Perpetrators of Child Abuse Versus. Perpetrators with Munchausen by Proxy Syndrome
Child abuse is an epidemic that has existed for decades, as perpetrators prey upon children that are too little to fight back and have no voice in the matter: classified by neglect, physical abuse, sexual abuse, and emotional abuse in addition to the common perpetrators from child abuse, comes a new breed of perpetrators. The ones who use their knowledge in medical education and know how to escape the system, ones that exhibit the symptoms of Munchausen by Proxy Syndrome; who feed on the attention they receive from their sick children, through medical child abuse. Both child abuse epidemics are not disappearing, but instead, the perpetrators are only finding new ways to inflict damage upon the innocent lives of children without getting caught as time continues. Although, child abuse and Munchausen by Proxy Syndrome, share the commonality of both being forms of abuse, MSBP and child abuse are different within the relation of their perpetrators in the areas of its history, signs and symptoms, and overall the diagnosis of both abuses.
From both discoveries of child abuse and MSBP, the perpetrators are different through their overall history and statistics within the United States. The history of child abuse is different from the overall discovery of Munchausen by Proxy Syndrome. "In 1874, there were no laws protecting children from physical abuse from their parents. It was an era of "spare the rod and spoil the child," and parents routinely meted out painful and damaging punishment without comment or penalty" (Markel). Parents could choose to punish their children if the scenario allowed for punishment and no authority or guidelines were given to tell them what was too far. In the area it was up to the parents to decide what punishment their child must face for the actions they made thus opening the door for abuse to happen. Due to this societal norm, the true origin of child abuse is not certain or able to be dated back to one specific time. However, although there is no definite date for the start of child abuse, one case has built a foundation for the prevention of child abuse and has ultimately opened the eyes of the public to seeing that abusing a child is not okay and should never be okay. "The first known case of child abuse is Mary Ellen, an orphan who was brutally physically abused by her adoptive mother daily after the death of her adoptive father" (Markel). Mary Ellen was abused severely by her adoptive mother and was forced to live every day facing her wrath due to the passing of her adoptive father. Mary suffered countless beatings from her adoptive mother until neighbors spoke out and the police became involved. "In December of 1874, the first child prevention agency in the world, New York Society for the Prevention of Cruelty to Children, was found" (Markel). Mary Ellen sparked a chain of events as her story and case opened the eyes of many individuals who were once blind to child abuse and now paved the way for countless other children to get out of their abusive household and restore their innocence and youth. "In the United States, the laws defining what constitutes child abuse vary from state to state, but generally speaking, child abuse can take these forms: physical abuse, sexual abuse, neglect and abandonment, and emotional or psychological abuse" (Lyness). No matter what child abuse classification one falls into is all child abuse and should be treated very serious as those within the hands of a perpetrator are suffering daily because of the illness of the offender. "In 2011, 3.4 million referrals were made to child protective authorities in the United States; 8.4% of the referrals were from medical personnel" (Magana). "Seventy-eight percent of child maltreatment reports were from neglect, 17.6% from physical abuse, and 9.1% from child sexual abuse... The rate of child maltreatment in the United States was 9.1 cases per 1000 children" (Magana). The rate of child abuse has not changed and is continuous within the progression of time. While the emergence of child abuse is hard to date back to a specific case, the background of Munchausen by Proxy disorder's origin is more specific. "Munchausen syndrome is named after a German military man, Baron von Munchausen, who traveled around telling fantastic tales about his imaginary exploits... in 1951, Richard Asher applied the term to people traveling from hospital to hospital, fabricating various illnesses" (Edwards). "The medical profession has since borrowed the name of this famous raconteur to describe a group of individuals whose complaints are fabricated, but nonetheless so convincing that patients are subjected to needless hospitalizations, diagnostic tests, and even surgery" (Criddle). Years later, in 1977, physician Roy Meadow took Asher's interpretation of Munchausen syndrome and coined the term Munchausen syndrome by proxy (MSbP) when he described two cases in which the apparent symptoms of Munchausen syndrome were projected onto dependent children by mothers who fabricated signs of nonexistent illness: One woman introduced her own blood into her baby's urine sample, and the other poisoned her toddler with excessive quantities of salt." (Criddle). An offender is able to intentionally harm and endanger the health of their own flesh and blood in order to receive attention from others and go against all motherly instinct to gain self-gratification at the expense of the health and safety of an innocent child. "MSbP is a strange combination of physical abuse, medical neglect, and psychological mistreatment that occurs with the active involvement of the medical profession however, although it is a type of child abuse, the statistics and is background are different from that of regular child abuse" (Criddle).
