Factitious disorder
imposed on another (FDIA), also known as Munchausen syndrome by proxy (MSbP), is a condition where a
caregiver creates the appearance of health problems in another person,
typically their child. This may include
injuring the child or altering test samples. They then present the person as being sick or
injured. This occurs without a specific
benefit to the caregiver. A permanent
injury or death of the child may occur.
The cause is unknown. The primary motive may be to gain attention
and manipulate physicians. Risk factors
include pregnancy-related complications and a mother who was abused as a child
or has factitious disorder imposed on
self. Diagnosis is supported when removing the child from the caregiver
results in improvement of symptoms or video surveillance without the knowledge
of the caregiver finds concerns. Those
affected have been subjected to a form of physical abuse and medical neglect.
Management may require putting the child in foster care. Therapy may help when the caregiver realizes
they need help. How commonly it occurs
is unknown, however, it appears to be relatively rare. More than 95% of cases involve a person's
mother. The condition was first named in
1977 by Roy Meadow. The presence of the disorder may indicate
criminal behavior.
Signs and symptoms
In factitious
disorder imposed on another, a caregiver makes a dependent person appear
mentally or physically ill in order to gain attention. To perpetuate the
medical relationship, the caregiver systematically misrepresents symptoms,
fabricates signs, manipulates laboratory tests, or even purposely harms the
dependent (e.g. by poisoning, suffocation, infection, physical injury). Studies have shown a mortality rate of between
six and ten percent, making it perhaps the most lethal form of abuse.
In one study, the average age of an the affected individual
at the time of diagnosis was 4 years old. Slightly over 50% were aged 24 months
or younger, and 75% were under six years old. The average duration from onset
of symptoms to diagnosis was 22 months. By the time of diagnosis, six percent
of the affected persons were dead, mostly from apnea (a common result of
smothering) or starvation, and seven percent had a long-term or permanent injury.
About half of the affected had siblings; 25% of the known siblings were dead,
and 61% of siblings had symptoms similar to the affected or that were otherwise
suspicious. The mother was the perpetrator in 76.5% of the cases, the father in
6.7%.
Most present about three medical problems in some
combination of the 103 different reported symptoms. The most-frequently
reported problems are apnea (26.8% of cases), anorexia or feeding problems
(24.6% of cases), diarrhea (20%), seizures (17.5%), cyanosis (blue skin)
(11.7%), behavior (10.4%), asthma (9.5%), allergy (9.3%), and fevers (8.6%).[9]
Other symptoms include failure to thrive, vomiting, bleeding, rash, and
infections. Many of these symptoms are
easy to fake because they are subjective. A parent reporting that their child
had a fever in the past 24 hours is making a claim that is impossible to prove
or disprove. The number and variety of presented symptoms contribute to the
difficulty in reaching a proper diagnosis.
Aside from the motive (which is to gain attention or
sympathy), another feature that differentiates FDIA from "typical"
physical child abuse is the degree of premeditation involved. Whereas most
physical abuse entails lashing out at a child in response to some behavior
(e.g., crying, bedwetting, spilling food), assaults on the FDIA victim tend to
be unprovoked and planned.
Also unique to this form of abuse is the role that health
care providers play by actively, albeit unintentionally, enabling the abuse. By
reacting to the concerns and demands of perpetrators, medical professionals are
manipulated into a partnership of child maltreatment. Challenging cases that defy simple medical
explanations may prompt health care providers to pursue unusual or rare
diagnoses, thus allocating even more time to the child and the abuser. Even
without prompting, medical professionals may be easily seduced into prescribing
diagnostic tests and therapies that are at best uncomfortable and costly, and
at worst potentially injurious to the child. If the health practitioner resists ordering
further tests, drugs, procedures, surgeries, or specialists, the FDIA abuser
makes the medical system appear negligent for refusing to help a sick child and
their selfless parent. Like those with Munchausen syndrome, FDIA perpetrators are known to switch
medical providers frequently until they find one that is willing to meet their
level of need; this practice is known as "doctor
shopping" or "hospital
hopping".
