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M?nchhausen Disorder 'biproxy' (by Proxy)


I am afraid my sister is harming my niece and nephew. However, from what I have seen and read the attack is usually by introducing false illnesses. My sister has had her 7 yr old on three mental medications for over 2 years. The child is like a zombie on the medication. I also have a boy the same age, and have never noticed any thing more than him just being a little boy. She has already lost custody of her daughter, and when she does have visitation their is always some major drama that ends up with a trip to the courthouse or hospital. She claims that her daughter is abusive and has even falsely accused her of sexual assault on her younger brother. It seems she is always looking for something to get sympathy and attention. Is is possible that she may have this problem, and how do you report it?

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Though what you are describing is a recognized form of mental disorder, a more simple way to think about what might be happening is that it results in child abuse. It is not a crime to have a mental issue; it is a crime to harm children. If you have to report this situation as child abuse, one of the best places to do that would be to contact your local Child Protective Services (CPS) government agency. A list of child abuse reporting contact telephone numbers by state is provided here. Such agencies exist in every major city and most minor ones (or exist at least at the county level). CPS agents, who are generally social workers, are charged to investigate allegations of child abuse and to intervene if necessary to prevent abuse from becoming ongoing. In practice, these agencies are almost always underfunded, and they intervene only in the worst scenarios, and with younger children. Older children tend to get written off. It’s not a perfect system by any means but it is what we have here in America.

Let’s talk about Münchhausen Syndrome, or Münchhausen’s Disorder for a moment. This is the popular name for the condition. the actual recognized name within DSM is Factitious Disorder. As you are aware, there are two types. There is Factitious Disorder by itself and Factitious Disorder by Proxy. (I liked your rendering of the term as "biproxy"; it reminded me of baking soda (sodium bicarbonate). Don’t worry about that, please, it’s an easy mistake. I’m someone who for years thought that the university in Baltimore was named after a guy named John Hopkins!

Factitious Disorder occurs when someone intentionally harms themselves in order to make themselves sick and get medical attention. It is not an attempt to get out of work, or get money or anything crass like that. It is purely about desperately wanting to be a patient.

When Factitious Disorder by Proxy occurs, the injuries are inflicted on a third party (often a child), and the motivation is thought to be vicarious as the sick role is assumed by someone the person is identified with but who is not themselves.

I can’t really say if your sister fits this pattern of Factitious Disorder by proxy. There are very plausible alternative explanations that could be made. For instance, she may have some other mental issue occurring which has altered her judgment, resulting in her treating her children as you have described. She may have no diagnosable issues at all and you and she simply disagree on what is best for her children. Given that something she has done has resulted in her losing custody of her children, and how you describe her as being very dramatic (often an indication of a personality disorder) I’m more liking my first alternative explanation over my second one, but still, I have no basis for making any real determination.

Keep in mind that your sister cannot prescribe her child medications on her own. She would have to get a doctor’s buy-in before this could occur. Probably the child has been diagnosed with either ADHD or Bipolar Disorder, both of which tend to be over-diagnosed, IMHO, and both of which are treated medically with drugs that alter behavior. Granted, diagnoses are not always made appropriately, and not all physicians know what they are doing with psychiatric medications, but still, if this is really a case of abuse, then the doctor is to blame more or less as much as the mother. What you’d want to see is a re-diagnosis by a physician who actually is good at understanding the particular problem which is suspected of being present, if that is the case.

It’s not a good position you’re in, I don’t think. You may be entirely justified in your fears (I hope not but I’m sure you’re responding to something that isn’t right), but your real ability to act is limited. You are not the parent or guardian. You can make a report to CPS, and you can even do that anonymously, but that is about what you likely can do. If your sister finds out that you reported her, that won’t do wonders for your relationship (or your ability to make contact with your nephew and niece either). Good luck figuring this out.

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