Collusion or Protection by Father and Extended Family

In two-parent families, husbands most often strongly support their wives in spite of clear evidence

Table 12-1. Common features of perpetrating caregivers and nonperpetrating partners in Munchausen by proxy

Most perpetrators are women.

Most situations involve mothers or mothering figures and their children.

Perpetrators cannot be identified by a given age, social class, or ethnicity.

Perpetrators are quite knowledgeable and competent in the care of the target child.

Perpetrators frequently have formal or informal interest in and association with the professional fields of the providers for the child (e.g., medicine, nursing, health management, laboratory technician, social work, holistic healer).

Perpetrators can quite convincingly pose as caring and knowledgeable parents.

Perpetrators often present with mixed character disorders, which require considerable diagnostic assessment to identify.

Many perpetrators have exaggerated, fabricated, or induced their own symptoms of physical or emotional illness or disability.

Nonperpetrating partners, if still in a relationship with the perpetrator, will support the stated values and beliefs of the perpetrator. In these situations, nonperpetrating partners often enable the continuation of the caring parent-sick child relationship.

Nonperpetrating partners who are separated, divorced, or estranged from the perpetrator are more likely to be able to identify the child's victimization and avoid supporting the perpetrator's stated values and beliefs about the child.

and legal findings of MBP abuse of their children. These fathers serve as messengers between their wives and their children and frequently encourage their children to support their mothers. Typically, fathers are involved only sporadically in the lives of their children; they essentially enable the abuse through passivity or collusion. These fathers are most likely to continue to support their perpetrator wives after detection, making them unreliable protectors of their children (Lasher and Sheridan 2004; Parnell and Day 1998; Schreier et al. 2009).

Fathers who are estranged from their children at the time of the mothers' abuse by pediatric condition or illness falsification are more likely to identify their wives' manipulation and acknowledge their children's victimization. They are typically separated or divorced; the wives often claim no knowledge of the fathers' whereabouts. However, with some limited detective work, fathers are usually located; they often have been paying active child support. This group of estranged fathers has been systematically shut out of their children's lives. Fathers are often willing to become reinvolved with their children if they have support from authorities and protection from their wives. Members of the extended family, particularly paternal relatives, are also often estranged and may be positive resources for care of the children (Artingstall 1999; Ayoub 2006).

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