By Joanie Bentz, B.S., M.Ed., CCBP, BC
Munchausen Syndrome by Proxy (MSBP) is a mental health problem in which caregivers make up or cause illness or injury in a person who is under their care, according to Michigan Medicine. The victims are usually children, the disabled, or the elderly. Some experts view MSBP as a type of sociopathic behavior, specifically as a subgroup of borderline personality disorder.
What does this syndrome look like?
Three different experiences of Munchausen Syndrome by Proxy
Chloe is a grown woman who has childhood memories revolving around doctor visits, her mother’s illnesses and her mother’s concern about others being sick. Her mother insisted on caring for others, but contradicted this kind image when she mistreated Chloe. Chloe’s mother only treated her with kindness when Chloe was sick and needed care. Now that Chloe has the cognitive maturity to be able to question the hyper focused behavior on illness and disease that was dumped on her in childhood, she wonders if her mother had some sort of mental health issue.
Loreen is a divorced mother and a healthcare worker with several children. Loreen had a physical disorder that required multiple surgeries and doctor visits. She spent most of her childhood being examined by doctors, poked and prodded. Her mother carried guilt that she smoked and drank during the pregnancy, thus creating the anomaly. Loreen’s mother never left her alone concerning her health, and always insisted she was not well, but gave her everything she wanted materially. Loreen now does the same thing to her own children. She over exaggerates their minor illnesses, seeking unnecessary interventions and providing her undivided attention and care. She also fabricates illnesses in the children to prevent her ex-husband from contacting them.
Caitlin is a healthcare worker who had several children, but all seemed to become very sick after birth. Caitlin was constantly bringing her children to the emergency room, eliciting pity and attention from the hospital workers. A few close family members suspected something was wrong when one of the children died as an infant. It was discovered that Caitlin was administering various substances into the children’s bloodstreams that were difficult to detect, so that they would appear sick from unknown causes.
Defining Munchausen Syndrome by Proxy and atypical profiles
In 1977, an English pediatrician named Roy Meadow, introduced Munchausen Syndrome by Proxy. Another term is factitious disorder by proxy. This syndrome is characterized by a person, most always a woman, that seeks attention by fabricating an illness in her children. If the mother’s children are found by doctors to need treatment of some sort, the mother gains a source of narcissistic supply through this treatment.
Read more: What’s a sociopath?
The mother, during a routine doctor visit, may bully the doctor into writing unnecessary prescriptions. She may also demand that he write false information about the children’s health. MSBP has been characterized as a sociopathic personality disorder, and has been described as being similar to a serial bully. Presenting oneself as a false victim is also a MSBP trait. They are convincing liars and seem to have a Jekyll and Hyde nature.
Most unnerving is that women who have this disorder often work as nurses, caretakers for the elderly, or other healthcare workers. They know the lingo, which gives them more credibility with the doctors treating their victims.
Varying degrees of disorder
MSBP seems to operate on a spectrum. With Chloe, we see that she was the victim of a mother who had a moderate form of the disorder. Chloe managed to recognize the pathological behavior and realized that her mother inordinately focused on sickness, medicines, hospitals and death. By capitalizing on the illness of others and rescuing them, the MSBP individual receives praise and enjoys the glory of being seen as a hero, gaining narcissistic supply. I had heard this behavior described as “malignant hero syndrome.”
Loreen seems to be a victim of transgenerational MSBP. Her mother’ guilt over Loreen’s birth defect mutated into an obsession over Loreen’s health. Her mother needed to be portrayed as the rescuer as a continual effort to overcome her self-loathing. Her mother created a sort of monster in Loreen, where Loreen seeks unnecessary medical attention for her children, and in a passive-aggressive manner, bullies her ex-husband and alienates him from the children.
Caitlin appears high on the spectrum, where the disorder results in severe mistreatment, abuse and eventually death in one of her children. When the mother brings her child to the ER, all focus is on the mother’s distraught nature which garners sympathy, and the mother feels significant and worthy of attention. Many times if the victim of a MSBP individual survives, they refuse to be a witness to the crime, as if Stockholm Syndrome is a factor in not reporting the facts to authorities.
