Dee Dee Blanchard was an exemplary parent, relentlessly working to provide for her critically ill child, Gypsy. She was her daughter’s full-time caregiver. Gypsy was extremely small and frail and used a wheelchair. On her face donned a large pair of glasses and her skinny frame was often accompanied by an oxygen tank. When asked, Dee Dee would regurgitate a long list of problems that ailed Gypsy, everything from epilepsy to eye problems. Figure 1 to the right shows the happy mother-and-daughter-duo a little after Gypsy had turned 8. However, do not be fooled. Behind the doting, rosy-cheeked face of Dee Dee hid an incredibly dangerous child abuser. After Dee Dee was murdered by Gypsy, it became clear that her daughter had never actually been sick, and Dee Dee had fabricated everything (Diaz & Valiente, 2018). The story quickly gained national interest, bringing Munchausen syndrome by proxy to the public’s attention. With an increasing number of child abuse and maltreatment cases reported each year, it is crucial to recognize the signs and symptoms of lesser-known types, such as Munchausen syndrome by proxy, and appropriately work to prevent and treat it.
Munchausen syndrome by proxy (MSbP) is often used synonymously with several terms including illness induction syndrome and fabricated or induced illness. Definitions vary slightly but it is described by Carter, Izsak, & Marlow (2010) as An often misdiagnosed form of child abuse in which a parent or caregiver, usually the mother, intentionally creates or feigns an illness in order to keep the child (and therefore the adult) in prolonged contact with health providers. The caretaker induces imaginary symptoms so that the child receives unneeded treatment. Unsuspecting medical professionals, who want to believe the perpetrators, accede to their demands and perform tests and administer treatments that unintentionally harm the child. Thus, they are unknowingly caught into the cycle of abuse.
One of the reasons medical personnel are easily tricked into prescribing unnecessary medications and ordering irrelevant tests is because the symptoms of the abuser are extremely difficult to identify. However, these signs are easier to recognize if the symptoms the child has are also considered. According to Criddle (2010), typically, the caregiver will seem loving and concerned for their child’s health, however, they will relentlessly request additional examinations, procedures, and consultations. They often have a background or some history within the medical field and show a degree of hospitality toward medical staff. When confronted, perpetrators will become hostile. Meanwhile, the child will have symptoms that only the caregiver observes. Standard treatments for common ailments do not seem to have any effect on the child; many times, the child suffers from a long list of problems. In addition to this, the child’s father is often not present in their life either. When looking for the signs of MSbP, it is best if both the caregiver and the child display warning signs. It is incredibly difficult to diagnose someone with MSbP because the findings that medical explanation cannot support cause doctors to search for new and unidentified medical conditions. Likewise, to accuse someone of having the disorder could become an ethical issue and requires excruciating evidence and support. Once someone is identified as having the disorder, both he or she and the child can begin treatment.
Removing the child from the abuser is the first step of treatment. This not only benefits the child’s overall safety but also removes them from the damaging physical and psychological effects induced by the perpetrator. Often, nutritional counseling services are provided to counteract the effects of malnutrition and prolonged exposure to unnecessary medications. For the perpetrators, treatment is not as straightforward. Psychoanalysis can be done but often delivers adverse and unclear results. As Eminson and Jureidini (2003) put it, MSbP is inaccurately believed to be a single diagnosis with a set list of explanations for inducing the symptoms. Comparing MSbP to bike theft, they argued it is better to prevent the situation early on, rather than try to understand the motives of the perpetrator later (Eminson & Jureidini, 2003). There is not a specific method of prevention to follow when dealing with the disorder; recognizing the warning signs early and trying to intervene before the situation becomes worse may be life-saving.
MSbP is a serious and dangerous form of child abuse. According to an estimate by the Cleveland Clinic, only 2 out of 100,000 children are affected (Fictitious Disorder, n.d.). This number seems small and realistically it is when compared to the total number of victims of all child abuse, however, one life saved is better than nothing at all. Child abuse is not just something that presently affects the child, but something that will continue to affect him or her. Close observation is crucial in identifying a case and recognizing discrepancies in symptoms and stories could mean the difference between life and death. The safety of the child is the overall goal when dealing with MSbP. A case such as Gypsy Blanchard’s may not have had such a violent and tragic ending if appropriate measures had been taken and the warning signs had been identified earlier on. Not all cases will end as violently as Gypsy’s but in order to prevent any more cases from occurring, it is imperative to be able to recognize the symptoms of MSbP early. If you believe that a child is in danger or at risk, contact law enforcement personnel who can carry out an appropriate intervention plan and connect both the child and the adult to treatment resources.
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