The perpetrator continues the abuse because maintaining the
child in the role of a patient satisfies the abuser's needs. The cure for the
victim is to separate the child completely from the abuser. When parental
visits are allowed, sometimes there is a disastrous outcome for the child. Even
when the child is removed, the perpetrator may then abuse another child: a
sibling or other child in the family.
Factitious disorder
imposed on another can have many long-term emotional effects on a child.
Depending on their experience of medical interventions, a percentage of
children may learn that they are most likely to receive the positive maternal
attention they crave when they are playing the sick role in front of health
care providers. Several case reports describe Munchausen syndrome patients
suspected of themselves having been FDIA
victims. Seeking personal gratification
through illness can thus become a lifelong and multi-generational disorder in
some cases. In stark contrast, other
reports suggest survivors of FDIA
develop an avoidance of medical treatment with post-traumatic responses to it. This variation possibly reflects broad
statistics on survivors of child abuse in general, where around 35% of abusers
were a victim of abuse in the past.
The adult care-provider who has abused the child often seems
comfortable and not upset over the child's hospitalization. While the child is
hospitalized, medical professionals must monitor the caregiver's visits to
prevent an attempt to worsen the child's condition. In addition, in many jurisdictions, medical
professionals have a duty to report such abuse to legal authorities.
Diagnosis
Munchausen syndrome
by proxy is a controversial term. In the World Health Organization's International Statistical Classification of
Diseases, 10th Revision (ICD-10),
the official diagnosis is factitious
disorder (301.51 in ICD-9, F68.12 in ICD-10). Within the United States, factitious disorder imposed on another (FDIA or FDIoA) was
officially recognized as a disorder in 2013, while in the United Kingdom, it is known as a fabricated or induced illness by
carers (FII).
In DSM-5, the
diagnostic manual published by the American
Psychiatric Association in 2013, this disorder is listed under 300.19 Factitious disorder. This, in turn,
encompasses two types:
Factitious disorder
imposed on self – (formerly Munchausen
syndrome).
Factitious disorder
imposed on another – (formerly Munchausen
syndrome by proxy); diagnosis assigned to the perpetrator; the person
affected may be assigned an abuse diagnosis (e.g. child abuse).
Warning signs
Warning Signs of the disorder include:
·
A child who has one or more medical problems
that do not respond to treatment or that follow an unusual course that is
persistent, puzzling, and unexplained.
·
Physical or laboratory findings that are highly
unusual, discrepant with patient's presentation or history, or physically or
clinically impossible.
·
A parent who appears medically knowledgeable
fascinated with medical details and hospital gossip, appears to enjoy the
hospital environment, and expresses interest in the details of other patients'
problems.
·
A highly attentive parent who is reluctant to
leave their child's side and who themselves seem to require constant attention.
·
A parent who appears unusually calm in the face
of serious difficulties in their child's medical course while being highly
supportive and encouraging of the physician, or one who is angry, devalues
staff, and demands further intervention, more procedures, second opinions, and
transfers to more sophisticated facilities.
·
The suspected parent may work in the health-care
field themselves or profess an interest in a health-related job.
·
The signs and symptoms of a child's illness may
lessen or simply vanish in the parent's absence (hospitalization and careful
monitoring may be necessary to establish this causal relationship).
·
A family history of similar or unexplained
illness or death in a sibling.
·
A parent with symptoms similar to their child's
own medical problems or an illness history that itself is puzzling and unusual.
·
A suspected emotionally distant relationship
between parents; the spouse often fails to visit the patient and has little
contact with physicians even when the child is hospitalized with a serious
illness.
·
A parent who reports dramatic, negative events,
such as house fires, burglaries, or car accidents, that affect them and their
family while their child is undergoing treatment.
·
A parent who seems to have an insatiable need
for adulation or who makes self-serving efforts for public acknowledgment of
their abilities.
·
A child who inexplicably deteriorates whenever
discharge is planned.
·
A child that looks for cueing from a parent in
order to feign illness when medical personnel is present.
·
A child that is overly articulate regarding
medical terminology and their own disease process for their age.