Munchausen Syndrome by Proxy and co-occurring disorders
MSBP is an attention-seeking, sociopathic disorder that can overlap with other disorders, such as narcissistic personality disorder and borderline personality disorder. It is difficult to identify which disorder is the dominant one driving the individual to harm their own children and other vulnerable people. When their victims are treated by doctors, they receive fuel to carry on, similar to how a narcissist behaves when they mistreat their targets. It can be an adrenaline rush for them.
It is especially important to take note that an individual with Munchausen Syndrome by Proxy commonly chooses a career in the healthcare industry. This fact in itself is alarming — but we should not be surprised in our world overrun with sociopaths and other disordered individuals.
Question: Are there harmless sociopaths?
I’ve often thought myself that Munchausen Syndrome by Proxy is simply a particular subtype of psychopathy. The worst cases illustrate this, like Waneta Hoyt, who murdered all five of her children, or of Marybeth Tinning, who murdered all nine of hers, including an adopted child. Perpetrating a heinous act without a shred of conscience, and for a trivial motive–simply to gain attention or sympathy, or be seen as a “hero” for “trying so hard to rescue” a sick child–is essentially psychopathic in character.
I was surprised to read that some experts view MSBP as a subgroup of borderline personality disorder. BPD is distinctly different in character and motivation from psychopathy. I wondered if this was due to the reputed tendency of some in the mental health profession to use BPD as a catchall diagnosis for disordered women especially; in certain cases perhaps, due to gender stereotyping, being reluctant to admit that some women are outright psychopaths. (Conversely, true borderline personality is probably underdiagnosed in men, as Donald Dutton found in his work with male abusers.)
If MSBP could be linked with any of the other Cluster B disorders, I would have thought it was histrionic personality disorder, since a central motive driving HPD is an obsessive need for approval or attention. When I checked with Wikipedia’s list of HPD symptoms, I found they did indeed include “Using factitious somatic symptoms (of physical illness) or psychological disorders to garner attention”
They ought to call it “fictitious” rather than “factitious”!
Unfortunately I was unable to read the full text of the article Joanie quoted on this topic, which is only available by subscription. I wasn’t going to shell out 36 bucks just to satisfy my curiosity on that small point. I did however find this article detailing an instance of a case where a woman displaying plain old Munchausen syndrome, or “factitious disorder”–that’s where people deceive doctors by feigning sickness in themselves, not in others–plainly fit nearly all the criteria for BPD. But this article on plain Munchausen’s (though it mentioned MSBP along the way) also had this to say:
It’s strange that they omitted histrionic personality disorder.
Anyway I was interested to read here about a “spectrum” of varying degrees of MSBP. Yet at the benign end of the spectrum, could Chloe’s mother really be classed as a case of MSBP? Unlike others, she doesn’t seem to have harmed anyone. She treated Chloe with kindness and didn’t try to “make” her sick. Meanwhile at the other end, “Waneta” Hoyt (whose parents were presumably illiterate and couldn’t spell!) was a heartless serial killer.
So it seems to me that instead of trying to understand MSBP as a discrete and unique disorder, or simply to “link” it with other disorders, what’s needed is to analyze the nature of such a disorder, to break it down into its separate component parts in terms of the individual motivations and other traits.
For instance, Chloe was right: her mother was not mentally healthy. This poor lady had an obsession with sickness and death. and along with that, an exaggerated need to act the part of a kind, caring person. It might be uncharitable to suggest she did that merely to gain approval or attention from others. She might just have had a craving to see herself in that benignant light. Possibly she was compensating for a lack of self esteem. If so, such a disproportionate focus on illness and mortality was not a healthy way of meeting an emotional need, and I hope Chloe herself didn’t suffer too much from being raised in such a morbid atmosphere.
Still, when an obsession grows so great that the real needs of others are disregarded, it becomes harmful to others. That’s clearly what happened with Loreen’s mother, whose behavior I’d say was driven not only by “guilt,” but by fear–a powerful and often dangerous motive when taken to excess. I’d say she damaged her daughter by passing her fears onto Loreen, who is consequently turning her own children into neurotics by acting out of the same fear. This was aptly illustrated by these lines in Pink Floyd’s classic song “Mother,” from “The Wall”:
Loreen’s hostility toward her ex-husband, and her parental alienation, similarly appear to be fear-driven, as if she imagines he might somehow “harm” his children, (They’re not just “hers,” they’re his as well.) And why are they divorced in the first place? Could it be because the poor man found this neurotic woman impossible to live with?
