What is Munchausen syndrome by proxy? Experts explain what’s behind medical child abuse
Andrea Dunlop’s reasons for creating a podcast on Munchausen syndrome by proxy are both educational and personal.
Dunlop, who lives in Seattle, wanted to “get into the humanity” of perpetrators of medical child abuse, in which a caretaker lies or creates symptoms in someone under their care to gain attention and unnecessary medical treatment.
But Dunlop also hoped to end her podcast with an interview with a Fort Worth mom, whose case is an infamous example of how far a person with Munchausen syndrome by proxy might go to create a fake sickness.
In the podcast “Nobody Should Believe Me,” Dunlop talks to experts across multiple fields and analyzes the complex story of Hope Ybarra, who faked her own cancer and is accused of stealing pathogens from a lab to make her children sick.
Ybarra, who was the subject of a Star-Telegram project on Munchausen by proxy syndrome in 2015, subjected one of her daughters to four years of unneeded surgeries and medical procedures, according to court documents. She was arrested in October 2009 on a charge of serious bodily injury to a child and was sentenced to 10 years in prison.
“When people commit heinous crimes, I don’t think it’s helpful to say that person’s a monster,” Dunlop said. “That puts it at arm’s length, like, ‘That is a crazy, one-off thing that would never happen to me.’ … If you think this couldn’t be your sister, your friend, you’re wrong.”
What is medical child abuse?
Medical child abuse occurs when a child, or someone in another person’s care, undergoes unnecessary medical treatments because their caretaker lies about or fabricates the victim’s symptoms. For example, a parent — often a mother — might repeatedly lie and tell a doctor their child cannot keep food down, while the parent might secretly be not feeding the child. In response, a doctor might order the child have a feeding tube inserted to get nutrition.
Medical child abuse can take countless forms. In one Tarrant County case, a mother told doctors her baby would suddenly stop breathing. The baby underwent tests and supervision in the hospital, but medical staff could not figure out what was wrong. The mother was eventually caught on video suffocating the baby against her chest.
Medical child abuse has specific red flags such as:
Doctor shopping, where the parents goes to multiple medical facilities, sometimes in different states, to have procedures done to the child
Inconsistent medical history
Symptoms that are only present when a parent is with the child
A parent doesn’t seem relieved or happy when a child improves or is found not to have an illness
A parent insists on a diagnosis that tests prove does not exist
People also have a hard time believing that medical professionals would perform unnecessary procedures on a child just because a mother said the child is sick. However, especially in young children, doctors rely on parents to give medical histories for the patient. Perpetrators use that to their advantage: If they say their 1-year-old threw up four times that day, a doctor is inclined to believe them.
Perpetrators of medical child abuse often choose illnesses that can be difficult to prove or disprove, said Dr. Carole Jenny, child abuse fellowship director at Seattle Children’s Hospital. A parent might say their child had a seizure or is not eating.
Some parents go further than lying about symptoms. In extreme cases, parents cause symptoms in their children. Of the 14 women accused of medical child abuse in Tarrant County since 2009, six are suspected of creating symptoms in their children either through withholding food, poisoning or suffocation.
In Ybarra’s case, she was accused of stealing pathogens from her workplace to poison her daughter, altering sweat tests to encourage a diagnosis of cystic fibrosis and draining blood from the child, starting a chain reaction of events that caused the girl to go into anaphylactic shock.
What is Munchausen syndrome by proxy?
Factitious disorder imposed upon another is considered a mental illness by the American Psychological Association. The disorder, also known as Munchausen syndrome by proxy, is often not identified and has a high morbidity rate, according to the National Library of Medicine.
People with the disorder often crave attention, and they are willing to gain it at the expense of their child’s health, according to the American Professional Society on the Abuse of Children guidelines.
Culturally, people either have never heard of Munchausen syndrome by proxy or think it is rarer than it is, Dunlop said. For many, the idea of a mother purposefully causing harm to their child contradicts society’s image of motherhood. But it is that very perception of a nurturing mother that often helps shield abusers from accusations.
“There is no more sympathetic figure in our culture than a mother with a sick child,” Dunlop said. “The motive is the attention and sympathy. So it’s sort of a lot of leaps for people to make.”
The disorder goes far beyond a parent being anxious about their child’s health and frequently taking them to a hospital or doctor. The key difference is the parent chooses to lie about symptoms solely to obtain unnecessary medical treatments, said Dr. Marc Feldman, clinical professor of psychiatry and adjunct professor of psychology at the University of Alabama. Feldman and Jenny are members of the American Professional Society of Munchausen by Proxy,
“This is deliberate behavior,” Feldman said. “This is willful, deliberate behavior focused on deception.”
Treatable?
There is limited research on how best to treat factitious syndrome imposed upon another. A 2017 review of the disorder for the National Library of Medicine notes that “no effective treatments have been demonstrated through well-conducted studies, and no diagnostic criteria exist.”
A person with factitious disorder imposed upon another can be treated, Feldman said, but first the person has to admit to what he or she has done. That step, Feldman said, is “almost impossible to surmount.”
“All these years later, I still haven’t found a conclusive way of getting the mothers to admit to what they’ve done,” he said. “If they won’t admit to it, you have no basis to do psychotherapy.”
If a person can pass that first hurdle, they should prepare for long-term, lifetime counseling.
Jenny’s husband ran a program in Rhode Island where mothers diagnosed with factitious disorder imposed upon another could receive treatment. For some mothers who were on the lower end of the spectrum — mothers who were not actively harming their children to make them appear sick — they were able to stop the abuse without taking the child away.
Disagreement also exists among experts and family members of perpetrators about whether people with factitious disorder upon another believe their own lies.
“I do think the behavior is criminal and should be treated as such,” Dunlop said. “But I also think perpetrators should get treatment. But they have to have a full accounting of their behavior. And that is vanishingly rare.”
Feldman and Jenny emphasized that while treatment is important for mothers, the focus in medical child abuse cases should be on helping the child who is being abused. Medical child abuse can be fatal. For those who do not die, they may “think they’re seriously chronically ill and go on to play that role for the rest of their life,” Jenny said.
If you or someone you know might be a victim of medical child abuse, contact the Childhelp National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453). All calls are anonymous and confidential.
