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by LOUISA J. LASHER,
M.A.
Topics addressed in the following article include:
FACTITIOUS DISORDER,
(of which MUNCHAUSEN SYNDROME is a sub-type), (also
called "Adult Munchausen", and "Adult Factitious Disorder")
is a formal, DSM-IV mental health diagnosis in which people deliberately
exaggerate and/or fabricate and/or induce physical and/or
psychological-behavioral-mental health problems in themselves. The primary purpose of this
behavior is to gain some form of internal gratification, such as attention, for
themselves.
MUNCHAUSEN BY
PROXY (MBP) (also called Munchausen Syndrome by Proxy,
Munchausen by Proxy Syndrome, and Factitious Disorder by Proxy) is a label for a
pattern of behavior in which caretakers deliberately
exaggerate and/or fabricate and/or induce physical and/or
psychological-behavioral-mental health problems in others.
This pattern of behavior constitutes a separate kind of maltreatment
(abuse/neglect) that manifests as physical abuse, sexual abuse, emotional abuse,
neglect, or a combination. The primary purpose
of this behavior is to gain some form of internal gratification, such as
attention, for the perpetrator.
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MBP/FDP is NOT a formal DSM-IV mental health diagnosis. It is a
recognized form of maltreatment.
 | Many MBP maltreatment cases happen within the outpatient setting, rather
than inpatient settings. |
| Most MBP maltreatment cases are confirmed through solid circumstantial
evidence; very few are confirmed through direct evidence such as covert
video surveillance. |
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There is virtually no physical or psychological-behavioral-mental health problem that cannot be exaggerated and/or fabricated and/or induced. |
Exaggerate: The perpetrator deliberately embellishes a genuine
problem.
Fabricate: The perpetrator deliberately makes up a problem story -
OR makes it look as if a problem exists.
Induce: The perpetrator deliberately causes a problem to exist.
| Exaggeration/fabrication cases should be considered as potentially lethal as
cases in which inducing is suspected or confirmed. |
| A caretaker may perpetrate MBP maltreatment through one or a combination of
exaggeration, fabrication, or inducing. The perpetrator may
change methods throughout the life of the case. |
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| The varied ways cases can present |
| Usual perpetrator characteristics |
| Usual perpetrator-victim dynamics |
| Suspicion indicators |
| Initial and subsequent methods and activities of investigation
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| Expertise and methodology to determine presence or absence of MBP
maltreatment |
| Court preparation and presentation
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| Victim risk assessment |
| Out-of-home victim placement decision making
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| Dangers of victim placement with relatives and need for specialized
relative evaluation |
| Selecting and working with foster parents
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| Case plan design and implementation
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| Victim visitation and supervision |
| Therapist selection and role |
| Other short and long term victim protection and case management activities
and issues |
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Difference between reported history and what is seen, or what makes sense
physically or psychologically-behaviorally.
- Problem does not respond to treatment as expected.
- Problem appears to originate only in association with suspected
perpetrator’s presence.
- Problem disappears or begins to improve when suspected victim is separated
from suspected perpetrator.
- Problem resumes after suspected perpetrator is told suspected victim has
recovered, is improving, or is soon to be released from the facility,
program, course of treatment, etc. - OR problem resumes shortly after
suspected victim goes home, treatment is discontinued, etc.
- Unexplained symptoms, illness, or death of other nuclear or extended
family members.
- A pattern of "Usual MBP Perpetrator Characteristics".
- Suspected MBP perpetrator behavior that appears to be consistent with
exaggeration and/or fabrication and/or induction of physical and/or
psychological-behavioral problems in the suspected victim.
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| MBP perpetrators are usually mothers. |
| MBP perpetrators usually present initially as "normal",
"good" caretakers. |
| MBP perpetrators are usually accomplished liars, deceivers, and
manipulators - and extremely believable, convincing, and superb in their
ability to give seemingly plausible reasons for their behavior. |
| MBP perpetrators know what they are doing. They are not simply
overanxious, overprotective caretakers. |
| MBP perpetrators may have extensive health care knowledge - or they may
not. |
| MBP perpetrators usually deny all or part of the maltreatment they have
perpetrated - even when there is extensive evidence. |
| MBP perpetrators do not usually stop their MBP behavior when they are
suspected or caught - but the behavior may change. |
| MBP perpetrators may add or change health care providers, or
"doctor shop" - or they may not. |
| MBP perpetrators may have "normal" mental health evaluations -
or there may be identified mental health pathology. |
| MBP perpetrators may have a history of symptom/illness falsification
with regard to themselves. |
| MBP perpetrator-victim dynamics usually initially appear good - even
excellent. |
| MBP perpetrators often have no prior child protection agency
involvement. |
| MBP perpetrators should be considered even more dangerous once they believe they are suspected. |
| MBP perpetrators use their victims as objects in trying to satisfy
internal needs through the attention they receive from having a child with
"problems". These needs are much more important to them than the
needs of their victims. External gain may also be present. |
| MBP perpetrators may seek attention from a variety of people -
professionals and non-professionals. |
| MBP perpetrators may have a "dramatic flair" or be involved in
exciting or dramatic events. |
| MBP perpetrators may change their maltreatment methods. |
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MBP is a recognized kind of maltreatment (abuse/neglect) -
it is something someone does, NOT something someone "has"
or "suffers from". It is behavior that one person deliberately
perpetrates on another. For MBP to be confirmed, there must be:
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(1) proof, through direct or circumstantial evidence (usually strong
circumstantial evidence), that the suspected perpetrator has deliberately
exaggerated and/or fabricated and/or induced a problem (physical and/or
psychological-behavioral-mental health) regarding another person, and
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(2) rationale that the behavior is consistent with MBP
maltreatment, rather than something else.
There is no mental health test or evaluation that can rule MBP
maltreatment in or out. There is no "profile" or combination of
personal characteristics or traits that can determine whether someone is or is
not an MBP perpetrator. The MBP confirmation-disconfirmation process involves
the gathering and specialized evaluation of all possible information regarded
suspected perpetrator(s), suspected victim(s), other children presently or
formerly in the home - even if now adults or deceased, and sometimes others -
depending on the case situation.
| MBP physical and emotional victim risk results from medical
and mental health interventions as well as from actual symptoms/illness
induced by the perpetrator. |
| Although labeling a case MBP maltreatment may not be
necessary in criminal cases, a confirmation of MBP maltreatment by or with
the assistance of a
credible MBP professional, and finding of MBP maltreatment in child
protection courts, is extremely important. Child protection case plans must
correspond to the kind of maltreatment that is confirmed. Appropriate MBP
case plans include elements unique to MBP maltreatment - activities that
must be successfully completed prior to consideration of reunification
between victim and perpetrator, and other activities related to where the
victim will live, other children in the home, contact between perpetrator
and victim and potential victims, visitation with others, and other short
and long term issues related to child protection. |
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Last revised:
04/05/2004
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