Caitlin appears “high on the spectrum,” her presumed murder of one of her children edging her into the company of women like Waneta Hoyt and Marybeth Tinning, along with those “angel” nurses sent not from Heaven, but from Hell, like Genene Jones and Beverley Allitt. I suspect that’s what happens when traits like a “craving for attention and sympathy” (a.k.a. “narcissistic supply”), together with sickness as a means of getting it, are combined with a psychopathic lack of any conscience.
I do believe Chloe’s mother genuinely wanted to be kind. She chose an unhealthy way of doing it at times, but her actions also sprang from, and were moderated by, a real caring for others. Lacking empathy or conscience, the psychopath has no such motivations–and no such inhibitions either. So when someone lusts after attention, sympathy, or recognition as a “hero,” with no internal impulses to check their means of gaining it at others’ expense, that’s a deadly combination.
Incidentally it’s a shame that Dr. Roy Meadow, who first identified MSBP as a disorder, blotted his copybook so disastrously in later life. His is another example of an obsession carried too far. Like those who in Joe McCarthy’s time saw “Reds under the bed” even when they weren’t, Meadow, so concerned with undetected abuse and murder of children, started seeing murder everywhere, even when it wasn’t. It was ironic that he was knighted by Queen Elizabeth for his services in the protection of children in 1998, just months before he pursued the prosecution of Sally Clark, an innocent woman, a shocking and tragic miscarriage of justice that killed Mrs. Clark and ruined Meadow’s reputation.
Although it’s irrelevant, I can’t help being reminded of Sir Thomas Bouch, the 19th century engineer who contributed so much to rail technology, such as the first “roll-on-roll-off” train ferry. His crowning achievement was the first bridge across the three-mile-wide estuary of the River Tay in Scotland, the longest bridge in the world at the time. For this he was knighted by Queen Victoria, who herself rode a train across his bridge in celebration. She was lucky. Just eighteen months later, at the end of 1879, the bridge fell down in a storm, killing 75 people riding a train over it at the time. The subsequent inquiry concluded that the bridge was “badly designed, badly constructed, and badly maintained, and that its downfall was due to inherent defects [for which] Sir Thomas Bouch is, in our opinion. mainly to blame.” Poor Sir Thomas, his reputation in tatters, died in despair the following year.
Unlike Sir Thomas, Sir Samuel Roy Meadow hasn’t yet kicked the bucket in despair. Yet his disgrace over the Sally Clark episode poses an instructive comparison, together with a polar contrast, with the story of the infamous Jeanne Weber in France a century earlier. Sally Clark was an innocent woman unjustly persecuted by “expert” witnesses, ultimately leading to her death. Jeanne Weber was a serial child killer unjustly exonerated by “expert” witnesses, leading to the death of two more children at her hands.
If anyone doesn’t know these stories here in the U.S., you can always Google them for the details. But to summarize, Sally Clark was a perfectly respectable English solicitor who had the bad luck to lose two infants in succession, both attributed to “crib death.” Meadow wasn’t having this. He claimed there was only a one in 73 million chance of a mother having two children die of crib death. This was statistically rubbish for several reasons, not least that two children from the same family could easily inherit the same fatal genetic defects. But in Meadow’s eyes it had to be murder. Worse still, his flawed “evidence” in court was supported by that of Dr. Alan Williams, who outrageously lied by omission by failing to tell the jury that Mrs. Clark’s second son had a bacterial infection probably responsible for his death. Sally Clark went to prison, separated from her third child, abused by other female prisoners who thought her a “baby killer,” Her life destroyed, even after being later cleared of murder, she died of alcoholism within a few years.
Jeanne Weber was the opposite. She murdered ten children, possibly others, by strangling or smothering them, and tried to kill at least two more. The most incredible feature of her case was that her guilt was so blindingly obvious to everyone, yet so many ignored it. Two crib deaths in a family can well be a tragic coincidence. But when multiple children from different families die within a few weeks while under the care of the same woman, who could doubt that it’s murder? Probability statistics do count at times!
