Beacon Hill Training

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What is Munchausens By Proxy?

One of the hardest areas of abuse to identify and to work with is Munchausen’s by Proxy, or  Fabricated illness.  It is seen as a rare, and so not one most people or professionals are not aware of it, even fewer actually understand it and know what to look for.  Because of this it is vastly under reported and often not identified … it is a form of abuse that is far more prevalent than most people would think, the problem is it is often unidentified.

Munchausen’s by Proxy is when a parent or carer for a child is for whatever reason making up (fabricating), or exaggerating a child’s condition.   This could be a male or a female carer, however the majority of cases do tend to be carried out by female carers, most often the mother of a child.  The reasons for this are unclear although it may be that it relates to how women view themselves in society as much as how society views and values them. 

So why do people do this?

There are many reasons why people would fabricate an illness, though the most common is that there is a ‘reward’ for the abuser.   The reward may be money, for example a parent is attempting to gain additional benefits etc by exaggerating illnesses.  This really isn’t uncommon.  There are often however more complex reasons.

Other ‘rewards’ for Fabricating illness are far subtler, let me explain.  All people feel better about themselves when given praise from professionals and family and friends.  For most of us it helps to know that other people understand what we are going through, or that our lives are hard. 

For the abuser, the praise from professionals such as Doctors, Nurses, Health workers, Teachers and even Social workers for being seen as a caring and nurturing parent is the ‘reward’.   People who abuse in this and a great many other ways are not simply ‘bad people’ but fall into ways of behaving and thinking, no one starts out ‘bad’.   For the abuser in Munchausen’s by Proxy it may be that they are prone to think negatively about themselves, they could be depressed or that there is another underlying mental health condition.  In cases I have seen isolation from ‘normal’ adult society that being a parent sometimes entails does seem to be a factor, people are robbed of gaining self-worth through the normal means of work and socializing for example.

For example, a starting point may be the mother who feels isolated and depressed who feels better about herself and others when professional’s friends and family tell her she is a great parent, and caring fantastic mother.  

Like a lot of things, it is a slippery slope, no one starts out as an abuser.  People slowly fall into the role of ‘needing’ to be respected and thought well of for being a caring and focused parent, they slowly begin to crave this focus and regard and so begin to seek it out, becoming reliant on this support.  It is only a small step between seeking this focus and reward to begin to exaggerate issues to gain it. 

It is often the case that a carer begins to fabricate illness in a child when a child is already ill, or particularly when the child begins to get better and there is a risk that the carers ‘reward’ is about to disappear.  

Due to being exposed to this support and positive regard of others they find they need it to carry on feeling positive about themselves, it’s like a drug, a reliance on it has been created.   It is at this point that the carer begins to do things that would indicate the child’s illness is worse than it is, this may include:

  • Exaggerating symptoms
  • Telling professionals, the child is in pain / suffering when they are not
  • Creating a medical situation, for example cutting themselves and putting the blood in a child’s nappy, or adding salt to the child’s food to make the child ill

Children suffering this form of abuse have suffered unnecessary and often invasive medical treatment, harmful medication, unnecessary surgery and even died as a result.

Fabricating behavioral problems

Fabricating illness is usually just seen as fabricating medical illnesses, it is the case however that the same rewards and positive support and regard from professionals can be gained by fabricating a child’s behavioral difficulties also.

This is something I have seen throughout my career, yet is not something that is not recognized as fabricated illness generally.  Fabricating behavioral problems is just as damaging, stigmatizing and far reaching as fabricating medical problems, perhaps more so as it enters into a child’s beliefs about themselves.

What can professionals do?

It is so important that all professionals need to be made aware of Munchausen’s by Proxy and the impact of the support they give.   They need to be aware of the dangers as well as the vulnerabilities of the people they work with.

Training in this area is sadly lacking, most professionals simply are not aware of this type of abuse, mainly because it is seen as rare, sadly it is an area of abuse that is not understood or identified, and is as such vastly under reported.  It happens all the time!

Professionals in all discipline’s need to be properly trained in this area, to be aware that the carer may get ‘addicted’ to the support they give and be mindful of the behaviors that can follow.

I hope this article has been helpful, here are some useful links that will help you gain a better understanding of this difficult and complex area.

Comments? Questions?