Reclaiming Control: Understanding the Long-Term Consequences of Munchausen Syndrome by Proxy

Munchausen syndrome by proxy (MSbP), also known as factitious disorder imposed on another, is a psychological disorder and a form of child abuse in which the caregiver of a child, typically the mother, either exaggerates, fabricates or deliberately induces real symptoms of illness in an effort to feign the child’s sickness and gather sympathy or attention from friends, family or healthcare workers (Kaneshiro, 2023). They may do this by withholding food, giving the child inappropriate medicines or withholding prescribed medicines, poisoning or suffocating the child (Jones, 2024). 

Victims of MSbP, typically under the age of six, are trapped in this complex web of deception and continue to exist, often for years, in the distorted reality presented to them by their caregiver. From a tender age, these individuals are robbed of the most fundamental form of control: control over their own bodies and minds. Human beings have a deep-seated drive to feel in control, which may be a means of fulfilling the psychological need for autonomy; the experience of being self-governed in thought, feeling and action (Ragunathan, 2016). It may also stem from the desire for certainty and predictability in a world where outcomes are unknown and their determinants, undefined. Some research has gone so far as to say that this drive is an adaptive behaviour serving an evolutionary purpose; a biological imperative (Leotti, 2010). From this, numerous questions arise: what lengths may individuals who have experienced a total lack of control during their formative years go to, in order to regain it? What long-term psychological consequences are faced by survivors as they navigate adulthood? Well after their formative years, are they able to regain the control they were deprived of? Can they heal from the emotional scars that were inflicted upon them, or will they follow down a similar path of manipulation, lies and abuse?

A detailed examination of mothers with MSbP by Bools, Neale and Meadow (1994) revealed that one third of the mothers reported childhood emotional neglect and abuse. Having a parental figure who exploited the control they had over them appears to have led these individuals to regain this control by manipulating their own children, in order to compensate for the complete lack of control in their own lives (Schnarch, 2011). According to Rosenberg (1987) it is possible that child victims of MSbP grow into adults who perpetuate MSbP. However, incidence rates for the evolution of victims of MSbP to becoming perpetrators of MSbP currently remain unknown due to limited follow-up research.

In many cases, victims as adults may also suffer from Munchausen syndrome (deliberately fabricating one’s own mental or physical symptoms), or somatization (the tendency to experience and communicate psychological distress in the form of somatic symptoms), in which case they are unable to regain control. A study by Libow (1995) also found that as adults, victims were highly prone to avoiding medical care at all costs, even when desperately needed. As a result, victims tend to ignore any health problems that they are experiencing, increasing the risk of complications. This appears to be related to a difficulty distinguishing reality from fantasy, particularly with regard to bodily symptoms and the need for medical attention. Individuals often reported struggling to identify whether the symptoms were real or imagined. With this in mind, in order to provide effective healthcare, it is  essential  that all medical professionals who are treating a survivor are aware of the history of abuse.

Victims can also suffer from lasting and severe psychological damage, affecting various aspects of their lives. This includes significant confusion about their health and relationships, displaying overly compliant or aggressive behaviours, decreased feelings of self-worth and the loss of a positive body image. Glazier (2009) found that suicidal ideation, anxiety, depression and post-traumatic stress disorder (PTSD) were also documented among victims. These detrimental consequences highlight the need for victims of MSbP to receive early interventions which focus on providing support, managing trauma, teaching coping skills and encouraging an optimal level of independent functioning. Typically, this is delivered in the form of Cognitive Processing Therapy or EMDR (eye-movement desensitisation and reprocessing) which is an interactive psychotherapy designed to relieve symptoms of trauma (Gotter & Raypole, 2023). However, the path to recovery for victims of Munchausen syndrome by proxy is not always so straightforward.  Most mental healthcare professionals receive no training specific to helping survivors of this form of child abuse. While many of the the treatments may be similar to treating a survivor of other forms of child abuse or trauma, the general lack of knowledge about the syndrome may serve as a barrier to effective treatment and leave victims feeling isolated or misunderstood.

Additionally, having friends and/or family members who recognize and affirm a survivor’s experience is crucial to recovery. In the case of MSbP victims, this may be a challenge for two reasons: Firstly, because of the low public awareness of Munchausen by proxy, the process of explaining what they have been through to friends and loved ones can be complicated. Secondly, victims often experience difficulty trusting others, having been betrayed by a person who was meant to protect them and may consequently struggle with building this kind of support system. Another factor that appears to play an important role in recovery is either setting well-defined boundaries, or cutting off contact with the perpetrator in order to maintain one’s own independence and wellbeing. Sometimes however, feelings of self-blame, shame and stigmatisation among victims may interfere with this process. Although more common among child victims, this could lead to victims maintaining a positive view of the offending caregiver and lying for or attempting to protect them by maintaining the falsehoods created by the perpetrator (A Guide for Therapists: Treating Perpetrators, Survivors and Family Members, n.d.). 

The multitude of psychological disturbances experienced by survivors of Munchausen syndrome by proxy abuse seem to share a common thread: the profound and enduring loss of control that permeates their lives long after the abuse itself has ceased. Addressing the above-mentioned obstacles to effective recovery is a crucial step in the process of reclaiming this control and can be achieved in two ways: The first is increasing awareness of how best to provide support to victims of MSbP (both among mental healthcare professionals and among the general public – especially  friends, family and colleagues of victims). The second is increasing the accessibility of early interventions that encourage optimal independent functioning and teach victims how to establish healthy boundaries with the perpetrator. By combining these approaches, we as a society can support and empower victims so that they are able to break the cycle of trauma, by giving them the opportunity to reclaim control over their own lives and write their own narratives.