Latest / It’s All Your Fault: High Conflict People / Navigating Concerns of Factitious Disorder: When High Conflict Distorts Perceptions
Transcript
- Speaker 1 (00:05): Welcome to, it's All Your Fault On True Story fm, the one and only podcast dedicated to helping you identify and influence the most challenging human interactions, those involving patterns of high conflict behavior. I'm Megan Hunter and I'm here with my co-host, bill Eddie. Speaker 2 (00:23): Hi everybody. Speaker 1 (00:24): We are the co-founders of the High Conflict Institute in San Diego, California where we focus on training, consulting, and educational programs and methods, all to do with high conflict. In today's episode, we're going to talk about something a little different. It's called factitious Disorder by Proxy, and this one is involving of course, high conflict. So factitious disorder previously called Munchhausen syndrome. You might've heard it called, that can be involved in many different facets of life. So we're going to talk about it in relation to child custody today. But first, a couple of notes send your high conflict related questions to podcast@highconflictinstitute.com or on our website@highconflictinstitute.com slash podcast where you'll also find all the show notes M links. So Bill, let's talk about factitious disorder. In the past, it was called Munchhausen's proxy or syndrome by proxy. And I think even in those days, not many people were very well aware of what it is, and now the name has been changed. And I guess the name change came from recognizing this as a behavioral pattern rather than an underlying psychiatric syndrome. So what's your background on this or your thoughts? Speaker 2 (01:50): First of all, my background is limited on this because there's limited examples. Fortunately, it's not a very common disorder. In fact, by looking at prevalence here and the diagnostic manual of mental disorders says that the prevalence of factitious disorder is unknown, it's got a lot of deception involved with it, and that makes it hard to find out. But I think a couple important things. First of all, they're not looking at the cause, they're looking at the behavior. The behavior is when someone wants someone else to be sick and to need medical attention and to need the parent's intensive involvement. So one of the most common examples people think of is a parent who says, my child stops breathing. Maybe this is a two or 3-year-old. My child stops breathing and needs help, takes the child to the doctor end in the hospital. And when nobody's looking, the parent smothers the child with a pillow and then the child stops breathing and they quick go, oh, the child needs help. Speaker 2 (03:10): She stopped breathing. And so what it is, is it's an imposed condition by someone who wants to have a dependent child. And this is an extreme and usually isn't related to divorce. It's intact families is where you run into it a lot. But divorce is common in these families because the parents can agree what's happening and one parent wants absolute power and control over the child. What's more common that I see in high conflict cases is where parents disagree whether a child has an illness. So A DHD attention deficit with hyperactivity disorder is a common one. One parent says, child's got a DHD needs to take medications. The other says, no, the child doesn't. Child's doing okay. Their behaviors within normal range, other types of problems, maybe asthma, maybe a mental health issue where the child's depressed. No, the child's not depressed or the child's anxious, no, the child's not anxious. Speaker 2 (04:27): So one parent thinks medication medical investment is needed and the other parent says no, it's a case by case basis. I think what you really start noticing though is if one parent really disagrees with several medical professionals coming to the same conclusion. So if several medical professionals say, there isn't a problem here and one parent keeps hunting for one that says there is or the opposite, several say there is a problem here, child needs medication, and the other parent says, my child never needs my child will tough it out. This is an interesting thing, but the extreme is really factitious disorder. Speaker 1 (05:11): Yeah, interesting. I recall a case I was involved in when I was on a licensure board and a parent in that case a mother had 11 children. I believe they had all been removed from her care because of at that time, Munchhausen's disorder or syndrome by proxy. Then she'd gone and had several more children in a different state and would take them to different doctors and new partners. Didn't even know about the previous love and children, but there was this pattern of going to a variety of doctors, sort of medical professional shopping. So we'll talk about that in a minute. So let's get to the case. So this is a question that's coming from a listener. Thank you for sending this in. It's a child custody case in which a father is concerned about and fears losing custody of his children or being accused of something terrible. Speaker 1 (06:08): In this case, the mother is aggressively seeking a diagnosis of A DHD and autism for their daughter who in all other contexts except when interacting with her mother, presents as healthy. The daughter has had a series of other medical tests and medical interventions this year that has impacted her ability to attend school and has also reduced contact with her family. The father has put up with many years of emotional abuse, but now that he can see damage being done to his daughter, he has drawn the line. However, it is a very difficult situation to navigate. The mother is well researched and when the father tries to gently suggest alternatives to trying to put their daughter on Ritalin, he is accused of it being a form of child abuse. We are all very concerned and my brother is very worried about how to carefully proceed. It is impacting his capacity to work as he's fearful of leaving his daughters for too long with his partner. So the question, the