MUNCHAUSEN SYNDROME

MUNCHAUSEN SYNDROME & MUNCHAUSEN SYNDROME BY PROXY

Every so often a heart-breaking story of Munchausen Syndrome by Proxy (MSP) is discovered. The story of Gypsy Rose Blanchard came to light in 2015 when the then 23-year-old had a boyfriend murder her mother. MSP is a variant of Munchausen Syndrome, also known as Factitious Disorder.

WHAT IS MUNCHAUSEN SYNDROME?

It is a rare mental illness where, in its most basic form someone fakes an illness. They lie about symptoms, the onset and severity and either appear to be sick or purposely make themselves sick. The person is usually very convincing. It results in unnecessary treatments, medications and invasive surgeries and is classified as a form of self-harm. The victim gains intense satisfaction, attention and validation from family, friends and health care professionals by playing sick.

WHO IS AT RISK?

Most prevalent are females who work within the healthcare profession as well as those who have a mental health disorder history like depression, PTSD, borderline personality disorder or other histrionic personality traits. Also, at high risk are those who suffered from chronic childhood illness or witnessed a close family member’s illness during childhood. Those with low self esteem or difficulty forming close relationships, people who have difficulty distinguishing reality from fantasy, the ability to lie or manipulate for gain or self-aggrandizement and those with an inability to accept personal failings are also in the high-risk population.

SYMPTOMS: HOW DO THEY PRESENT?

• Extensive medical history (tests, procedures, operations, prescriptions)
• Inconclusive multiple test results
• A collection of unrelated symptoms and when one is discounted another appears
• Impressive medical knowledge
• Desire for medical procedures and surgeries
• Frequent Flyers to may doctors, hospitals, ER’s and crossing state lines
• No improvement despite all best efforts

BEHAVIORS

In a bid for sympathy and attention these sufferers often:

• Pretend pain. Exaggerate/fake symptoms most of which occur when there are no witnesses. These include chest/stomach pains, fevers, headaches, seizures, dizzy spells, vomiting and diarrhea.
• Poisoning themselves by eating contaminated foods or infecting wounds with dirt or feces.
• Prevent healing by reopening/reinfection of wounds
• Cut or burn themselves or cut off circulation to digits or limbs
• Often ignore legitimate health concerns until they becomes serious
• Keep family and healthcare professionals from communicating with each other

The complications of all this include prescription drug side effects, overdoses, harm from poisoning or other unnecessary medical procedures and other self-harm behaviors including permanent disability and death.

MUNCHAUSERN SYNDROME BY PROXY (MSP)

This is the most publicized variant of the disease and most often perpetuated by a mother.  Dr. Gail Salltz, Associate Professor of Psychiatry, NY Presbyterian Weill-Cornell School of Medicine says the perpetrator “fabricates an illness or injury or induces an illness or injury upon someone in their care (most often their child) for the purpose of being a victim by association and getting medical attention and care from others.” In 1996, a social worker accused Debbie Mathers, mother of rapper Eminem of MSP against both he (real name Marshall Mathers) and his younger brother. He has rapped about this numerous times although she has denied the allegation. It is also known as medical child abuse and may be the deadliest form, resulting in 6-9% of discovered cases. This form of abuse is also perpetuated against the elderly by their (usually female) family caregivers.

The most infamous case of Munchausen by Proxy is Gypsy Rose Blanchard which became public in 2016. By age 8, her mother DeeDee had her diagnosed with multiple sclerosis and leukemia and requiring a wheelchair and feeding tube. DeeDee also had her treated for seizures, asthma, hearing and vision impairments. Gypsy underwent multiple surgeries over the years including removal of her salivary glands, leading to gum disease and tooth loss. By all accounts, DeeDee was charming, believable and devoted. Gypsy’s estranged father complimented DeeDee on the extraordinary care she but lavished on their daughter. At age 14 a neurosurgeon suspected Gypsy was a victim of MSP but never reported it due to lack of proof. At about this time, DeeDee, claiming to be a victim of Hurricane Katrina received federal aid and relocated from Louisiana to Missouri where two things happened: Gypsy’s medical records became conveniently destroyed and Habitat for Humanity built them a wheelchair accessible home. As Gypsy got older, she became harder for her mother to control and tried to run away several times, each time being returned to the control of her mother. In 2015 with the aid of the Internet, Gypsy convinced an online boyfriend to murder her mother. They are both in prison now, but Gypsy is eligible for parole in 2024. Dr. Mark Feldman, an expert in MSP likens her case to a hostage situation and Gypsy herself has said she was so conditioned to depend on her mother she felt no one would believe the truth. HBO produced the film “Mommy Dead and Dearest” chronicling this horror story.

MUNCHAUSENS SYNDROME BY INTERNET

I have to admit this was a new one for me. Dr. Marc Feldman, an expert on Munchausen’s explains this new variant as when a person joins a legitimate on-line support site (Leukemia, Fibromyalgia, Cystic Fibrosis, miscarriage/stillbirth) designed for mental, emotional and physical health issues by feigning the illness. These groups are designed to be a safe haven for people to come together to share experiences, strength, tips, difficulties, encouragement and support. When this betrayal is discovered, it can have a negative effect on the on-line community where trust, compassion and shared experience are the touchstones. It may cause members to lose faith in the group, themselves and their situation or worse yet, quit altogether. As with this type of mental illness, it is selfish and destructive, and the collateral damage is difficult to assess.

MALINGERING

This is not Munchausen’s per se but can manifest itself in similar ways albeit for quite different reasons. This is faking, exaggerating or inducing an illness for 3 reasons:

• Financial reward through sick pay or paid leave
• Avoidance of work/responsibilities or jail time
• Obtaining medications either for personal use or resale

The most famous case is that of Belle Gibson, a popular wellness blogger with a cookbook and App (The Whole Pantry). Belle claimed to have cured her brain cancer through diet and raised substantial charitable donations, all of which she pocketed. Malingering is not an illness, bur rather a crime of greed.

Munchausen’s Syndrome and its offshoots are serious and dangerous diseases because of the high risk for self-harm or dependent abuse. There are two or more victims in cases of Munchausen’s by Proxy. People have seriously injured themselves or others in order to feed this deep inner need for attention and validation.

Munchausen’s in any form is difficult to diagnose because healthcare professionals must first wade through and rule out all legitimate mental and physical illnesses, plus it is rare. The National Hospital Discharge Survey in 2013 reported 6.8 cases per 100,000. Treatment involves psychotherapy focusing on the cognitive and behavioral aspects/risk vs. reward. It often involves family therapy to teach warning signs, appropriate responses and to prevent enabling. Group therapy is also helpful to reduce feelings of isolation and self-pity. There are no known preventative measures or medications for treatment and it is best to think in terms of management vs. cure.

NHS Solutions has a pool of Interim Healthcare Leaders who specialize in Behavioral Health. Contact us for more information.