·
A child that presents to the Emergency Department
with a history of repeat illness, injury, or hospitalization.
Epidemiology
FDIA is rare. A study in Italy found that 4 out of more than
700 children admitted to the hospital met the criteria (0.53%). In this study,
stringent diagnostic criteria were used, which required at least one test
outcome or event that could not possibly have occurred without deliberate intervention
by the FDIA person. One study showed that in 93 percent of FDIA cases, the abuser is the mother or
another female guardian or caregiver. A
psychodynamic model of this kind of maternal abuse exists.
FDIA may be more
prevalent in the parents of those with a learning difficulty or mental
incapacity and as such the apparent patient could, in fact, be an adult.
Fathers and other male caregivers have been the perpetrators
in only seven percent of the cases studied. When they are not actively involved in the
abuse, the fathers or male guardians of FDIA
victims are often described as being distant, emotionally disengaged, and
powerless. These men play a passive role in FDIA by being frequently absent from the home and rarely visiting
the hospitalized child. Usually, they vehemently deny the possibility of abuse,
even in the face of overwhelming evidence or their child's pleas for help.
Overall, male and female children are equally likely to be
the victim of FDIA. In the few cases
where the father is the perpetrator, however, the victim is three times more
likely to be male.
Society and culture
Terminology
The term "Munchausen
syndrome by proxy", in the United
States has never officially been included as a discrete mental disorder by
the American Psychiatric Association,
which publishes the Diagnostic and
Statistical Manual of Mental Disorders (DSM), now in its fifth edition. Although the DSM-III (1980) and DSM-III-R
(1987) included Munchausen syndrome,
they did not include MSbP. DSM-IV (1994) and DSM-IV-TR (2000) added MSbP
as a proposal only, and finally being recognized as a disorder in DSM-5 (2013) – yet each of these last
three editions of the DSM listed
this disorder (or proposal) with a different name.
FDIA has been
given different names in different places and at different times. What follows
is a partial list of alternative names that have been either used or proposed
(with approximate dates):
Factitious Disorder
Imposed on Another (current) (U.S., 2013) American Psychiatric Association, DSM-5
Factitious Disorder
by Proxy (FDP, FDbP) (proposed) (U.S., 2000) American Psychiatric Association, DSM-IV-TR
Fictitious Disorder
by Proxy (FDP, FDbP) (proposed) (U.S., 1994) American Psychiatric Association, DSM-IV
Fabricated or Induced
Illness by Carers (FII) (U.K., 2002) The
Royal College of Pediatrics and Child Health
Factitious Illness by
Proxy (1996) World Health
Organization
Pediatric Condition
Falsification (PCF) (proposed) (U.S., 2002) American Professional Society on the Abuse of Children proposed
this term to diagnose the victim (child); the perpetrator (mother) would be
diagnosed "factitious disorder by
proxy"; MSbP would be
retained as the name applied to the 'disorder' that contains these two
elements, a diagnosis in the child and diagnosis in the caretaker.
Induced Illness (Munchausen Syndrome by Proxy) (Ireland,
1999–2002) Department of Health and
Children
Meadow's Syndrome
(1984–1987) named after Roy Meadow. This label, however, had already been in use
since 1957 to describe a completely unrelated and rare form of cardiomyopathy.
Polle Syndrome
(1977–1984) coined by Burman and Stevens,
from the then-common belief that Baron
Münchhausen's second wife gave birth to a daughter named Polle during their
marriage. The baron declared that the
baby was not his, and the child died from "seizures"
at the age of 10 months. The name fell out of favor after 1984, when it was
discovered that Polle was not the baby's name, but rather was the name of her
mother's hometown.
While it initially included only the infliction of harmful
medical care, the term has subsequently been extended to include cases in which
the only harm arose from medical neglect, noncompliance, or even educational
interference. The term is derived from Munchausen syndrome, a psychiatric
factitious disorder wherein those affected feign disease, illness, or
psychological trauma to draw attention, sympathy, or reassurance to themselves.
