Health Female Adda
6 months ago
Munchausen by proxy: Can parents hurt their own children for attention?

It’s the rule of nature to protect and preserve your offspring even if it is at the cost of your own life. Stories of parental sacrifices are dime a dozen and studies have also confirmed that maternal love is hardwired into the human brain.1 But that doesn’t mean we don’t see aberrations to this rule every once in a while. One such story was of teenager Twinkle Dwivedi, who was the subject of a documentary by  National Geographic.

The child was suffering from a mysterious ailment, which made her cry tears of blood. The Dwivedi family ran pillar to post, trying to find an explanation for her distressing illness. Everything from platelet disorder to hematidrosis was hypothesised, but even the best of doctors couldn’t exactly pinpoint what was wrong with the child.

Curiously, the bleeding episodes coincided with the girl’s menstrual cycle and nobody had witnessed her cry tears of blood except for her mother. It didn’t take too long for psychologists to guess the child’s ailment: Munchausen by proxy, a form of child abuse in which the caregiver (usually a parent) harms the child to give the impression that he or she is suffering from an illness.

Although there wasn’t enough evidence to term her case as Munchausen by proxy, doctors were convinced that Twinkle’s mother was using the teenager’s menstrual blood to create the fake tears. This shone a light on a rather uncomfortable topic: whether progenitors could actually harm their offspring for selfish gains. Read how parents may be emotionally hurting the child

What is Munchausen by proxy?
To understand Munchausen by proxy, it is important to know Munchausen syndrome, where instead of being harmed by a caretaker, the person fakes an illness for attention. The disease is named after Baron Munchausen, an 18th-century German nobleman known for concocting stories about his travels and exploits for attention. In Munchausen by proxy, the victim is usually young or vulnerable, being abused by the adult who would go as far as to poison or cut the victim. The perpetrator then revels the sympathy and attention that is showered on them by the society.2 Here are some signs that your child is being sexually abused

Dr Era Dutta, Consultant Neuropsychiatrist and Therapist Mind Wellness & Fortis Healthcare explains how it works: “Munchausen by proxy should be understood as a multidimensional — biological, psychological and emotional. Biologically, it is an interplay of many neurochemicals in the brain. Emotionally, it’s a cry for help to draw attention, sympathy, or reassurance to themselves via their affected loved ones. It is also a way to play a role of importance in the life of the dependent individual. And psychologically, it often stems from their own childhood issues of abuse, trauma, and parental neglect; anxiety and personality issues.”

Common characteristics of parents who perpetrate Munchausen by proxy
Usually, the victims are vulnerable children who are dependent on their parents for care and protection. Dr Dutta lists out some of the attributes of the perpetrators of Munchausen by proxy. The parents commonly have certain attributes:

- Caregivers to either young children or dependent persons (e.g. chronically ill adults, mentally challenged individual)

- Excessive anxiety over small health issues

- Good medical knowledge and background

- Constantly changing doctors or doctor shopping

- Problematic childhood

- Marital problems or poor social support

“Early life experiences are integral to all our future developments. A strong secure base in childhood leads to a happy, well-adjusted adulthood,” says Dr Dutta. So conversely, a bad childhood becomes the genesis of deviant behaviour, Munchausen included. The common issues noticed in the childhood of parents who carry out Munchausen by proxy are:

- Poor upbringing

- Absent or abusive parents

- Themselves not getting the help they needed in their childhood

- Wish to play saviour

- Attention seeking

- Subjected to Physical, emotional, sexual abuse in childhood

How Munchausen by proxy affects the abused child
Any kind of sustained abuse at the hands of a trusted caregiver is bound to cause profound psychological damage to the child. “The long-term outcome of the victims has been studied in a few cases,” says Dr Dutta. “Some don’t survive to tell the tale, as the parent my jeopardise their life. Other children may grow up to themselves develop either Munchausen syndrome. There are also abandonment issues, issues of trust seen in these children.”

A 1995 study3 published in The Child Abuse & Neglect journal states that victims of Munchausen by Proxy generally felt unloved and unsafe in their childhood. Although a few were aware of their parents’ deceptions, they didn’t do much to alert others. The victims reported feeling emotional and physical problems in adulthood like insecurity, reality-testing issues, reluctance to seek medical treatment and PTSD symptoms.

Many victims’ siblings were also abused by the parents. The subjects confessed to feeling anger towards their abusive mothers, but surprisingly, they were considerably sympathetic towards the fathers who passively colluded with the mother or failed to protect them from the abuse. Strangely, some of the perpetrators have continued fabricating stories of their own medical illnesses and harassing their adult children decades after the abuse.

What are the signs that the child is being abused?
There are some obvious red flags and patterns of parent-child behaviour that indicate a possible case of Munchausen by proxy. Dr Dutta recalls an incident she was witness to a few years ago where a 21-year-old girl with moderate to severe mental retardation and cerebral palsy was admitted to the psychiatric ward. Like Twinkle Dwivedi, the girl also suffered from bloody tears. The girl’s mother said that whenever she was upset, she’d end up crying tears of blood.

It was noticed that the bleeding episodes cropped up only when the girl went to the bathroom with the mother. Curiously, there weren’t any instances of blood tears when she was accompanied by the hospital staff. On being confronted, the mother admitted using vermillion or sindoor in the girl’s eyes to mimic bleeding. “The reason cited was that it was difficult to take care of her special needs daughter at home due to limited constraints. By feigning symptoms she could get her daughter free food, care in the government hospital,” Dr Dutta revealed. She urges hospital staff to look out for the following signs.

- Repeated unexplained cuts, bruises, fractures, illness in a child

- The child gets better when separated from the parent responsible

- The child improves in hospital and worsens at home ALWAYS

- Chemicals in bodily fluid samples to make the tests bizarre or positive

- Overconcerned parent who may report similar symptoms or that they had same illness in their childhood

- The parent trying to over-involve themselves in diagnosis. This could be by constantly changing the narrative of illness or by adding new symptoms each time to confuse the doctors.

- Doctor shopping by parents, especially in the backdrop of all negative assessments and reports

- Marital discord between parents

- Medical knowledge or background in the parent

References:
1. Noriuchi, M., Kikuchi, Y., & Senoo, A. (2008). The functional neuroanatomy of maternal love: mother’s response to infant’s attachment behaviors. Biological psychiatry, 63(4), 415-423.
2.Yaacob, B. M. . (1999). Munchausen Syndrome by Proxy. The Malaysian Journal of Medical Sciences : MJMS, 6(2), 30—31.
3.Libow, J. A. (1995). Munchausen by proxy victims in adulthood: a first look. Child abuse & neglect, 19(9), 1131-1142.

Image source: Shutterstock

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