When the arts get it wrong: Munchausen by Proxy Syndrome Ten real warning signs

​In an article titled, Painful Internet Truths, Munchausen Syndrome by Proxy was briefly mentioned. Today, we take a deeper look at this issue, and the way it is often portrayed in the arts.
 
Munchausen by Proxy Syndrome (MSBP) is a form of domestic and/or child abuse in which the perpetrator/abuser creates, invents, or exaggerates the target/victim’s health problems for personal gain.  MSBP is not a single isolated incident, but a pattern that is carried on for as long as the perpetrator can get away with it.
 
In MSBP, the primary goal of the perpetrator is to establish an identity for themselves as a devoted and loving caretaker for a disabled or sick person, and gain the attention and admiration that identity typically brings. The perpetrator may also have secondary goals, such as getting money, gifts, or benefits, or using a child to control a spouse or former spouse in divorce proceedings or other breakup.
 
Because the disorder is most often seen with a parent or other steady caregiver as the perpetrator and the child as the target/victim, parent and child relationship red flags are the most common. However, MSBP can exist between people in other relationships, such as spouses, adults living with elderly or infirm parents to provide care, or live-in personal care aides and clients.
 
While art almost always illuminates issues, provides a voice for those with a legitimate complaint, generates compassion by providing a glimpse into lives we have not led, inspires research and solutions to real problems, and/or provides pure entertainment, MSBP is one of those issues where film, novels, and other art forms tend to rely on over-dramatization and shock value. Most recently, the movie “Run” featured a victim doing things like scurrying across her roof on disabled legs, making a scene in a drug store as she raced away from her knife wielding mother in the wheelchair she didn’t truly need, and screaming for help in the middle of the road. In real MSBP, nobody is going to be pulling themselves across the roof by their arms or getting into a high speed chase in their wheelchair.
 
 Here are  ten real warning signs:
 
1.The parent (or other caregiver) takes the target to multiple health professionals, or makes regular visits to professionals with a reputation for selling diagnoses.
 
Munchausen by Proxy perpetrators work to create and maintain a medical record stating that their victim has the health issues the perpetrator has decided they have. They may accomplish this by “doctor shopping,” or taking their victim to a series of doctors until they are able to convince a doctor to make the diagnosis they want, or knowingly taking the victim to doctors with a reputation  for falsifying medical forms in exchange for their fee.
 
2.The target/victim’s medical issues lessen or disappear when they’re separated from the abuser, or the diagnosis changes when the caregiver is no longer able to join them at the doctor’s office.
 
In many cases, the perpetrator is making the victim sick. The victim will then get better when the perpetrator is not around to sicken them.  Even if the perpetrator is faking or exagerating the illness rather than poisoning, injuring, or otherwise directly creating medical issues for the victim, they will almost always hover and intimidate them into saying what they want, or will talk over them to manipulate the information the doctor receives. The diagnosis changes when the victim sees the doctor alone, because the doctor is able to examine the person without interference or inaccurate reports.
 
3.The caregiver’s knowledge of the victim’s alleged illnesses and/or disabilities seems extensive given their educational and professional background, but skewed or incomplete.
 
Learning every test, symptom, and treatment for a disorder and attempting to ingratiate themselves with medical staff by talking “as fellow experts” is common MSBP perpetrator behavior. At the same time, the person may deny information about the disorder that would fail to serve their purpose. For example, a parent with no medical training may know every medical procedure someone with the disability could possibly have, but brush off material that suggests children with this disorder benefit by being allowed to socialize with peers separate from the parent. Or they might not be able to provide basic information a doctor who actually did diagnose someone with the disability or illness would tell a caregiver, but be able to provide a startling amount of other information.
 
4.The target is observed doing things the perpetrator claims they cannot do, to the extent that a parent or other caregiver would not simply fail to realize the target had a specific skill or knew a specific fact.
 
It’s not at all uncommon for a parent to realize their child knows how to navigate the internet much better than they thought, or for the child to learn a few words in another language at school, or pick up another skill the parent does not know about. But if the parent or other caregiver is insisting the child, teen, or adult still living at home lacks significant insight, interests, abilities or skills the person clearly has, that is a warning sign. The perpetrator may insist the child cannot eat, even though they’re seen eating meals at school. Or they may behave as though their teen does not understand what dating and intimate relationships are, while the person talks at length about crushes and dream dates whenever the parent is out of earshot.
 
5. Behaviors that are normal or even expected for the target’s culture are treated as “problems” that need to be “corrected,” but only in their own dependent.
 
