New podcast uncovers the hidden realities of Munchausen by proxy

Seattle-based author Andrea Dunlop created a podcast that caught our ear recently. "Nobody Should Believe Me" explores the psychological condition Munchausen by proxy. Dunlop talked to KUOW’s Kim Malcolm about her journey surrounding this little-understood syndrome.

This interview has been edited for clarity.

Kim Malcolm: We're not going to be able to get close to the full scope of what you present in your series. But let me start by asking you to define Munchausen syndrome for us.

Andrea Dunlop: Munchausen is the more commonly known name for the clinical diagnosis of factitious disorder, which is when someone exaggerates, invents, or even induces illnesses in themselves for the express purpose of sympathy and attention.

You dive even deeper into that. You look at Munchausen by proxy. How is that different from the larger syndrome?

Munchausen by proxy is really a term for two separate things. One is an underlying psychiatric condition called factitious disorder imposed on another. The other is the act of medical child abuse. That is when a parent or caregiver exaggerates, invents, or induces illnesses in a child, again, with that same, intrinsic motivation of getting attention and sympathy.

What does it look like, Munchausen by proxy?

It can really encompass a pretty broad range. We see a lot of premature births and feeding issues that come after that. We see a lot of breathing issues. Seizures are another thing that comes up. Often seizures that no one else sees, except for the caregiver who is reporting it. So really, anything that would be primarily based on a caregiver’s report to a doctor.

It is really an alarming, startling condition to consider. How did you come to create this series and host the show?

I have a personal history with this topic. My sister has been investigated for medical child abuse twice. She has never been charged with a crime. I want to be sure to mention that. That first investigation happened about 12 years ago, so we have a long history with it. I wrote a novel called "We Came Here to Forget" that came out in 2019. Munchausen by proxy was a topic in that novel.

When I was doing press for that book, I met an amazing expert called Dr. Marc Feldman. He's someone we interview on the podcast. He introduced me to an incredible group of experts that's part of the American Professional Society on the Abuse of Children (APSAC.) They have a Munchausen by proxy committee. I met with them, and I'm now a member of that committee. They're really doing incredible work on this topic.

As I was hearing all of these incredible, fascinating, and harrowing stories about these other Munchausen by proxy cases, and really having these in-depth conversations with these experts, and really wanting to find a way to make their work more accessible to the public, I just thought, this would be perfect for a podcast. That was two years ago.

Part of what you explore in this series is the question of how common or how rare these cases are, which I know is part of a longer story, but what did you find in your exploration?

One of the biggest takeaways for me from doing this podcast was really the discovery that none of the experts that we talked to think that this abuse is rare. They think it's very rare that it's caught, and even more rare that there is a successful criminal conviction. But in terms of the actual abuse happening, all of the experts I talked to were unanimous that they do not think that is rare. They think it's on par with other rates of child abuse. That was a huge revelation for me.

It does leave me wondering what happens to these children. How do we hear from them?

I’ve talked to a number of adult survivors. The reality is, I don't think I've talked to a single survivor who was permanently separated from their abuser, and in most cases, they weren't separated from them at all. They usually have some recollections of some rumblings with family court at some point, or in one case that I know of, criminal investigation, but by and large victims end up being raised by their perpetrators because again, convictions in these cases are really rare.

That's another real focus that I wanted to have in the show going forward, that survivors right now are very isolated. Everyone I've ever talked to who is involved with one of these cases, whether it's a family member or a survivor, feels like they're the only person on Earth that this has ever happened to. That's something I'm hoping to remedy by bringing some of this to light.

You seem to be underlining that the systems that we have in place to detect and prevent this kind of abuse, self-abuse and child abuse, are not up to the job. Is that your understanding of the situation right now?

Yes. And again, that is from talking to all of these experts who have worked on dozens of cases over decades of time. I think the understanding of this issue is so minimal in the public sphere and in all of the systems, like child protective services, like family court—where these cases often end up either at the same time there's a criminal investigation, or in lieu of a criminal investigation—like police departments, really all of the systems that we have in place to protect children from abuse.

Those folks, by and large, do not receive any training on this abuse. They don't often even have a passing knowledge of what Munchausen by proxy is. They're not able to differentiate. One really common misconception is that this is some sort of exotic psychological disorder, and we need to have psychologists come in and diagnose, like with a mental illness. And while there is an underlying mental illness that causes people to do this, to abuse their children in this way, child abuse itself is a crime. For something like that, you need evidence. It needs to be going through the criminal courts.

So I think there's just so much confusion on what it is. If it's a mental illness, does that mean that someone is not culpable for the crime? And the answer, I should say, is no. It's not something that makes people delusional or criminally insane. I think upping that knowledge for anybody who interacts with kids is crucial because most of us interact with kids on some level.

For someone listening, and maybe a bell is ringing for them about something they're seeing in their family or someone close to them, what's a good place to start for resources on this issue?

I would send people to Munchausensupport.com. That is a resource website Dr. Marc Feldman and I put together with our APSAC colleagues. That has resources for both professionals who work with kids and also family members and survivors. That's also a great place to get in touch with us if you need help.

Editor’s note: After this interview aired, we heard from Andrea Dunlop’s sister, who told KUOW she denies the allegations that she ever abused her children.

Hear an extended version of Kim Malcolm's interview below: