The Munchausen Syndrome By Proxy

What causes a mother (or less frequently, a father) to harm her son or daughter? How
often does this phenomenon occur?

These are questions that we ask ourselves with some concern when we learn about cases related
to Munchausen Syndrome by proxy. Not only is it a pediatric phenomenon, there is a psychodynamic
factor that is activated during the very existence of this syndrome and that we can describe in a
didactic way.

The Munchausen Syndrome by proxy is a clinical event that is reported infrequently: A child is taken
to pediatric care with clinical symptoms of disease indicated or observed by an adult figure
responsible for providing care appropriate to the age of the infant. The frequency with which this
adult figure (usually the mother of the infant) requests medical assistance is higher than normal,
leading to hospitalization events, considerable morbidity and sometimes the death of the child.

But what clinical or behavioral criteria must this event fulfill in order to be classified as such
syndrome?

1: Fictitious illness or health-related anomaly concocted by one of the parents, 2: The boy or girl is
taken to the doctor for medical treatment very frequently, 3: The parental figure that takes the child
to medical treatment does not accept the diagnosis provided by the specialists, 4: The presence of
other elements associated with the abuse, abandonment or intentional death of the infant that
excludes the clinical and behavioral characteristics of Munchausen Syndrome by proxy.

What is the phenomenological description of this syndrome?

1: the presence of persistent or recurrent diseases in the child that can not be explained from the
medical - biological explanation. 2: the medical diagnoses vary according to the general state of the
child's health and not according to the symptoms reported by the mother, 3: the symptoms and
signs observed by the specialists lead them to doubt their own knowledge since they can not identify
them with any known disease, 4: the symptoms disappear when the mother is kept away from their
children, 5: medical treatments give poor results in the evolution of the case, 6: the doctors
considers the organic symptomatology of the child as a disease strange and unusual, 7: the clinical
syndrome found does not respond to the medical treatment provided.

How superficially are these parental figures (father or mother) who are involved in such
events? How is your behavior at a glance?

Mother: pleasant, collaborative, grateful and in favor of good medical assistance (until it is informed
of the technical diagnosis), intelligent and with extensive information on medical treatments and
diagnoses. Father: little integrated into the family, absent from home for prolonged periods,
confirms the diagnoses reported by the mother although there is no evidence of them.

One of the psychodynamic characteristics that can be observed clinically in the expression of the
behavior of these parents towards their "sick" children, is the absence of healthy parental
attachments. Rather, the absence of the natural nexus that is exposed between father - mother -
infant is appreciated. There is no perception of emotional restraint but projection of discomfort of
the mother towards the affected child, seen as evicted objects, lost (or that can not be recovered),
loaded with persecutory fantasies (diseases), but that "obligatorily" you have to take care of them,
protect them from themselves since they are perceived in a destructive vision, as if they are death-
charged.

The mothers involved in this toxic dynamics have particular characteristics that allow them to be
identified beyond what is merely descriptive. Some of them seek medical attention for their children
as a way to project their own anxieties, burnout, depression or inability to take care of their sons or
daughters. Normally they are an active part of a conflictive family context, where domestic violence,
difficulty in relating to their partner, the presence of unwanted children are elements rooted in their
psychological and behavioral development. In general these mothers accept psychotherapeutic
help.

Other mothers related with the syndrome show an almost organic obsession in providing medical
treatment for nonexistent diseases in their children. They are able to construct false symptoms and
medical histories about them. Believing that their sons or daugthers are really sick, denying medical
evidence that says otherwise and perform their own treatments. They tend to show suspicion
towards the treatment given by the doctors, being antagonists and paranoids before the clinical
environment. They tend to be distrustful and violent, conforming as a whole picture associated with
mental disorder, almost psychotic. These mothers can make others feel guilty by invoking love for
their children, family and professional conscience. They can exploit the moral feelings of others
(duty, generosity, courtesy, humanism) to meet their needs, questioning the competence,
personality and qualities of others, creating anguish and then judge and remain as champions of the
health and well-being of your children.

There is a typology of these mothers, quite dangerous that defines them as active inducers of harm
on their children. These mothers never feel responsible for anything, for them the others are
responsible for everything, in their behavior dominates the cruelty, absence of guilt, generating in
their psyche a death wish on the child who is perceived and conceived as alien that deserves the
hurt. They can get to procure death in the children.

