Munchausen Syndrome and
Munchausen Syndrome By Proxy (MSBP)
Factitious disorder, factitious disorder by proxy
Munchausen Syndrome is an attention-seeking personality disorder which is more common than statistics suggest.Munchausen Syndrome, named after a German soldier renowned for exaggerated tales, is a predominantly female disorder in which an emotionally immature person with narcissistic tendencies, low self-esteem and a fragile ego has an overwhelming need to draw attention to herself and to be the centre of attention.
In Munchausen Syndrome, this is achieved by capitalising on, exploiting, exaggerating or feigning illness or injury or personal misfortune. The opportunities for being centre of attention can be increased if feigning victimhood through alleged victimisation, isolation, exclusion or persecution is added to the equation; the Munchausen person can then depict another person (often a family member) as a victimiser or persecutor and herself as the victim.
Presenting herself as a false victim is also a Munchausen trait.
In Munchausen Syndrome By Proxy (MSBP), occasions for being centre of attention are created by deliberately causing illness, injury or harm to others to provide opportunities for rescue and care.
Often the MSBP sufferer will work as a nurse, perhaps in a hospital ward for sick children (especially very young babies) or in a home for elderly persons, or with severely handicapped people, or as a care giver.
The common thread is a victim whose is vulnerable, whose verbal skills or emotional state or mental condition prevents them from explaining what the MSBP person is doing to them and whose hold on life may already be precarious.
Even if the victim survives, they cannot or will not be a witness. Because death amongst these groups occurs normally and is therefore not unusual or unexpected, her activities in causing death may escape notice for years.
Few people ask questions, for how many people would dare to think that this wonderful, kind, caring, compassionate person who has devoted her life to helping others is, in reality, a murderer? Or, given the repeat nature of the crime, a serial killer?
How many people suspected that Beverley Allitt, that kind, comparing, compassionate nurse who cared for sick babies at Grantham Hospital was, in reality, killing them, one by one?
Her behaviour merited the label of Angel of Death. How many people suspected that the kind, avuncular doctor who eased his elderly female patients' suffering with morphine was, in reality, Britain's most prolific serial killer?
Manchester GP Harold Shipman was sentenced to life in prison for his killings.
Shipman committed suicide in January 2004. Shipman is not a Munchausen case but the circumstances of his murderous actions are similar to MSBP.
Harm can be inflicted by any means which leaves little or no forensic evidence, such as restricting breathing by holding a hand over the mouth, fingers over the nostrils, lying on top of the baby, smothering, placing plastic or cling film over the person's face, withholding food, withholding medicine or over-medicating or medicating when unnecessary, or by delaying calling for medical assistance when an emergency arises. When the victim reacts with a fit, breathing difficulties, collapse etc, the MSBP sufferer can - after ensuring the condition is sufficiently life-threatening - rush to the rescue and later be hailed as a hero for being such a wonderful, kind, caring, compassionate person for having saved this person's life.
The MSBP sufferer is often a mother who deliberately harms her child with the intention of gaining the attention of the medical services. She gains gratification from being in the presence of doctors, nurses and medical personnel and revels in the attention that a concerned mother inevitably attracts in these surroundings. It appears that the intent is to induce illness and injury, rather than commit murder, for the death of the child would take away the object which she repeatedly manipulates for her gratification. Death may also arouse suspicions to the point of investigation. However, the injury or illness must be severe enough to warrant the need for medical intervention; if, as often happens, she miscalculates and the child dies, then the sympathy for a grieving mother becomes another opportune vehicle for gaining attention. The MSBP nurse can wallow in the attention and the gratitude of bereaved parents for the kindness she showed during their baby's short life. However, the MSBP nurse cares nothing (except for herself) for she has an endless supply of potential victims.
The MSBP mother or nurse also knows that if family members or colleagues have suspicions, they are unlikely to voice them for fear of being wrong. No-one wants to make an accusation or report their suspicions to the authorities; if they are wrong, it could mean a libel action or ostracism from the family or workplace. If the MSBP person finds out that an allegation has been made, and she can guess who has made the allegation, this is deemed persecution and victimisation and becomes another, even bigger, opportunity for being the centre of attention. When this happens within the family, it's an opportunity to turn the whole family against the person making the accusation - or against anyone the MSBP sufferer can label as likely to have made the suggestion. Munchausen sufferers, as with most attention seekers, are always plausible and convincing.
It's been estimated that as many as one in five cot deaths is really a murder resulting from a mother with Munchausen Syndrome By Proxy. The MSBP mother (who becomes a serial killer) knows that fear [by the police or investigating authorities] of accusing the wrong person is usually enough to evade accountability and prosecution. No-one is going to challenge a grieving mother, and the father may be in ignorance of what has really happened and thus steadfastly supporting his partner. Evidence is minimal and the cause of death is put down as cot death (also known as Sudden Infant Death Syndrome or SIDS), choking, breathing difficulties or some other plausible reason. However, MSBP is an ongoing condition and it is the repeated deaths from ambiguous or unidentified causes which arouse suspicion. There's a saying in social services: one [death] is cot death, two is suspicious, three is Munchausen. But who is going to take the risk of wrongly accusing a bereaved mother or a caring nurse?
If questioning does take place, the Munchausen mother is likely to give the most convincing performance of innocence whilst the innocent mother is likely to be less convincing due to a combination of grief, sadness, loss, disbelief, bewilderment, anger and guilt, all of which are heightened by trauma.
Recent court cases have demonstrated that the number of infant deaths alone is not grounds for conviction, and that when genetic factors are taken into account, the odds are statistically higher that a family who has suffered genuine cot death is more likely to suffer further cot deaths. Paediatrician Professor Sir Roy Meadow, who made a career acting as expert witness in cases of mothers accused of murdering their children, has recently been shown to have used flawed data (which he has inexplicably shredded) and been backed up by bad science to obtain convictions. In July 2005 Professor Sir Roy Meadow was struck off by the General Medical Council (GMC) for serious professional misconduct after his misleading evidence in the case of Sally Clark. Recent research suggests that up to 80% of repeat cot deaths in the same family are not suspicious. It's likely that the best indicator of guilt is behaviour profile and history of attention-seeking behaviour including manipulation and deception, at which Munchausen cases excel.
Further reading
In many cases the Munchausen Syndrome sufferer's behaviour contains many of the characteristics listed under the profile of a serial bully. The pages on attention-seeking tactics and Narcissistic Personality Disorder may also be enlightening, as may be the page on bullies in the family.
Links
Munchausen Syndrome Hub
Salt poisoning mother is jailed
source: Munchausen Syndrome
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