Chapters
Shownotes Transcript
Wondery Plus subscribers can listen to Something Was Wrong early and ad-free right now. Join Wondery Plus in the Wondery app or on Apple Podcasts. Just a warning, this episode contains discussion of child abuse and may be difficult for some listeners.
Hi friends, it's Andrea Dunlop. I am the creator of Nobody Should Believe Me, an investigative true crime podcast about Munchausen by proxy, and the author of The Mother Next Door, Medicine, Deception, and Munchausen by Proxy, which comes out February 2025 from St. Martin's Press. I am also a member of the American Professional Society on the Abuse of Children's Munchausen by Proxy Committee and the founder of Munchausen Support, the
the nation's only nonprofit dedicated to helping survivors and families dealing with Munchausen by proxy, which is what I'm here to talk to you about today. I am honored to be guest hosting this episode of Broken Cycle Media's new series of educational episodes, Data Points. These special episodes will include educational information, statistics, and support on different topics that are important to our community. Thank you so much for listening. So first, let's get into some definitions.
Munchausen syndrome is the name coined by Dr. Richard Asher in The Lancet back in 1951. This original name pays homage to a German nobleman, Baron von Munchausen, who was known for telling tall tales about his exploits. And it's used to describe someone who fabricates, exaggerates, or induces illness in themselves for the purposes of sympathy and attention.
It's currently listed in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders, otherwise known as the DSM, as factitious disorder imposed on self. But colloquially, and even professionally, most people still use Munchausen. And if you've heard of this phenomenon at all, this is likely the term you've heard.
The term Munchausen by proxy was first introduced by the British pediatrician Dr. Roy Meadow in 1977, though this term has never been used in either the International Classification of Diseases, that's the ICD, or in the DSM. But much like Munchausen, it's often still used by professionals and laypersons.
One of the questions I get asked most frequently is whether Munchausen by proxy, also known as MBP, is a crime or a mental illness. Because MBP is used interchangeably to describe the act of medical child abuse, a term coined by child abuse pediatrician and nationally recognized expert, Dr. Carol Jenny and her co-author, Dr. Thomas Rosler, in a book of the same title, and factitious disorder imposed on another, also known as FDIA.
which is the official DSM diagnosis for a caregiver who perpetrates medical child abuse, or in some cases, medical abuse on a vulnerable adult, for the purposes of getting sympathy and attention. If you're feeling confused, you are not alone. The confusion over terminology is at the heart of our immense cultural bewilderment over the issue itself.
Whether Munchausen by proxy, or FDIA, should be considered a discrete mental illness is the subject of serious debate among doctors and academics. But the most important thing to understand is that this is primarily abuse, and it is extremely dangerous with a death rate of 9%.
What's crucial to understand is that perpetrators who engage in this behavior are not suffering from psychosis or delusions. Perpetrators of MBP abuse understand right from wrong, and they're culpable for their actions. The intentional deception in this abuse is both pervasive and deliberate.
I come to this topic by way of a situation in my own family. And so unfortunately, I know firsthand how strong the taboo around this is. And many experts I've spoken to, including Dr. Mark Feldman, a psychiatrist who's written five books on this topic, believes that a huge contributing factor to this taboo is the prevalence of female perpetrators. Around 96% of people who commit this abuse are mothers who victimize their children.
As to why this instance is so high, Dr. Feldman describes MBP as a crime of opportunity. And since mothers are likely to be the ones caring for kids, they're also the most likely to commit this abuse. Misinformation about this abuse is unfortunately rampant, and MBP is often described as extremely rare. And while criminal convictions are rare, every expert I've spoken to believes it's far more common than people think.
One study out of Children's Hospital in Seattle that tracked cases of medical child abuse found that the confirmed cases each year were about equal to two-thirds the number of abusive head trauma cases confirmed each year. And it's worth mentioning that abusive head trauma is a common form of physical child abuse, and it is, in fact, the leading cause of death in children under two years of age. More information is sorely needed on all fronts, but it's worth saying that there is no substantive debate
within the scientific or medical community about the existence of Munchausen by proxy.
However, the same cannot be said for the way the issue is discussed in the media or handled in court, where long outdated or faulty data is often used to support the idea that people are being falsely accused of this abuse. For example, one defunct British study was referenced just this year by a city comptroller in Lehigh, Pennsylvania, in a report about, quote, over-diagnosis of medical child abuse. Again, the recognized experts on Munchausen by proxy are unanimous that it is
underdiagnosed, not the other way around. It's worth noting that these same beliefs were, up until quite recently, widely held about child sex abuse. And the data we now have, thanks to the many brave survivors who came forward, tells a much different story. And based on what I've learned from my research, I believe that we are in for a similar cultural reckoning about Munchausen by proxy abuse. So what can we do about it?
Awareness is a crucial first step. Here are things medical professionals who work with kids should watch out for.