What’s just as inexplicable is that members of her own family kept letting her babysit her nieces, despite losing three in a row, while “Auntie Jeanne” had recently lost two of her own three children, garnering her much sympathy. Poor little Georgette, Suzanne, and Germaine were all sent to Heaven in the single month of March 1905. This couldn’t be “bad luck.” Wasn’t it obvious that wherever Madame Weber walked, Death walked with her? It was only when an in-law brought another attempt to the authorities’ attention that Jeanne Weber was arrested. In the meantime she had strangled her third child, Marcel, besides two unrelated children three years before.
Her arrest only led to more craziness. Although the press and the public could see she was guilty as sin, Madame Weber was defended by “experts” in court, possibly in part out of blind “gallantry” that females, and mothers especially, could never be guilty of such awful crimes. One was Dr. Léon Henri Thoinot, one of Paris’s most prominent “expert” witnesses. Another was Maître Henri Robert, an unscrupulous lawyer but a “great defender.” A third was Paul Brouardel, who himself had written a detailed book on the entire topic of strangulation and suffocation. Together they combined to “get her off” in court, though the judge had no doubt of her guilt.
The craziness did not end there. The year afterwards, she murdered a boy in a different part of France. Instead of admitting their error, the same team of Thoinot and the rest ganged up to “prove” she was still innocent, and the case was dismissed. Some naive suckers felt sorry for her “persecution,” and employed her in a children’s home! When they caught her trying to strangle another child, they let her go quietly because they didn’t want to admit the mistake they’d made.
Finally she was caught in the very act of fatally strangling a little boy, and nobody could doubt her guilt. Just as staggeringly, the good Dr. Thoinot and Maître Robert declared that poor Jeanne Weber had been innocent all along until this moment, and it was the stress caused years of persecution that had at last driven her to commit a real murder.
Needless to say, the press and public laughed them to scorn. But it only goes to show how far an obsession can go, including when so-called “expert” witnesses have a reputation to defend, won’t admit their own mistakes, and are so convincing that some people believe them. (Sir Bernard Spilsbury was probably another.)
Even there, the incredibilities of Jeanne Weber’s life did not end. She should have gone to the guillotine, but was never prosecuted. Instead, she was quietly declared “insane” and shuffled off to a mental institution, where she ended her life in 1918, ironically by a method many thought might be impossible: strangling herself with her own hands.
I’m sure she was a classic case of Munchausen’s Syndrome by Proxy, for the sympathy she garnered every time a poor child died under her reluctant hands. And a psychopath as well. We should watch out for evildoers masquerading as “caring” people. But another lesson is just as important. Beware of so-called “experts,” especially those who won’t admit when they’re wrong. They frequently are.
My ex was at the very least a malignant narcissist and his mother was described as an hysteric. She certainly had some sort of personality disorder. She had a disabled son, more than likely because she insisted on a home birth which subsequently went wrong. This caused her son’s disability. His health, alongside her own became her obsession. She died about 8 years ago, her allegedly very sick son is still alive surviving with very little medical intervention.
My ex mother in law made much of minor illness too, I think she’s a sociopath but then I’m biased! 😂
Narcissists will try to twist the facts and say that an enthusiastic and genuine advocate for health and wellness is obsessive, disordered, selfish, etc. when in fact we are all stewards of our own health and passing along the job to someone else is skirting accountability that you are in charge of YOU.
However, this disorder, whether it is by proxy or not, is an whole different animal, in that the motivation for the behavior is a shattered core self, and instead of seeking the origination of the problem, they hurt others to smother the actual origins of the problem. It’s easier to hurt others than to admit you are psychologically damaged.
This video explains how we are all being treated on global scale as patients, wearing masks, treating everyone as if they are sick, dehumanizing by isolation, as we are being tortured through Munchhausen syndrome. Our body is our ultimate privacy, and now, it is being violated. Great video which goes into how this disorder is being forced upon us through indoctrination……
https://www.youtube.com/watch?v=2deFTjEDgGA