Munchausen
syndrome by proxy perpetrators, by contrast, is willing to fulfill their
need for positive attention by hurting their own child, thereby assuming the
sick role onto their child, by proxy. These proxies then gain personal
attention and support by taking on this fictitious "hero role" and receive positive attention from others,
by appearing to care for and save their so-called sick child. They are named after Baron Munchausen, a literary character based on Hieronymus Karl Friedrich, Freiherr von
Münchhausen (1720–1797), a German
nobleman and well-known storyteller. In 1785, writer and con artist Rudolf Erich Raspe anonymously
published a book in which a fictional version of "Baron Munchausen" tells fantastic and impossible stories
about himself, establishing a popular literary archetype of a bombastic
exaggerator.
Initial description
"Munchausen
syndrome" was first described by R.
Asher in 1951 as when someone invents or exaggerates medical symptoms,
sometimes engaging in self-harm, to gain attention or sympathy.
The term "Munchausen
syndrome by proxy" was first coined by John Money and June Faith Werlwas in a 1976 paper titled Folie à deux in the parents of psychosocial
dwarfs: Two cases to describe the abuse-induced and neglect-induced symptoms of
the syndrome of abuse dwarfism. That same year, Sneed and Bell wrote an article
titled The Dauphin of Munchausen:
factitious passage of renal stones in a child.
According to other sources, the term was created by the British pediatrician Roy Meadow in 1977. In 1977, Roy
Meadow – then professor of pediatrics at the University of Leeds, England – described the extraordinary behavior
of two mothers. According to Meadow, one had poisoned her toddler with
excessive quantities of salt. The other had introduced her own blood into her
baby's urine sample. This second case occurred during a series of Outpatient visits to the Paediatric
Clinic of Dr. Bill Arrowsmith at Doncaster Royal Infirmary. He referred
to this behavior as Munchausen syndrome
by proxy (MSbP).
The medical community was initially skeptical of FDIA's existence, but it gradually
gained acceptance as a recognized condition. There are now more than 2,000 case
reports of FDIA in the literature.
Reports come from developing countries, as well as the U.S., with one case from
2012–2013, in Orlando, Florida, and
the most recent in Westchester, New York,
in early 2015. Other reports come from Sri Lanka, Nigeria, and Oman.
Controversy
During the 1990s and early 2000s, Roy Meadow was an expert witness in several murder cases involving MSbP/FII. Meadow was knighted for his
work for child protection, though later, his reputation, and consequently the
credibility of MSbP became damaged
when several convictions of child-killing, in which he acted as an expert
witness was overturned. The mothers in those cases were wrongly convicted of
murdering two or more of their children, and had already been imprisoned for up
to six years.
One case was that of Sally
Clark. Clark was a lawyer wrongly convicted in 1999 of the murder of her
two baby sons, largely on the basis of Meadow's evidence. As an expert witness
for the prosecution, Meadow asserted that the odds of there being two
unexplained infant deaths in one family were one in 73 million. That figure was
crucial in sending Clark to jail but was hotly disputed by the Royal
Statistical Society, who wrote to the Lord
Chancellor to complain. It was
subsequently shown that once other factors (e.g. genetic or environmental) were
taken into consideration, the true odds were much greater, i.e., there was a
significantly higher likelihood of two deaths happening as a chance occurrence
than Meadow had claimed during the trial. Those odds in fact range from a low
of 1:8500 to as high as 1:200. It
emerged later that there was clear evidence of a Staphylococcus aureus
infection that had spread as far as the child's cerebrospinal fluid. Clark was released in January 2003 after
three judges quashed her convictions in the Court of Appeal in London, but suffering from catastrophic trauma
of the experience, she later died from alcohol poisoning. Meadow was involved
as a prosecution witness in three other high-profile cases resulting in mothers
being imprisoned and subsequently cleared of wrongdoing: Trupti Patel, Angela
Cannings, and Donna Anthony.