Munchausen By proxy Syndrome is very rare within its diagnosis thus, making MSBP hard to prove. Although the condition is often characterized as "rare," lack of a standardized definition and centralized reporting repository make it difficult to quantify the incidence of MSbP...expert estimates range from 1 in a million children to 2.8 in 100,000 children" (Munchausen). "There are no reliable statistics regarding the number of people in the United States who suffer from [MSBP], and it is difficult to assess how common the disorder is because many cases go undetected" (Munchausen). This disorder highlights individuals who have mastered the skill of manipulation, allowing for the offenders to stay away from the attention of the authority and prevent their disorder from being found; thus, causing a dark areas within the statistics regarding the commonality or the rarity of Munchausen by Proxy Syndrome.
In addition, to the differences within the background of both regular child abuse
and Munchausen by Proxy Syndrome, both abuses are also different in terms of their signs, and symptoms of their abusers. "A perpetrator who abuses, can be any person who has care, custody, or control of the child at the relevant time... or anyone with whom the child has contact.... the parent or regular caretaker can be held responsible for abuse or neglect perpetrated by another; when a parent allows the spouse to physically abuse their child, or when a child is left in inappropriate care and subsequently suffers abuse or neglect" (Detecting). It is important to understand the signs and symptoms that an offender has so that as an individual you may be able to stop a child from being abused and overall save the life of that child that is not able or afraid to speak against the manipulative abuser. When it comes to abuse, there is no simple answer as to why an individual does what they do, abuse or neglect rarely occurs in clear, simple, and specific terms instead, abuse usually results from a complex combination of a range of human and situational factors within a perpetrator's life. "Adults who abuse or neglect children usually will share several of the following general characteristics... Isolation, poor self-concept, immaturity, lack of parenting knowledge and interpersonal skills, abuse substances, have unmet personal needs" (Detecting). An abuser will take the personal problems occurring within their lives and instead of internalizing this frustration or seeking help from a professional, these abusers take their issues out on their child and use abuse as an outlet to alleviate their stress, anger, and lack of selflessness. "Sometimes, people who abuse kids can show some behavioral signs... parents who abuse their children may avoid other parents in the neighborhood, may not participate in school activities, and might be uncomfortable talking about their children's injuries or behavioral problems" (Lyness).Not only does an abuser physically injure the victim but in addition, the offender prevents the child from interacting with peers and overall damages social interaction as well as the ability for the child to make peer relations. Abuse is a game to the perpetrator imposed on the child by their own self-interest. The child becomes a ploy in their mind games seeing how much they can strip away from their child and how much control they can impose on one without the fear of getting caught. A typical child abuse offender may be identified from select characteristics. The offender, "shows little concern for the child...appears unable to recognize physical or emotional distress in the child...denies that any problems exist at home or school, or blames the child for the problems...consistently blames, belittles or berates the child and describes the child with negative terms, such as "worthless" or "evil"...expects the child to provide him or her with attention and care and seems jealous of other family members getting attention from the child...uses harsh physical discipline or asks teachers to do so...demands an inappropriate level of physical or academic performance...severely limits the child's contact with others...offers conflicting or unconvincing explanations for a child's injuries or no explanation at all"(Child). Perpetrators impose the anger that is from personal problems onto the child allowing them to exploit the pain and anger that they feel by taking it out of the child for their personal gain. Many times an offender will place the blame on a child for problems that are not remotely their fault however, in the eyes of the offender the only way to gain release from their problems is by assaulting and abusing their child. In addition to knowing the signs and symptoms of a child abuser, many people want to know why an abuser abuses a child and how a human being can void all human and moral obligations in order to seek the relief of life stressors upon the innocent life of a child. "Many times, people who abuse children were themselves abused as kids. This cycle of abuse can be hard to break and can pass down for generations within a family" (Lyness). The common expression when raising a child is "monkey see monkey do", many times, a child's best and most influential teacher is their parents, meaning that if someone is raised within a household of abuse, then that is all the child will know. This in effect, increases the odds of a child raised within a house of abuse to