Munchausen by proxy: What you need to know

— -- The much-publicized case of Gypsy Blanchard may be the first introduction many people have to the concept of Munchausen by proxy. It’s a fascinating syndrome – and one that comes attached with its fair share of myths and misconceptions. Blanchard is serving 10 years in prison for her role in the stabbing death of her mother, who forced her to use a wheelchair she didn't need and subjected her to unnecessary treatments for years. Some professionals have speculated that Blanchard’s mother Dee Dee Blanchard may have had Munchausen by proxy.

Below are answers to some of the more common questions about this phenomenon.

What is Munchausen syndrome by proxy?

Munchausen by proxy is a form of mental illness that falls under the umbrella of what are known as factitious disorders, a group of mental disturbances that includes patients intentionally who act physically or mentally ill to seek attention and empathy without obvious benefits, like financial gain.

As its name suggests, however, in Munchausen by proxy the symptoms of a disease are fabricated by someone close to the patient – most commonly a parent – leading to unnecessary and often painful intervention and treatment. Interestingly, 30 to 70 percent of those who falsify illness in children also falsify illness in themselves.

The term "Munchausen syndrome by proxy" was first coined in 1977 by an English pediatrician, Roy Meadow. "Munchausen by proxy" derives from Munchausen syndrome -- in which the medical fabrication is self-directed -- and is named after a German cavalry officer known for exaggeration. The most common scenario of Munchausen by proxy involves a parent, who causes symptoms in the child and repeatedly takes the child to medical professionals with the goal of having procedures performed on their child.

How does someone get this disorder? How common is this?

Many perpetrators show features of borderline personality disorder and often have histories of difficult childhood relationships with their parents, or even their own history of abuse and neglect.

Munchausen by proxy is incredibly rare – so rare, in fact, that reliable numbers on its incidence in the U.S. are difficult to come by. Research in other countries, such as Australia and the U.K., suggests that only a tiny percentage of children diagnosed with serious illness are cases of Munchausen by proxy.

What are the features of this disease?

A child of a parent suffering with the disorder may have a long history of unexplained illness. These parents are typically very willing to have their children experience the discomfort and risk associated with medical procedures, including surgery, and are familiar with the supposed illness and procedures associated with it. Although these parents may demonstrate a wide base of knowledge about medical conditions, they are also simultaneously vague about the details of their children’s illnesses.

These parents may be prone to exaggeration, or lying about other aspects of their lives, and may even get hostile or antagonistic if challenged.

Is there a cure?

Unfortunately, those with this disorder are nearly always resistant to treatment. Psychiatrists may first try to establish what is known as a “contract conference” in which the therapist will encourage these parents to better learn to express themselves and their pain – ultimately with the goal being that they do not channel these negative emotions in a way that leads to harm to their children. Once the parent is able to do this, it opens the door for the psychiatrist to help these individuals work through their issues.

Medications have not proven helpful in treatment, although they may be prescribed for symptoms of anxiety or depression if the individual also meets criteria for an anxiety or mood disorder. Some literature has reported a response to antipsychotic medications (such as pimozide).

What is the prognosis?

Unfortunately, it is often difficult to find out what happens to these patients, as they are often difficult to track over time. Of cases found in literature the course of the mental illness is usually chronic.

Because it is considered a form of abuse by the American Professional Society on the Abuse of Children, suspicions of Munchausen by proxy should be investigated to secure the safety of a child.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990557/

https://my.clevelandclinic.org/health/diseases/9834-factitious-disorder-imposed-on-another-fdia