Munchausen by Proxy Abuse Involving Adult Victims
There are very few published reports on adult victims of Munchausen by proxy abuse (MBPA). Such cases may be especially hard to detect, because we expect adult victims—who are usually dependent adults or the vulnerable elderly—to have some ailments that can then be misunderstood as authentic and spontaneous, rather than falsified or induced. Of course, even in clearcut cases, health care professionals and others may not be academically inclined and choose not to write and publish about the adult cases they have indeed encountered.
- The psychological rewards for the perpetrators appear to be largely the same as when the victim is a child. Among the most salient are the positive attention and unconditional support as the apparently indefatigable caregiver of a person whose aliments are severe and defy diagnostic evaluation.
- As with child victims, unusual or multiple problems are generally evident. These unexplained ailments often lead to repeated unwarranted investigations and hospitalizations. The perpetrator is almost always female and the principal caregiver for the victim. A significant proportion have a background in healthcare. The diagnosis often hinges on strong circumstantial evidence, rather than on direct observation of abuse and/or neglect.
- Improvement on separation from the suspected caregiver is a cardinal sign of likely abuse for both children and adults.
- When reasonable suspicions of MBPA with adult victims arise, it is vital to identify local procedures for protection of vulnerable adults. Cases should be reported promptly to relevant services before the perpetrator is confronted, so that a safety plan for victims (and sometimes for the perpetrator) can be put in place. The patient should be followed over time to counter the skepticism that almost inevitably creeps into these cases as they proceed through protective services and/or law enforcement, as well as during steps involving any medical reassessment.
- The patients themselves should be questioned directly about their problems whenever possible, though most of these patients are unaware of the maltreatment.
- Health care providers can unwittingly perpetuate the MBPA by treating caregiver-induced pathology as legitimate. Awareness of this variant of MBPA and early diagnosis can prevent or reduce so-called iatrogenic complications caused by overzealous or misdirected medical intervention.