This type of mother distorts, interprets and tells lies to hide (or discover) the truth. Lies (even by
omission), invokes the urgency to gain an advantage over others, achieves its objectives to the
detriment of others and is able to get others to commit undesirable or criminal acts.

Many questions arise when we approach the psychodynamics of those who participate in
this syndrome. How was the relationship of these parents with their own parents? What
were their experiences during pregnancy? How is the psychodynamic of the victim of the
caregiver?

There is no evidence to suggest that the caregiver who suffers from Munchausen Syndrome by proxy
is unaware of their actions. It can be inferred that planning and organization involve even the
slightest attention and discretion, since attacks occur without the presence of witnesses, and the
web of lies expressed to the medical team suggest a conscious action. The action of the Munchausen
Syndrome by proxy is voluntary and also violent.

Many times the victim unconsciously assumes the position of the sick person as a way to obtain
positive maternal attention, a phenomenon that is associated with emotional and cognitive aspects
that allow recreating the son or daughter as another human being, but in the case that concerns us,
we know that sometimes this does not happen in the psyche of the mother. Knowing that the
psychological state of the mother influences the fetus, both at the neurobehavioral level and in the
alterations in development that manifest themselves in the postnatal period, we can assume that
some personality or mental alteration could significantly affect the relationship mother-baby.

The condition of victim can be adopted with some type of physical or psychological dependence, in
such a way that the caregiver has the possibility of exaggerating or worsening the preexisting
symptoms or causing additional symptoms.

As we can see, it is a dynamic event between two or more, it is not unilateral. We must take into
account that the majority of victims of Munchausen Syndrome by proxy are infants and children
who start walking, so it is presumed to be more affected because they can not be expressed orally
and because they are physically more defenseless. Older children and teenagers victims of the
Munchausen Syndrome by proxy, whose abuse begins several years earlier, may adopt the fictitious
symptoms and signs as their own, suggesting that they may later develop Munchausen Syndrome
or another type of personality disorder.

How can we intervene effectively when we have detected the presence of Munchausen
Syndrome by proxy?

The most sensible thing is to protect the boy or girl victim of the caregiver, mother or if it is the case,
father. We must commit to addressing the case with a multidisciplinary team: social workers,
psychologists, doctors and nurses, lawyers. A whole team that allows a comprehensive approach,
defining the intervention actions under clear indicators and with an organized protocol. The family
must be evaluated but also needs support. After having confronted the family with the diagnosis of
Munchausen Syndrome by proxy, the mother, who is often the one who executes the harmful
actions, as well as the father, are in a research situation. The development of the child must be
evaluated, both psychologically if their age allows it, as well as socially and physically.

A child victim of Munchausen Syndrome by proxy is at high risk of suffering harm. If the caregiver or
family member suspected of acting against the victim desisted abruptly from the attacks, it does not
ensure that the situation is over. The impulse to attack the child repeatedly, the ability to transform
the child's death impulse in the first place and then use it as a tool, expresses a problem in the
empathy so deep that it completely obstructs the maternal capacity, that is: executed action is
understood in its entirety, but simply does not care about the extent of the damage.
Quiz

1. What are the main characteristics of the syndrome?

A. The mother is It is responsible and reliable with children

B. Accept the differences between different households. It is her responsibility - not theirs - to
adapt to the routines and patterns of different families

C. The presence of persistent or recurrent diseases in the child that can not be explained from the
medical - biological explanation

Answers: C. The presence of persistent or recurrent diseases in the child that can not be explained
from the medical - biological explanation

2. Characteristics of the father related to the syndrome

A. Pleasant, collaborative, grateful and in favor of good medical assistance.

B. Show an almost organic obsession in providing medical treatment for nonexistent diseases in
their children

C. Little integrated into the family, absent from home for prolonged periods, confirms the
diagnoses reported by the mother although there is no evidence of them.

Answers: C. Little integrated into the family, absent from home for prolonged periods, confirms the
diagnoses reported by the mother although there is no evidence of them.

References

Burman D, Stevens D. Munchausen family. Lancet (1977)

Jennens, Roger. Munchausen Syndrome by Proxy: Implications for Professional Practice in Relation
to Children's Education. Journal: Child Care in Practice (2009)

Meadow R. Munchausen syndrome by proxy. The hinterland of child abuse. Lancet (1977)