Munchausen’s Syndrome by Proxy

If you’ve watched the Emmy award winning series The Act (which is based on a true story), or the show The Politician on Netflix, you’ve come across instances of a mental disorder known as Munchausen Syndrome by Proxy (MSBP). MSBP is a mental disorder in which a primary caregiver, very often the mother, either makes up false symptoms or causes actual real symptoms in an adult victim or child to make it seems like the victim has an actual mental health issue. For example, in The Act, the mother Dee Dee Blanchard has fabricated disabilities and illnesses of her daughter Gypsy Blanchard right from when she was a child. The series shows how their relationship goes downhill as Gypsy slowly discovers how her mother has lied about her illnesses- like, Gypsy finding out that she was led to believe that she had cancer all her life, when she never did.

Munchausen syndrome by proxy has been classified in the DSM-5 as FDIA or ‘factitious disorder imposed on another.’ This indicates the belief that this disorder displays a behavioural pattern more than an underlying psychiatric syndrome.

Symptoms

The symptoms for this mental disorder will be present in both the perpetrator (caregiver) and the victim. Thus, in order to make a formal and concrete diagnosis, it is vital that the clinician take into account symptoms and signs in both parties. When it comes to the caregiver, few of signs to look out for are:

• The caregiver’s reports are different from those of medical personnel.
• The reports provided by the caregiver show the victim’s medical history to be vague, spotty and inconsistent.
• Caregiver has some medical knowledge. For example, Dee Dee Blanchard had prior experience of working as a nurse’s aide, which made her seem educated on the medical issues she suggested her daughter had, given that she was well-versed with medical terminology.
• Caregiver refusing to leave the victim’s side when they are being medically assessed.
• Caregiver seeks out constant approval from medical staff.
• Invasive surgical and diagnostic procedures are accepted without question by the caregiver. The caregiver may also ask for additional interventions and procedures.

Symptoms in a victim of MSBP include

• Symptoms that actually improve when under proper medical care.
• A long history of multiple illnesses/ injuries, surgical procedures or interventions.
• Reported medical issues (by caregiver) that do not respond to treatment.
• Symptoms may appear when in the presence of the caregiver.

Causes

The exact cause of MSBP is yet unclear, but experts have stated that problems in the caregivers’ childhood could be a major factor. In the case of Dee Dee Blanchard, she engaged in petty theft as a way to retaliate when things did not go her way.

On the flip side, the behaviour of the caregiver may be encouraged given all the attention they get because of the sick child, not just from medical staff, but also from the community they live in. For example, they may get money or freebies due to the victim’s condition, and the neighbours may try to help by doing chores or getting them meals.

Treatment

Child protective services, doctors and law enforcement authorities are all included in the treatment for MSBP. Caregivers with this mental condition generally need to receive long-term counselling. Of course, this is often met with resistance and denial, given that the it would be intervention on behalf of the victim by the doctor or another agency.

Medicines are generally not prescribed for the caregiver unless they have another disorder along with MSBP. As for the victim, treatment may include both psychological and medical interventions. Psychotherapy is important so that the victim can deal with and understand the abuse that they have undergone by the caregiver.