Munchausen Syndrome by Proxy

FBI Law Enforcement Bulletin,The, August, 1995 by Kathryn A. Artingstall

As the baffling symptoms continue, doctors or hospital administrators may call on law enforcement to investigate the mysterious circumstances surrounding such cases. In fact, as the medical community becomes increasingly familiar with MSBP and its warning signs, doctors and medical staffs seem to be more inclined to request the assistance of local law enforcement agencies.

The growing list of MSBP cases underscores the need for investigators to understand the various - and often complex - issues related to MSBP. During the past several years, a number of variations to the normal offender patterns have emerged, accompanied by a clearer understanding of how law enforcement should respond to cases believed to involve MSBP. The more investigators know about MSBP, the better able they will be to identify perpetrators, clear innocent suspects, and most important, protect children.

Research on MSBP

Researchers documented the serial nature of MSBP victimization in a study of 5 families with a total of 18 children.(1) In this study, 72 percent of the children were known to be MSBP victims.

In each family, only one child was involved at any given time, and a total of five children seemed to be unaffected. Of those children affected, 31 percent died. In only one instance was there any other form of abuse present.

The characteristics of the maternal perpetrators in this study indicated the following: 80 percent possessed backgrounds in health professions; 80 percent manifested Munchausen Syndrome (self-inflicted injury) themselves; 80 percent received psychiatric treatment prior to diagnosis; and 60 percent of the mothers attempted suicide. Denial persisted in most cases.

The research also shows that individuals who initially engaged in Munchausen Syndrome may eventually practice Munchausen Syndrome by Proxy.(2) The degree to which the offspring of Munchausen offenders become the subjects of abuse may increase proportionately with the number and increased severity of incidents of self-inflicted abuse.

MSBP may occur when the perpetrator of Munchausen Syndrome crosses over the threshold of self-inflicted injury into abuse of an unsuspecting child. Oftentimes, the caregivers (offenders) claim that injuries to the child were inflicted by a fictitious bad guy. In some instances, offenders injure themselves in order to substantiate the presence of this unknown perpetrator. Cautious, diligent investigation of these allegations often leads to dead ends based on a series of false crime reports.

Although there seems to be a multigenerational link between Munchausen Syndrome and MSBP, this connection has not been established scientifically to the level that most courts require. The level of understanding that members of the criminal justice system possess regarding Munchausen Syndrome and MSBP makes a crucial difference to the outcome of these cases. The ever-present possibility of continued victimization of children at the hands of MSBP offenders further underscores the importance of handling these cases expediently.

Establishing MSBP as a possible extension of Munchausen Syndrome will not be an easy task for investigators and prosecutors if the acts have not advanced to the point of physical abuse. Most courts are unwilling to remove a child from a parent's custody without concrete evidence to support charges of child abuse.

Understandably, detectives experience considerable frustration when working on these types of cases. Incidents falsified by offenders and seemingly verified by means of self-mutilation only add to the mystery when a perpetrator cannot be identified.

Perpetrators

In the standard offender-victim relationship, suspicion centers on the biological mother. In fact, the vast majority of MSBP cases resolved through investigation have implicated the victim's mother as the sole offender.(3)

Investigators should be aware, however, that the MSBP offender profile has widened to include other perpetrators, both within and outside the victim's family structure.(4) Fathers, grandmothers, aunts, and babysitters have been identified as offenders. Regardless of the relationship to the victim, the offenders all had one thing in common - each acted as the victim's primary caregiver.

In very rare cases, medical professionals also could be included in the list of potential suspects. While it appears that only immediate family members would receive the gratification from attention, increased self-esteem, and false sense of belonging afforded by MSBP, similar motivations lead some health-care workers to cross the line of the Hippocratic Oath into the realm of child abuse. By inflicting MSBP, and then "saving" the child, these offending medical practitioners hope to excel within their fields and win acceptance by their peers.

Fortunately, the frequency of cases involving health-care workers has been relatively low thus far. The possibility exists, though, that a medical professional's actions might indicate MSBP in certain circumstances.

Investigations of this type are highly sensitive. Often, medical personnel are wrongly accused by actual offenders who perceive that they have come under suspicion. Still, an investigator's decision to suspect or accuse medical professionals of MSBP should be based on the same standard of investigation used for other suspects. However, the primary caregiver status inherent in the most common offender profiles continues to place mothers at the height of suspicion.