Reported symptoms are behaviors that don't match what others observe. An extremely common example of this is when an abuser reports that their child is unable to eat and pursues interventions such as feeding tubes, yet others observe the child eating normally with no issues. Another thing to keep an eye out for is discrepancies between the abuser's report of a child's medical history and what's in the actual record. An example of this is an abuser claims their child has leukemia despite having tested negative.
Another sign a child may be the victim of Munchausen by proxy is if extensive medical assessments have been conducted and there is still no medical explanation for the child's reported problems. There also may be laboratory findings that don't make medical sense, are clinically impossible or implausible, or identify chemicals, medications, or contaminants that should not be present. Basically, tests that indicate poisoning.
Often when abuse is being investigated, a first step will be a court-ordered separation test, where the victim is removed from a parent's care. If the victim's symptoms suddenly dramatically improve, this is a strong indication that the parent is the problem.
Another red flag is if symptoms improve or disappear in one child and then appear in another child, such as when a younger child is born and begins to have similar or other unexplained symptoms. In many cases, the caregiver may be reluctant to provide medical records, claim that past medical records are not available, or refuse to allow discussion of care with previous medical providers. The abuser may also report that the other parent is not involved, does not want to be involved, or is unreachable.
It's also a red flag if any family member expresses concern about possible falsification and, of course, clear observations of falsification or induction by the caregiver, such as false recounting of past medical recommendations, tests or exam results, conditions or diagnoses, should be taken seriously as well.
Now, importantly, warning signs are not in and of themselves evidence of abuse, and these investigations are extremely complex and usually involve an expert reviewing thousands of pages of medical records, as well as the police collecting social media records and interviewing doctors, friends, and family members. So, what if abuse is found? In most cases, it is not safe for a perpetrator of this form of abuse to be home with a child or have unsupervised visitation.
The research shows that MBP abuse is highly unlikely to stop because of diagnosis or confrontation. Because most abusers with FDIA also have personality disorders and deny their abusive behaviors, treatment is frequently not possible. And the more severe the abuse, for example in cases of suffocation, poisoning, or starvation, the less likely a perpetrator is to benefit from therapy or other mental health interventions.
Here is what the American Professional Society on the Abuse of Children's guidelines say about the necessary conditions for a perpetrator to be considered treatable. Number one, the caregiver is able to fully admit the abuse and neglect, including the details. Number two, the caregiver is able to demonstrate empathy for the victimized children.
Number three, the caregiver has developed strategies to better identify and manage their needs in order to avoid abusing the children in the future. And four, the caregiver has demonstrated these skills with monitoring over a significant period of time.
FDIA and other factitious disorders are extraordinarily hard to treat because of the persistent and pathological deception involved. Offenders paint a complex and challenging picture from a mental health perspective, as there is a high rate of comorbidity or coexistence with certain personality disorders, such as borderline, narcissistic, and histrionic, as well as high rates of severe depression. Because of this, getting to the first step—taking
taking full accountability for one's actions almost never happens. The most important thing is protecting the children, which is why MBP shouldn't ever be seen primarily as a mental health concern in the parent.
Detective Mike Weber, who is a nationally recognized law enforcement expert in Munchausen by proxy and has worked on child abuse cases for decades, has a helpful way of cutting through the confusion that arises here. Munchausen by proxy is used the same way the term pedophilia is often used to describe both the act of child sex abuse and the DSM diagnosis of pedophilic disorder, which are related but separate.
I find the comparison helps those new to the topic, both in understanding the relationship of mental illness and actions, and also in grasping the seriousness of what's happening. In both cases, children are being victimized by abusers, who, though they may struggle with their mental health, are still culpable for their actions and understand the difference between right and wrong.
This is a complex and horrifying form of abuse. And in order to protect children and to support adult survivors, we need to better understand it. In addition to the physical danger this abuse poses to children, the psychological and emotional impacts on survivors are severe and lifelong. If you want to learn more, you can listen to my podcast, Nobody Should Believe Me, where I've interviewed numerous experts, survivors, family members, and even a perpetrator.
You can also visit the American Professional Society on the Abuse of Children's website, that's absac.org, A-P-S-A-C dot O-R-G, where they have practice guidelines for this abuse.
If you or someone you know is a victim or survivor of Munchausen by proxy, you can go to munchausensupport.com where you can connect with professionals who can help as well as peer support networks. Dr. Mark Feldman's books and his website are also excellent resources. He can be found at munchausen.com.
For a comprehensive list of nonprofit organizations and resources, please visit somethingwaswrong.com backslash resources. That's somethingwaswrong.com backslash resources. You can also listen to episode number 72 of What Came Next, entitled Stories That Need To Be Told, to hear more about my personal journey. You can find that wherever you listen to podcasts. Thank you so much for listening and learning with us.
If you like Something Was Wrong, you can listen early and ad-free right now by joining Wondery Plus in the Wondery app or on Apple Podcasts. Prime members can listen ad-free on Amazon Music. Before you go, tell us about yourself by filling out a short survey at wondery.com slash survey.