In 2003, Lord Howe,
the Opposition spokesman on health, accused Meadow of inventing a "theory without science" and
refusing to produce any real evidence to prove that Munchausen syndrome by proxy actually exists. It is important to
distinguish between the act of harming a child, which can be easily verified,
and motive, which is much harder to verify and which FDIA tries to explain. For example, a caregiver may wish to harm a
child out of malice and then attempt to conceal it as an illness to avoid
the detection of abuse, rather than to draw attention and sympathy.
The distinction is often crucial in criminal proceedings, in
which the prosecutor must prove both the act and the mental element
constituting a crime to establish guilt. In most legal jurisdictions, a doctor
can give expert witness testimony as to whether a child was being harmed but
cannot speculate regarding the motive of the caregiver. FII merely refers to
the fact that illness is induced or fabricated and does not specifically limit
the motives of such acts to a caregiver's need for attention and/or sympathy.
In all, around 250 cases resulting in conviction in which
Meadow was an expert witness were reviewed, with few changes, but all where the
only evidence was Meadows' expert testimony were overturned. Meadow was
investigated by the British General Medical
Council (GMC) over evidence he gave in the Sally Clark trial. In July 2005, the GMC declared Meadow guilty of "serious
professional misconduct", and he was struck off the medical register
for giving "erroneous" and "misleading" evidence. At appeal, High Court judge Mr. Justice
Collins said that the severity of his punishment "approaches the irrational" and set it aside.
Collins's judgment raises important points concerning the
liability of expert witnesses – his view is that referral to the GMC by the losing side is an
unacceptable threat and that only the Court should decide whether its witnesses
are seriously deficient and refer them to their professional bodies.
In addition to the controversy surrounding expert witnesses,
an article appeared in the forensic literature that detailed legal cases
involving controversy surrounding the murder suspect. The article provides a brief review of the
research and criminal cases involving Munchausen
syndrome by proxy in which psychopathic mothers and caregivers were the
murderers. It also briefly describes the importance of gathering behavioral
data, including observations of the parents who commit criminal acts. The
article references the 1997 work of Southall,
Plunkett, Banks, Falkov, and Samuels, in which covert video recorders were
used to monitor the hospital rooms of suspected FDIA victims. In 30 out of 39 cases, a parent was observed
intentionally suffocating their child; in two they were seen attempting to
poison a child; in another, the mother deliberately broke her 3-month-old
daughter's arm. Upon further investigation, those 39 patients, ages 1 month to
3 years old, had 41 siblings; 12 of those had died suddenly and unexpectedly. The use of covert video, while apparently extremely
effective, raises controversy in some jurisdictions over privacy rights.
Legal status
In most legal jurisdictions, doctors are allowed to give
evidence only in regard to whether the child is being harmed. They are not
allowed to give evidence in regard to the motive. Australia and the UK
have established the legal precedent that FDIA
does not exist as a medico-legal entity.
In a June 2004 appeal hearing, the Supreme Court of Queensland, Australia, stated:
As the term factitious
disorder (Munchausen's Syndrome)
by proxy is merely descriptive of behavior, not a psychiatrically
identifiable illness or condition, it does not relate to an organized or
recognized a reliable body of knowledge or experience. Dr. Reddan's evidence was inadmissible.
The Queensland
Supreme Court further ruled that the determination of whether or not a
the defendant had caused intentional harm to a child was a matter for the jury to
decide and not for the determination by expert witnesses:
The diagnosis of Doctors
Pincus, Withers, and O'Loughlin that the appellant intentionally caused her
children to receive unnecessary treatment through her own acts and the false
reporting of symptoms of the factitious
disorder (Munchausen Syndrome) by proxy is not a diagnosis of a recognized
medical condition, disorder, or syndrome. It is simply placing her within the
medical term used in the category of people exhibiting such behavior. In that
sense, their opinions were not expert evidence because they related to matters
that could be decided on the evidence by ordinary jurors. The essential issue
as to whether the appellant reported or fabricated false symptoms or did act
to intentionally cause unnecessary medical procedures to injure her children
was a matter for the jury's determination. The evidence of Doctors Pincus, Withers, and O'Loughlin that the appellant was
exhibiting the behavior of factitious
disorder (Munchausen syndrome by
proxy) should have been excluded.
