A disorder called Munchausen by proxy has made headlines lately, thanks to fictionalized TV accounts of malicious moms on shows like The Politician, The Act, and Sharp Objects. But the often misunderstood condition is far more complicated — and more insidious — than one might immediately believe.
According to the National Institutes of Health, MBP almost always involves a mother abusing her child by causing or feigning symptoms and then seeking out unnecessary medical treatments for the child. Ninety-six percent of perpetrators are women. Though MBP and its parent condition, Munchausen syndrome, are considered rare, there’s not enough research being done to make any definitive conclusions about how many people are truly afflicted.
Both disorders are deemed “factitious disorders,” or conditions in which a person pretends to have a physical or mental illness in order to gain attention or sympathy. With MBP, a caregiver feigns an illness in her child and takes him to the doctor unnecessarily. This was the case for recently convicted Texas mom Kaylene Bowen-Wright, who subjected her healthy 8-year-old son to more than 300 unneeded doctor’s visits and procedures, as well as 13 major surgeries.
Bowen-Wright was recently sentenced to six years in prison. Her son survived.
But not all victims of MBP are so lucky. In 2014, a New York woman named Lacey Spears killed her son, 5-year-old Garnett, by slowly injecting him with sodium through his feeding tube in the hospital. This occurred after years of medical child abuse on Spears’ part: Since his infancy, she had dragged her son from hospital to hospital for an array of health concerns she’d been inducing herself. Spears is now serving 20 years in jail for her crime.
What are some of the most common myths associated with MBP, and what is the reality behind this disturbing phenomenon?
Myth 1: Munchausen by proxy is very rare.
“It’s incredibly isolating, which makes people think it’s incredibly rare,” Dunlop tells PEOPLE. “I believe it’s underreported. Most perpetrators are never convicted, and never end up with their kids taken away.”
Dr. Marc Feldman, author of the book Dying to Be Ill and a leading expert on MBP, agrees. “Most cases are never recognized,” he says. “Instead, the child undergoes years of suffering without any doctor, relative, or friend ever realizing that the mother herself is the reason the child is so sick. It is not nearly as rare as many people think.”
There also aren’t many statistics about this kind of abuse because it’s not as deeply studied as other forms of child abuse, Dunlop notes.
Myth 2: People with MBP are ‘crazy.’
Women who abuse their children in this fashion often “seem very normal and credible, and are very smart,” Dunlop says.
Most of them have been manipulating doctors, relatives and friends for years. “A lot of times, the perpetrators are middle-class moms, some of them with medical backgrounds,” says Dunlop.
This means the women are often knowledgeable about what to do — and not do — to evade suspicion.
A big point of contention when discussing MBP is whether it qualifies as a mental illness. Feldman does not believe it does. “I view MBP as a form of abuse,” he says, noting that many experts refer to it as “medical child abuse.” But the American Psychiatric Association considers Munchausen by proxy linked with a mental disorder called Factitious Disorder Imposed on Another (FDIA).
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“This terminology … opens the door for accused perpetrators to claim in court that they were merely the helpless victims of a mental illness,” Feldman says.
Myth 3: MBP is treatable.
Munchausen by proxy is not easy to treat. Why? Because usually, the people who perpetuate this kind of child abuse don’t believe they’re doing anything wrong. “The typical reaction upon confrontation of the mother is firm denial, even when there are video recordings of her abusing the child,” says Feldman. If the mother won’t acknowledge any wrongdoing, therapy generally can’t succeed.
However, Feldman has seen some positive outcomes. As he discusses in Dying to Be Ill, one patient initially denied lying about her kids having constant seizures. Despite the initial denial, Feldman says she improved “remarkably” over the next few years with “psychotherapy, treatment for depression, parenting classes, and further education,” and eventually was reunited with her child.
Myth 4: MBP is about financial gain.
“Some shows like The Act confuse [MBP] with malingering: When people fake illnesses for material gain. It’s totally separate, but it is confusing, because there is sometimes financial fraud in Munchausen by proxy cases [too],” Dunlop says.
In fact, the term “malingering by proxy” (MAL-BP) is used “when the fabrication of symptoms is intended to achieve tangible personal gain,” according to Feldman. Still, some Munchausen moms, such as Dee Dee Blanchard, do use sites like GoFundMe or organizations like Make a Wish to solicit donations and monetary assistance. (Blanchard even had a free house built for her through Habitat for Humanity.)
In most cases, the primary motivation for MBP moms is not money — it’s attention. “The main reasons the mothers behave this way is that they are after attention and concern,” says Feldman. “They seek to control their child … or they are angry, rageful people with sadistic tendencies. This last group is the most likely to actually kill the child,” he says.