first question is how does a partner and or extended family member or entire family intervene and put the safety of the child first without making it worse or risk becoming totally alienated from the child or even worse harm, bring harm to the child? Speaker 2 (07:29): Yeah, I think in these cases, this is where professionals can be really helpful and should be used and I think actually multiple professionals so that you're getting a consensus. And so medical professionals should be considered and get second and third opinions. It's very concerning when a parent has made their own diagnosis and now they're shopping for professionals that will agree with it. I've had cases like this, allegations of child sexual abuse that everyone agrees or unfounded, other illnesses dependencies. The goal really of one of the parents seems to be having power and control over the child, which is not unusual for cluster B personality disorders. Since we talk about personality disorders here, some research has found cluster B, which is borderline narcissistic, antisocial and histrionic to be strong in the areas of domineering this vindictiveness and intrusiveness. And I think this is an example of domineering this and intrusiveness to be having the child have a lot of medical tests. And if you don't like the outcome going for more, if you've got two or three doctors agreeing on something, then I think you need to get the legal professionals involved and get the court involved if necessary to put a stop to that kind of putting the child through that. And I know of several examples where children are just constantly being tested and checked and Speaker 1 (09:21): Poked and prodded. Speaker 2 (09:22): Yeah. And so there's got to be some limits set on that. But with that said, I think with legal professionals, they really have to come in with an open mind that there's three possibilities that maybe mom is exaggerating, maybe dad is exaggerating or distorting or maybe both are. And that we can't just jump to one conclusion anymore and maybe never should have. You have to consider multiple theories of what's happening with an open mind and get multiple sources of information. So I think that's the way to go and that's what to try for. And if you can't get the other person to cooperate with two or three opinions and then work with them, then get some legal involvement to restrict, because that's one of the thing, high conflict people can't stop themselves. And that's the idea that I think you run into with this is people really need restraints who don't have self-restraint. Speaker 1 (10:33): A case such as this involves so much confusion and kind of a push pull because you want to protect your child, you want your children to be healthy If they need medical attention, of course we want to help. So you feel that pull to believe that all of this is going on, but then over time you see that it's a pattern and you are not seeing the evidence on the other side, which to me, reeks of some antisocial, that confusion that we get with the antisocial personality of not really any evidence showing where there's a lot of talk happening. Speaker 2 (11:10): Yeah. Well, first of all, I think you're right on target with saying you need to look at the patterns. What are the patterns of behavior here that starts to point you towards what's really going on? Now, I wouldn't necessarily say it's antisocial. It could be, and more likely if the person consciously knows what they're doing and they're doing it to get power and control, but say someone, say with borderline personality disorder who sees crises that other people see as normal behavior and they interpret it that way and they feel it in their gut and it's very strong, but they're wrong. So that's got to be considered. And we haven't talked much about histrionic personality disorder, but when I've given trainings to nurses, they say of all the personality disorders we see, that's the one we see the most. That goes with people being very dramatic about healthcare issues. That may be more likely what's happening in some of these cases, but ultimately it's helpful to get a psychological evaluation of the parents because you may find, especially if they do psychological testing, one of the parents may have a personality disorder that may be distorting their perception because that's part of a personality disorder is disordered perception of self, of others, and of events, Speaker 1 (12:42): Which means if they have a distorted perception, then they are honestly believing that their child has a medical problem. So that's I guess for our listeners just kind of getting that your mind's wrapped around that, that it is honestly believed typically by this individual. Speaker 2 (12:59): Right. And one reason courts need to learn about all this and understand this is the court process is one of trying to figure out who's telling the truth, but what do you do when someone truly believes something that's false? And so you can't tell by their demeanor that they're lying because they might be totally honest. And that's what makes these cases so confusing a way I feel courts really need judges, lawyers, mental health professionals, mediators need to be trained in personality disorders because they present in such a confusing way because one thing about personality disorders is that people look normal on the surface, but under the surface they have these distorted perceptions of self, others, and events. And so you can't trust that they're accurate reporters. And that's why I think psychological evaluations are helpful in those cases. And in these cases it's generally one person is having a serious problem and courts, family courts are oriented towards seeing everything as equal family systems, everybody contributes. Speaker 2 (14:19): Well, that's true in terms of communication, but it's not true in terms of behavior. That's why you have real domestic violence where the target or victim survivor isn't a cause of the problem. The other person's lack of self-restraint is the cause false allegations