Principles of law and implications for legal processes that may be deduced from these findings are that:
Any matters brought before a Court of Law should be determined by the facts, not by suppositions
attached to a label describing a behavior, i.e., MSBP/FII/FDBP;
MSBP/FII/FDBP is
not a mental disorder (i.e., not defined as such in DSM IV), and the evidence of a psychiatrist should not therefore be
admissible;
MSBP/FII/FDBP has
been stated to be a behavior describing a form of child abuse and not a medical
diagnosis of either a parent or a child. A medical practitioner cannot
therefore state that a person "suffers"
from MSBP/FII/FDBP, and such
evidence should also, therefore, be inadmissible. The evidence of a medical
practitioner should be confined to what they observed and heard and what
forensic information was found by recognized medical investigative procedures;
A label used to describe behavior is not helpful in
determining guilt and is prejudicial. By applying an ambiguous label of MSBP/FII to a woman is implying guilt
without factual supportive and corroborative evidence;
The assertion that other people may behave in this way,
i.e., fabricate and/or induce illness in children to gain attention for
themselves (FII/MSBP/FDBY),
contained within the label is not factual evidence that this individual has
behaved in this way. Again, therefore, the application of the label is
prejudicial to fairness and a finding based on fact.
The Queensland
Judgment was adopted into English law in the High Court of Justice by Mr.
Justice Ryder. In his final conclusions regarding Factitious Disorder, Ryder states that:
I have considered and respectfully adopt the dicta of the Supreme Court of Queensland in R v. LM [2004] QCA 192 in paragraphs 62 and 66. I take full account of the criminal
law and foreign jurisdictional contexts of that decision but I am persuaded by
the following argument upon its face that it is valid to the English law of
evidence as applied to children proceedings.
The terms "Munchausen
syndrome by proxy" and "factitious
(and induced) illness (by proxy)" are child protection labels that are
merely descriptions of a range of behaviors, not a pediatric, psychiatric or
a psychological disease that is identifiable. The terms do not relate to an
organized or universally recognized body of knowledge or experience that has
identified a medical disease (i.e. illness or condition) and there are no
internationally accepted medical criteria for the use of either label.
In reality, the use of the label is intended to connote that
in the individual case, there are materials susceptible to analysis by
pediatricians and of findings of fact by a court concerning fabrication,
exaggeration, minimization or omission in the reporting of symptoms and
evidence of harm by act, omission or suggestion (induction). Where such facts
exist the context and assessments can provide an insight into the degree of
risk that a child may face and the court is likely to be assisted as to that aspect
by psychiatric and/or psychological expert evidence.
All of the above ought to be self-evident and has in any
event has been the established teaching of leading pediatricians, psychiatrists and
psychologists for some while. That is not to minimize the nature and extent of
the professional debate about this issue which remains significant, nor to minimize
the extreme nature of the risk that is identified in a small number of cases.
In these circumstances, evidence as to the existence of MSBP or FII in any individual case is as likely to be evidence of mere
propensity which would be inadmissible at the fact-finding stage (see Re CB and
JB supra). For my part, I would consign the label MSBP to the history books and however useful FII may apparently be to the child protection practitioner I would
caution against its use other than as a factual description of a series of
incidents or behaviors that should then be accurately set out (and even then
only in the hands of the pediatrician or psychiatrist/psychologist). I cannot emphasize too strongly that my conclusion cannot be used as a reason to re-open
the many cases where facts have been found against a carer and the label MSBP or FII has been attached to that carer's behavior. What I seek to
caution against is the use of the label as a substitute for factual analysis
and risk assessment.
In his book Playing
Sick (2004), Marc Feldman notes
that such findings have been in the minority among the U.S. and even Australian
courts. Pediatricians and other physicians have banded together to oppose
limitations on child-abuse professionals whose work includes FII detection. The April 2007 issue of the journal Pediatrics specifically mentions Meadow
as an individual who has been inappropriately maligned.
