Family Members of Perpetrators

The realization that a beloved family member is committing this horrific abuse is heartbreaking and life-altering. Family members of perpetrators often feel betrayed, confused, and terrified when they begin to suspect abuse. Because many medical, CPS, and law enforcement professionals don’t receive the necessary training to understand MBP, they may feel stranded in their quest to protect the victims. Perpetrators of this form of abuse are typically highly manipulative and many people will only see the heroic mother of a sick child, causing those aware of the abuse to second guess themselves. Suspicions of abuse may be highly divisive with some non-perpetrating spouses and other family members continuing to support the perpetrator regardless of the strength of the evidence against them, and even following a conviction and prison sentence.

Important Points for Family Members

  • Medical child abuse is real and extremely dangerous if allowed to continue. It may have the highest mortality rate of any form of abuse
  • If you observe the warning signs below, you should contact the hospital treating the victim (if applicable), CPS, AND the police.
  • Professionals are often not well-informed about Munchausen by Proxy. Please refer them to the APSAC guidelines, this site, and reach out if you need help.
  • If you suspect abuse, document as much of your interaction with the perpetrator as possible, including text messages, emails, phone calls, and social media posts as these may be important evidence in a case against them.
  • When confronted, MBP perpetrators will typically deny the abuse even when presented with direct evidence. They commonly turn on anyone who suspects them. If possible, it’s best to maintain contact and avoid direct confrontation until the children can be safely removed.
  • Though family members may be concerned for the perpetrator’s well-being in addition to that of the victim’s, it’s important to understand that Munchausen by Proxy is characterized by intentional deception. Though there is an underlying disorder—Factitious Disorder Imposed on Another—it is very difficult to treat (link) and the welfare of the children must be paramount.
  • Family members often experience betrayal trauma, PTSD, and other mental health concerns as a result of the distress and chaos brought by this abuse. It’s important for family members to look after their own mental health and seek therapy as needed.
Warning Signs (via APSAC)

According to the American Professional Society on the Abuse of Children (APSAC), here are some common signs of MBP maltreatment to watch out for:

  • Reported symptoms or behaviors that are not congruent with observations. For example, the abuser says the child cannot eat, and yet the child is observed eating without the adverse symptoms reported by the abuser.
  • Discrepancy between the abuser’s reports of the child’s medical history and the medical record.
  • Extensive medical assessments do not identify a medical explanation for the child’s reported problems.
  • Unexplained worsening of symptoms or new symptoms that correlate with the abuser’s visitation or shortly thereafter.
  • Laboratory findings that do not make medical sense, are clinically impossible or implausible, or identify chemicals, medications, or contaminants that should not be present.
  • Symptoms resolve or improve when the child is separated and well protected from the influence and control of the abuser.
  • Other individuals in the home or the caregiver have or have had unusual or unexplained illnesses or conditions.
  • Animals in the home have unusual or unexplained illnesses or conditions – possibly similar to the child’s presentation (e.g., seizure disorder).
  • Conditions or illnesses significantly improve or disappear in one child and then appear in another child, such as when another child is born, and the new child begins to have similar or other unexplained symptoms.
  • Caregiver is reluctant to provide medical records, claims that past records are not available, or refuses to allow medical providers to discuss care with previous medical providers.
  • The abuser reports that the other parent is not involved, does not want to be involved, and is not reachable.
    A parent, child, or other family member expresses concern about possible falsification or high-healthcare utilization.
  • Observations of clear falsification or induction by the caregiver. This may take the form of false recounting of past medical recommendations, test or exam results, conditions, or diagnoses.

Munchausen by Proxy

(APSAC Practice Guidelines 2017)