continue what they learned on future families that they create. "Factors that may increase a person's risk of becoming abusive include...physical or mental illness, such as depression or post-traumatic stress disorder (PTSD)...Family crisis or stress, including domestic violence and other marital conflicts, single parenting, or young children in the family, especially several children under age 5... a child in the family who is developmentally or physically disabled...financial stress or unemployment...social or extended family isolation...poor understanding of child development and parenting skills...alcoholism or other forms of substance abuse"(Detecting). Now that the signs and symptoms of a child abuser has been identified, we can now move into the signs and symptoms of a perpetrator with Munchausen by Proxy Syndrome. "In MBPS, an individual - usually a parent or caregiver- causes or fabricates symptoms in a child...The adult deliberately misleads others (particularly medical professionals), and may go as far as to actually cause symptoms in the child through poisoning, medication, or even suffocation... In most cases (85%), the mother is responsible for causing the illness or symptoms" (Lyness). "Unlike the typical physical child abuser, who seeks to release his or her own frustrations by striking out at a child, the motivations of the MSbP abuser are far more complex" (Criddle). "The goal of the MSbP perpetrator is to draw recognition and positive attention to herself; she has an insatiable need for social and emotional gain that must be fulfilled regardless of the harm to her child" (Criddle). This need and craving for attention allows the perpetrator to void them of all motherly intuition to fulfill their selfish desires at the expense of the health and wellbeing of their helpless child. Along with the distinct characteristics that can identify a child abuser, an offender of MSBP also has a set of defining characteristics that are distinctive to that of its perpetrator. Characteristics of abuser include: "Is almost always the child's mother or other female guardian... Seeks medical care all the time.... reluctant for the child to leave health care and instead insists on more tests and treatments...eager to impress providers with her medical knowledge and concern for her child...Needs to be viewed as "the devoted mother."... Craves the attention and approval of medical staff; demands specialists.... Quickly becomes embroiled in unit/ department happenings including the personal lives of staff members and other patients' families" (Criddle). Although the characteristics and defining factors of a perpetrator should be known, the signs and characteristics of the victim should also be common knowledge when seeking a diagnosis of MSBP. Characteristics of the child being victimized include: "Is less than 5 years old at the time of symptom onset... Has a history of frequent contacts with health care providers... Experiences objective symptoms that are witnessed only by the mother/caregiver... Presents with multiple findings that are vague and confusing... Is not helped by standard treatments... Has a dead sibling or a sibling with a complicated medical history... Has an absent or emotionally distant father... Deteriorates whenever discharge is planned" (Criddle). Often times, MSBP will be suspected by seeing the symptoms of the patient and their interaction with the caretaker. After MSBP is suspected, authorities will keep a close eye on the victim to further the conclusion and diagnosis of MSBP. "Injuries in the MSbP child are generally more subtle than those produced in typical cases of physical abuse and they differ from the usual pattern of injuries common to child maltreatment" (Criddle). In MSBP, the offender does not want individuals to find out about their illness but instead wants the attention they receive from the sick child thus calling for more subtle and mysterious illnesses. Some of these injuries that are inflicted by the perpetrator, include: "foreign bodies, osteomyelitis, nonhealing wounds, recurrent conjunctivitis, and fractures that fail to heal are all examples of injuries that do not blatantly suggest nonaccidental trauma...suffocation is a particularly common form of symptom induction" (Criddle). Remember, the goal of the perpetrator is to manipulate health professionals into thinking they are loving mothers who are deeply concerned for their child's health thus, leading them to secretly poison and harm their child so that they continue to seek medical attention. "One would assume that abuse would stop while the child was hospitalized, that fear of discovery would dissuade further harm....however, 70% of perpetrators who induce symptoms will continue to do so during hospitalization because maintaining the child in the sick role is the only way to keep fulfilling the abuser's need"(Criddle). The need for attention is so strong, that even while the child is under supervision and in the hospital, the offender continues to jeopardize the health of the child to accommodate their sick desires. The primary distinguishing feature that differentiates MSbP from garden variety physical child abuse is the degree of premeditation that the offender takes to abuse their victims. " Whereas most physical abuse entails lashing out at a child in response to some behavior (eg, crying, bedwetting, spilling food), assaults on the MSbP victim tend to be