Where Family court judges, attorneys ad litem, and even child protective attorneys go wrong in these cases of abuse is that they often fall into the mental health trap. To clarify this topic, lets address what this abuse is and how it’s classified in the Diagnostic and Statistical Manual of Mental Disorders, when that classification occurred, and what that classification means.
The term “Munchausen Syndrome by Proxy” was first coined by Sir Roy Meadows, a British Pediatrician who first identified this crime in a 1977 article in The Lancet which documented two cases of this abuse. Unfortunately, the term Meadow chose for the abuse has caused significant misunderstanding of a very dangerous form of child abuse. The term was meant to be applied to the child, but media mistakenly began applying the term to the criminal offender.
Even today, if you read a media article about this abuse, you will most likely not see the word “abuse” ever appear in the article. Instead the article will focus on the “mother’s mental illness.” So, is this correct? Does the offender have a “Mental Illness?” Any offender who hurts a child has something wrong with them mentally. They act outside societal norms. But are they culpable for their actions?
The most common psychological finding in these offenders, when carefully assessed by someone qualified to evaluate this specific form of abuse (read: not a standard psych test and only talk therapy), is a personality disorder (Ayoub, 2010; Bass & Jones 2011). The most common among these personality disorders is borderline personality disorder and narcissistic personality disorder. But only a very small percentage of people with these personality disorders commit this crime.
Every national expert agrees that in a normal presentation of this abuse, these offenders know what they are doing and know it’s wrong when they are doing it. The pattern of deception in the medical (and other) records indicate that they know they are falsifying the victim’s condition. They are not legally insane. They do not really believe their child is ill. This is back up in police interviews of these criminal offenders.
In these interviews, these offenders will adjust their story to information given them by the detective conducting the interview. They will first lie. If they do make admissions, they will minimize their admissions until further directly confronted with evidence, at which point they may re-adjust their minimization to fit the evidence presented, rarely admitting their entire course of criminal conduct. This behavior demonstrates a consciousness of guilt. These offenders present no differently than any other child physical or sexual abuse criminal offender.
Standard psychological testing can be the automatic position of family court judges in these cases. Unfortunately, there isn’t a “Munchausen by Proxy test.” I have personally read where a psychologist appointed by the family court wrote that a standard psychological test showed that the offender “doesn’t have Munchausen by Proxy.” That psychologist didn’t bother to conduct a full review of medical records. This result is common when a standard psychological test is given by someone without a specialty in this abuse. It’s a recipe for disaster and something that is common practice in family court. This is exactly like giving a pedophile a psychological test to see if he “has pedophilia.” The only way to diagnose this abuse is through a full medical record review, supplemented by an effective Child Protective and Police investigation. Ad litems and CPS attorneys should avoid the standard psychological test trap at all costs.
Pedophilia and Medical Child Abuse actually have many commonalities. Offenders in both abuse scenarios groom their victims. In both forms of abuse, the victim usually loves the offender and can be protective of the offender. Both these offender types can only be successfully psychologically treated if they admit their entire course of conduct (Sanders, Bursch 2019). Both engage in compulsive behavior that both these offenders choose despite the possible consequences, and both will lie to avoid discovery of the abuse and consequences for the abuse.
Factitious Disorder Imposed on Another (yet another name for Medical Child Abuse) was introduced into the DSM 5 in 2013. What does the DSM say about this abuse?: “Whereas some aspects of factitious disorders might represent criminal behavior (e.g., factitious disorder imposed on another, in which the parent’s actions represent abuse and maltreatment of a child), such criminal behavior and mental illness are not mutually exclusive. The diagnosis of factitious disorder emphasizes the objective identification of falsification of signs and symptoms of illness, rather than an inference about intent or possible underlying motivation. Moreover, such behaviors, including the induction of injury or disease, are associated with deception.” So the DSM calls this criminal behavior.
Anyone who has worked in the criminal justice system knows that mental illness and criminal behavior are not mutually exclusive. Depression (a documented mental illness in the DSM) is not legal grounds to claim an insanity defense. Neither is this behavior. Again, these offenders know what they are doing and know its wrong when they are doing it.
“But it’s in the DSM” you say? Well, it’s been in there only since 2013. The DSM 5 is the first professional psychological publication to apply a mental health diagnosis to the offender, and it did so in 2013 (this abuse was listed in the appendix of the DSM 4 as Factitious Disorder by Proxy for consideration of inclusion in future issues). Pedophilia? It’s been in the DSM since 1952 as a psychological diagnosis. Yet do we make mental health excuses for those offenders? Certainly not. If a criminal offender is committing this crime, they should be held accountable not only by family court, but by the criminal court system if the abuse rises to a criminal level. A full medical record review is required to diagnose this abuse. A separation period from the suspected abuser is also imperative for a diagnosis of this abuse. An effective CPS investigation and police investigation can uncover evidence to which the medical community does not have access. This can be extremely important evidence that can greatly strengthen evidence and the diagnosis of this abuse.