In the most common form of MSBP, where the child is the target and the parent is the perpetrator, this appears as a refusal to allow the child to grow up and/or grow attached to other people. The child may be punished for normal childhood behaviors, such as laughing loudly when playing with neighborhood kids, shamed and punished for getting their first crush, or humiliated and restricted when they express the desire to hang out with a peer group instead of their parents as they grow into their preteen and teen years. This is done to both perpetuate the image of the child being delayed and dependent in others’ eyes, and to keep control over the child as he or she grows up.
 
The same parent will have a completely different set of standards for everyone else. They may insist their nineteen-year-old daughter “can’t date,” but berate another parent for being too strict when they set the dating age at sixteen instead of fifteen. Or they might mock a forty year-old for moving back in with his parents after a divorce or job loss, insisting a grownup should be out on his own, but behave as though it’s perfectly natural that their forty-three year old has never lived outside of the family home.
 
6.The target/victim always seems to be “trying too hard” or afraid to be themselves.
 
Children and teens experiment with different identities and interests during the course of a completely healthy life. Most kids will pretend to like a band just because their friends like them, or not dare admit they don’t really care for sports when their friends are all obsessed with making the school team. But the kid who always seems to be looking for a new crowd to join, or who appears to go out of his or her way to be outrageous, funny, shocking, quirky, or just plain strange may be trying to distract from something serious going on at home, or hoping someone will “rescue” them.
 
They may also simply be afraid to be themselves. When you grow up with MSBP, you grow up conditioned to believe that people will only care for you if you present and perform the way they want you to all of the time, in every way.  When they meet new people, and those people are kind to them, or they happen upon a group of people they think might be kind to them, they’re conditioned to immediately start dressing, acting, and pretending to think like those people in order to gain acceptance.
 
7.Treatment for the target’s illnesses or disabilities is sporadic.
 
The perpetrator may insist their child needs to go to physical therapy every week, behavioral counseling twice a week, and occupational therapy once a week, stick to that for weeks, months, or even years. They may then stop one or all of those suddenly, despite acting like it was vital just a week before.
 
This is likely due to professionals getting too close to the truth, or the perpetrator becoming paranoid they will be discovered to be faking the target’s issues.
 
8.The perpetrator talks at length about sacrificing for the target, and often uses the person’s care as an excuse to get out of things they do not wish to do, but rarely if ever gives up something they want.
 
MSBP perpetrators promote a narrative that they have given up their hopes, dreams, wants, and even basic needs to devote to the care of their child or other person in their home.
 
On the surface, this often appears to be true. A parent may insist the reason they don’t have a paying job is because caring for the child is their full time job. A spouse who victimizes his partner in this way may claim he cannot clean the house or go back to school because his partner’s care takes up all his time. But the perpetrator will rarely, if ever, make a true sacrifice for the target. They may move the person away from resources they would need if the condition were genuine upon finding their own dream home, spend money on themselves before investing in improved care, or use funds, benefits, or other support the target has received for their illness or disability on their own wants.
 
9.The perpetrator has an extreme love/hate relationship with clinics, hospitals, or other medical settings.
 
When things are going according to the perpetrator’s wants and needs, they will often behave as though the doctor’s office, clinic, or hospital is their absolute favorite place on earth. They may greet the doctors and other hospital staff as though they’re old friends, make themselves at home in the hospital room or exam room right away, and light up when describing the target’s supposed medical issues, basking in the attention.
 
Should someone on staff begin to ask too many uncomfortable questions or challenge them, the hospital staff who was a second family to them a minute before will suddenly turn into their worst enemy. The perpetrator will flee, vowing never to return, with nothing nice to say about the place they used to treat as a second home.
 
10. The target seems inappropriately controlled by the perpetrator.
 
Extreme and/or inappropriate levels of control over another person is a red flag for any form of domestic abuse, and is certainly present in MSBP cases. The target may need to ask their parent if they are allowed to eat a piece of candy, even though they’re sixteen years old and plenty old enough to make that decision on their own, or they may be an adult living at home, but still be expected to ask their parents if they can go to the mall with a friend.
 
The target may seem strangely afraid of punishment should they displease the perpetrator. A victimized spouse might beg friends not to tell their partner they were out of their wheelchair, or an adult son or daughter might behave as though they were going to be grounded for arriving home too late.
 
Munchausen Syndrome By Proxy is a relatively rare, but serious disorder. Because we are often led to look for dramatic signs, it can also be easy to miss. Its targets/victims may not need a valiant, Hollywood movie style rescue….or the treatment they’ve grown to believe they need, but they do need understanding, support, and respect as they heal from this very serious form of abuse.