unprovoked"(Criddle). The abuse is unsuspected and overall unprovoked and instead lead by the desire and selfish wishes of the offender. "The Munchhausen syndrome by proxy abuser is almost always the child' s mother or other female guardian, seeks medical care all the time, is reluctant for the child to leave health care and insists on more tests and treatments, eager to impress providers with medical knowledge and concern for child, needs to be viewed as the "devoted mother", craves attention and approval of medical staff, quickly becomes involved within the personal lives of staff members and other patients families... victims present with findings that are often vague, but the story is specific and usually present with an atypical illness" (Criddle). Most of the differences between a perpetrator of child abuse and an offender of Munchausen by Proxy Syndrome can be found when looking at the symptoms an abuser exhibits while the abuse is occurring. "The typical physical child abuser is commonly the child's stepfather or moms boyfriend, is reluctant to seek medical attention, pushes for early release of the child from care, is threatening, bullying, sullen, or hostile, needs to be in charge, feels threatened by medical staff and is fearful of specialists, avoids contact with staff members... the victims present with findings that are often specific, but the story is vague and usually present with physical injuries or signs of neglect" (Criddle). Along with the multitude of differences that can be identified through both offenders, both perpetrators of typical child abuse and those of Munchausen by Proxy syndrome also share some common features. "The child usually has a long history of medical visits at multiple health care facilities ("doctor shopping")... Abusers become angry and hostile when confronted with their behavior...Abusers do not accept responsibility for the child's health status....The child's condition quickly improves when separated from the abuser...Abusers may abscond with the child if they detect suspicion" (Criddle). Most the similarities found within both perpetrators surround the idea that the offender negatively affects the health of the child and does not see the wrong in what they are pursuing.
Although, a typical child abuser and a Munchausen by Proxy abuser share common traits among abuses, the differences between the two are far greater than the similarities, as differences continue on through both of the abuser's diagnosis. The conviction and diagnosis of a typical child abuser is far more simple and common than that of the conviction of a perpetrator of MSBP. The conclusion of child abuse is found based upon evidence found within the victimization of a child. "It's sometimes difficult to tell the difference between the ordinary scrapes and scratches of childhood and a physical sign of child abuse...multiple bruises or those that keep coming back, black eyes, and broken bones are certainly red flags, but other signs - like a child's emotional health - are also telling"(Lyness). The effects of child abuse are far from the physical injuries that can be seen. Instead, abuse cuts deeper than what can visually be seen. "Kids who are being abused may act withdrawn, fearful, depressed, have low self-esteem, or engage in self-harm, like cutting... have trouble developing and maintaining relationships... act out in class and are disruptive... Other kids might not act out in the typical ways, but will avoid going home after school or doing any activity that would cause them to spend time alone with the abuser" (Lyness). Being abused, has an impact on the emotional and mental health of the victim in addition to the physical scares. "Some children overcome the physical and psychological effects of child abuse, particularly those with strong social support who can adapt and cope with bad experiences....others, however, child abuse may result in physical, behavioral, emotional or mental issues - even years later" ( Child). Being a victim of abuse has lasting effects as the memories are forever inbetted within the victims mind. Often time the victim is a young child meaning that they do not understand why they are being abused and in turn will find a way to blame themselves and tell themselves that they deserve this abuse because why would the individual who is supposed to love them, hurt them intentionally without proper reasoning. "A child who's being abused may feel guilty, ashamed or confused. He or she may be afraid to tell anyone about the abuse, especially if the abuser is a parent, other relative or family friend. In fact, the child may have an apparent fear of parents, adult caregivers or family friends" (Child). Many times the abuse happens when the child is young and unable to tell anyone that the abuse is occurring meaning at a highly influential age, they are made to think that all adult interaction may lead to a heavy hand thus prompting their innate fear of adults. If a child is suspected of being abused it is important to know what to do in the situation to provide the child with safety and protection. "If a child tells you they are being abused you can encourage them to talk, remind the child that they are not responsible for the abuse offer comfort, report the abuse, seek medical attention if needed, and help the child stay safe... To further prevent child abuse, make sure to offer your child love and attention, don't respond in