In my last blog, I talked about three women who were convicted of medical child abuse in the face of overwhelming physical evidence, a confession, or both. Now that we know that Munchausen by proxy (also called medical child abuse and factitious disorder by proxy) really happens, we are left with an even greater mystery; why. Why we’ll probably never untangle the complex psyche that drives any single perpetrator, research is shedding light on what medical child abusers seem to have in common.
Let’s start with their childhoods.
Disorganized Attachment: Frightened and Frightening Parents
In 2005, U.K. researchers interviewed 67 mothers who had been referred by the court system for child maltreatment arising from what they called “abnormal illness behavior.’’ These were mothers who had used their children to gain attention from medical professionals. Some of these women lied or exaggerated about a child’s illness while some went so far as to induce an actual medical crisis. Seven had been charged with manslaughter.
Knowing that the way we ourselves are parented influences how we parent our children, they were interested at how these mothers felt about their own parents and, in particular, the quality of the emotional bond between them. A little background; four main attachment styles have been identified - secure and three subtypes of insecure. Securely attached children have a parent who is emotionally available, appropriately responsive, and is able to see, and accept, the negative and positive attributes of her offspring. On other hand, insecurely attached children tend to have parents who are either distant/disengaged, inconsistent (sometime sensitive, sometimes neglectful) or extremely erratic (ranging from passive to intrusive, frightening to frightened).
Not surprisingly, the vast majority of these women (85%) described an insecure, ambivalent attachment with both their own parents and their children. As children, these mothers saw their own parental figures as an unpredictable. They were the source of both hurt (over half reported physical and/or sexual abuse as children) and comfort.
As a result, these mothers failed to develop a consistent way to interact their parents; after all, if you don’t know whether your parent is going to hit or hug, how do you know when to approach and when to stay away? (Interestingly, a significant subgroup of these women demonstrated a type of attachment known as insecure-dismissing, i.e., a tendency to dismiss a child’s distress at times of illness, fear or loss).
Children whose parents are unable to develop a clear and consistent attachment are caught on the horns of a dilemma, especially when that parent is abusive. On the one hand, a child’s survival instincts tell her to get the heck away from the source of her pain and to safety. On the other hand, our parents are supposed to be the source of our safety. Long-term studies of children with disorganized attachment have found that, as parents, they often become either compulsive or controlling caregivers. Given the extreme maternal devotion noted by health professionals as well as friends and family members of convicted medical child abusers, it is possible that Munchausen by proxy is one expression of highly disorganized attachment.
Illness: The Devil You Know
But why would a mother develop this variant? As it turns out, there’s another life experience that tends to bond women who become medical child abusers – physical illness. For instance, in the 2005 study previously mentioned, almost 2/3rds of the women reported the death of a close family member either in childhood or adulthood. Given that the average age of this group was 28, and that 1 out of 7 American children lose a parent or sibling by age 20, this seems unusually high. Some had experienced multiple bereavements in their lives or lost a close family member when pregnant.
It is also common for Munchausen moms to come from a family background where physical symptoms – real, imagined, or faked – are used to get attention. Children learn that physical illness is the best way to get a parent’s attention while more direct ways (crying, expressing emotional distress) are ignored. Several Munchausen moms have described growing up with a parent who used routinely medical deception to gain the attention of physicians and nurses. Indeed, it is common for the perpetrators themselves to have extensive medical records and a history of faking illness.
The Bottom Line
Most children who grow up in chaotic or abusive homes do not become medical child abusers. Most children who experience the early loss of a close family member do not become medical child abusers. And, most children whose parents use physical symptoms – even fake ones - to get attention do not grow up to induce illness in their own children. However, a combination of all three may set the stage for an abnormal relationship between parent, child and the medical profession. Whether or not the parent will act out this childhood drama depends on other factors (to be discussed in future blogs).