Notable cases
Beverley Allitt,
a British nurse who murdered four children and injured a further nine in 1991
at Grantham and Kesteven Hospital,
Lincolnshire was diagnosed with Munchausen
syndrome by proxy.
Wendi Michelle Scott
is a Frederick, Maryland, mother who
was charged with sickening her four-year-old daughter.
The book Sickened,
by Julie Gregory, details her life
growing up with a mother suffering from Munchausen
by proxy, who took her to various doctors, coached her to act sicker than
she was and to exaggerate her symptoms, and who demanded increasingly invasive
procedures to diagnose Gregory's enforced imaginary illnesses.
Lisa Hayden-Johnson
of Devon was jailed for three years
and three months after subjecting her son to a total of 325 medical actions –
including being confined to a wheelchair and being fed through a tube in his
stomach. She claimed her son had a long list of illnesses including diabetes,
food allergies, cerebral palsy, and cystic fibrosis describing him as "the illest child in Britain"
and receiving numerous cash donations and charity gifts, including two cruises.
In the mid-1990s, Kathy
Bush gained public sympathy for the plight of her daughter, Jennifer, who
by the age of 8 had undergone 40 surgeries and spent over 640 days in hospitals
for gastrointestinal disorders. The acclaim led to a visit with first lady Hillary Clinton, who championed the Bushs' plight as evidence of
a need for medical reform. However, in 1996, Kathy
Bush was arrested and charged with child abuse and Medicaid fraud, accused
of sabotaging Jennifer's medical equipment and drugs to agitate and prolong her
illness. Jennifer was moved to foster
care where she quickly regained her health. The prosecutors claimed Kathy was
driven by Munchausen Syndrome by Proxy,
and she was convicted to a five-year sentence in 1999. Kathy was released after serving three years
in 2005, always maintaining her innocence, and having got back in contact with Jennifer
via correspondence.
In 2014, 26-year-old Lacey
Spears was charged in Westchester
County, New York, with second-degree depraved murder and first-degree
manslaughter. She fed her son dangerous amounts of salt after she conducted
research on the Internet about its effects. Her actions were allegedly motivated
by the social media attention she gained on Facebook,
Twitter, and blogs. She was convicted of second-degree murder on March 2,
2015, and sentenced to 20 years to life in prison.
Dee Dee Blanchard
was a Missouri mother who was
murdered by her daughter and a boyfriend in 2015 after having claimed, for
years, that her daughter, Gypsy Rose,
was sick and disabled, to the point of shaving her head, making her use a
wheelchair in public, and subjecting her to unnecessary medication and surgery.
Gypsy possessed no outstanding illnesses. Feldman said it is the first case he
is aware of in a quarter-century of research where the victim killed the
abuser. Their story was shown on HBO's documentary film Mommy Dead and Dearest and is featured in
the first season of the Hulu
anthology series, The Act.
Rapper Eminem has
spoken about how his mother would frequently take him to hospitals to receive
treatment for illnesses that he did not have. His song “Cleanin' Out My Closet” includes a lyric regarding the illness, “...going through public housing systems
victim of Münchausen syndrome. My whole life I was made to believe I was sick
when I wasn’t ‘til I grew up and blew up...” His mother's illness resulted
in Eminem receiving custody of his
younger brother, Nathan.
In 2013, Boston
Children's Hospital filed a 51A report to take custody of Justina Pelletier, who was 14 at the
time. At 21 she was living with her parents. Her parents are suing Boston Children's Hospital, alleging
that their civil rights were violated when she was committed to a psychiatric
ward and their access to her was limited. At the trial, Pelletier's treating
neurologist described how her parents encouraged her to be sick and were
endangering her health.
Directed towards
animals
Medical literature describes a subset of FDIA caregivers, where the proxy is a
pet rather than another person. These cases are labeled Munchausen syndrome by proxy: pet (MSbP:P). In these cases, pet
owners correspond to caregivers in traditional FDIA presentations involving human proxies. No extensive survey has yet been made of the
extant literature, and there has been no speculation as to how closely FDIA:P tracks with human FDIA.