anger, think supervision, know your child's caregivers, emphasize when to say no, and reach out" (Child). A child deserves to be shown and cared for with love and if one cannot give a child a life of safety and love that they deserve one should look at the other options available to provide a better more suitable home for this innocent adolescent. A regular child abuser is regularly sought out and convicted within the justice system after provable evidence is in possession however, due to the rarity of MSBP, conviction strikes controversy among many as its diagnosis is hard to reach. "Diagnosis of fabricated disorders is especially difficult because clinical findings are undetectable when they are exaggerated or imagined and are inconsistent when fabricated...findings that defy simple medical explanations send health care providers down a path of "chasing zebras" in an attempt to uncover unusual conditions" (Criddle). An offender of MSbP is a master manipulator and wants so showcase the medical knowledge that they have taught themselves. The offender fabricates symptoms for the child and in turn allows the health professionals to continue walking in circles not getting any closer to finding the cure for the child, which is what the perpetrator wants as they desire to receive as much attention as they can for as long as they can. "A diagnosis of Munchausen syndrome may be even more difficult in children and adolescents...a physician may be able to recognize a pattern of symptoms (e.g., those that occur only when the child is alone or that begin only when the parent is present with the child) or the child may admit to fabricating or self-inflicting symptoms upon questioning...surveillance video may record the child or the child's caregiver inducing symptoms" (Munchausen Syndrome). Surveillance footage gives concrete evidence to the abuse that may be occurring thus allowing for the perpetrator to be convicted and removed from the care of the child. "The American Academy of Pediatrics' Committee on Child Abuse and Neglect maintains that only two circumstances need be present in order to diagnose MSbP: (1) harm or potential harm to the child involving medical care, and (2) a caregiver who is causing the harm or potential harm to happen" (Criddle) If these two circumstances are present within the evaluation of the child, the offender can be taken into custody and removed from the care of the child further, preventing the perpetrator from causing any more harm to the child. The prognosis for Munchausen syndrome by proxy (MSBP) is very poor if the child involved is left unattended and not removed from the hands of their abuser. "The overall mortality rate is difficult to assess but is thought to be between 6% and 10%; however, it can be as high as one-third when poisoning or suffocation are involved...also a high rate of chronic illness (morbidity) and death (mortality) in siblings of children with MSBP" (Edwards). "Some extreme cases have been reported in which children developed destructive skeletal changes, limps, mental retardation, brain damage, and blindness from symptoms caused by the parent or caregiver" (Lyness). The offender does not look at the future effects that may result from the choices that the abuser makes when harming the child. Instead, the perpetrator looks at the here and now and does whatever they can in the heat of the moment to further push the limits of their child's health. "The child may come to feel that he or she will only be loved when ill and may, therefore, help the parent try to deceive doctors, using self-abuse to avoid being abandoned... some victims of MBPS are at risk of repeating the cycle of abuse" (Lyness). The effects that the abuse has upon the child are long lasting causing the child to stay with the pain and memories of being abused throughout their lifespan as it is all they knew growing up in a house of horrors. "Both the diagnosis and the cure for the victim of MSbP is complete separation from the perpetrator, a total "parentectomy" (Criddle). This separation ceases the abuse of the child and also serves as a definitive facto of the diagnosis because after the parent is removed from the care of the child, the child's health is slowly restored thus proving that the caregiver was purposely harming the child in care.
Overall, the profiles of both a typical child abuser, and that of a perpetrator of Munchausen by Proxy Syndrome share commonalities within being both types of abuse and sharing the goal of getting the child to safety; however, both offenders have more differences within their overall background, signs and symptoms, and both diagnosis and prognosis. Child abuse, no matter which type, is a serious epidemic within our world and should be voiced, as a main concern for all children. With the proper awareness and overall knowledge, that is within a typical child abuser, and that of an MSBP perpetrator, the statistics and morality rate of children that are abused can start to decline, and as a society, we can save the lives of innocent children by being aware and taking action.
Works Cited
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Lyness, D'Arcy, editor. "Child Abuse." KidsHealth, The Nemours Foundation
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"Munchausen Syndrome by Proxy (Factitious Disorder)." Cleveland Clinic, the Cleveland Clinic Foundation
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