type abuse. Much of the above can also be indications of a normal anxious parent with a sick child or indeed a child with organic, but
undiagnosed illness or disability. People are by nature different and no one can fit the ‘profile’ of MSBP perfectly.

An ethical diagnosis of MSBP should include a detailed evaluation of the child, an evaluation of the parents and of the family dynamics. Diagnoses based only on a quick review of the child’s medical
chart can often be misleading and can brand an innocent mother guilty.
The profile of msbp shows that in the event a mother is wrongly
diagnosed, the stigma would be much like a permanent imprint on their
life. This would affect various aspects of their lives. The victim of a
false diagnosis may then spend many years in a system clearing her name.