one person makes those, the other person is innocent of doing the things they're accused of. So it's possible it's this person possible, it's that person. And still possible it could be both. But I think that figuring that out is so important. And unfortunately, people jump to conclusions called confirmation bias and then run with that. And if you emotionally hook professionals in on your side, these problems can really go for years without really getting objectively understood. And that's what we really want to know. And when people say, well, personality disorders are pretty rare, I want to remind listeners that the DSMs as personality disorders are about people with personality disorders, about 10% of the adult population possibly worldwide. So this is something we have to take seriously, and I think that's what's happening in these cases that drives the distortion of perception of the child's illness or health. Speaker 1 (15:46): Well, let's take a short break bill and we'll be back in a moment, we'll talk a little bit more about how to speak to medical professionals and mental health professionals and maybe some other solutions around how to handle this. We'll be right back. Speaker 1 (16:08): All right, and we are back. So Bill, let's talk about speaking with medical professionals. If you're that parent that is kind of confused about this and fears losing custody of your child or even time with your child, and there's all of this medical stuff going on, how do you talk to a medical professional? Because I know a lot of times people report that they'll speak to a professional and they come off sounding kind of crazy. If you walk in and say to let's say a psychologist or even a medical doctor, Hey, I think my child's other parent has fictitious disorder by proxy. And they then go, oh, you've been Googling, you've been searching online, haven't you? And then it almost sets up a bias against you in some cases. Have you experienced this or heard this from clients? Speaker 2 (16:58): Oh yes, very much. And it's important I think, with anybody investigating or evaluating something that you don't use those technical terms because it does make it look like you're on a campaign to prove something that you're not qualified to prove. So it's best if you say, here's my concerns, here's a pattern of behavior I've seen over and over again. I saw it five years ago, two years ago this year. And these are examples. Talk about examples of behavior. Don't talk about conclusions saying, my wife has borderline personality disorder, or My husband has narcissistic personality disorder, and therefore, you don't want to do that, especially with official evaluators in your case, you want to give them the hardcore information. Here's what happened yesterday. Here's what happened last week, is the who, what, where, and when of behavior. And I'm concerned, I want your help. I need your help. Speaker 2 (18:08): I need your guidance. What's interesting is high conflict people and cluster B personality disorder, people come in and they tell professionals what to do and what to think and what's happening. My child's been abused, and you've got to protect my child from that evil other parent. No, go in and say, I don't know what's happening, but here's the behaviors my child is showing. Can you help me? Can you figure this out? And feel free to talk with the other parent if they don't want you to talk to the other parent. That's often a warning sign. Now, if they say the other parent lies a lot, and here's some examples, then I know going in to talk to the other parent to be cautious, but I found this as a mediator. When people tell me before the mediation, I meet with them each individually and they say, bill, the other person will you. Speaker 2 (19:09): They're manipulative, they're a liar, they're all these things. I always consider these three theories that may be true, might not be true at all, or maybe both people are shaky. But you've got to have that open-minded approach. But as a parent, come in, open-minded and say, I want to help my child. I'm worried because I see these specific behaviors. And that's what people need to know. And they need to know the most extreme behavior, not the chronological list of what happened in the last five years, but the worst behaviors. One of them might've been a year ago, another one a week ago, but give them the picture. What you want to do is paint the picture and let them reach the professional diagnosis of what's happening. Speaker 1 (19:58): And in a way to paint that picture is show things on a timeline, have dates or at least approximate dates this month. This happened during this year and two months later the same thing happened, et cetera, et cetera. So one last question, bill before we wrap up, and that is, should you ask your child if they really have these medical issues? Speaker 2 (20:20): I think you don't want to discuss it with the child as soon as you think there's a medical problem or a bad behavior coming from the other parent is don't be the one that's interrogating the child, is get a professional, take them to a counselor, take them to the police if you have to. But I've seen cases where a parent has had the child interviewed 25 times on whether they were sexually abused in a case that we were able to prove that the parent knowingly lied about it and that didn't happen, but 25 interviews and the child said nothing in the first two or three interviews and then started saying, guess what the mother was saying and the mother was saying it in front of the child. That's another thing. A parent should talk to a professional with the child in another room. So the child ist influenced by what the parent's saying. Speaker 2 (21:24): So these are considerations, but don't interrogate your child as soon as you have a concern. I'll just briefly mention, I've had parents that have tape recorded conversations with the child to then prove things. But don't do that. Don't even have that conversation with the child. Get them to an expert. Talk to a counselor yourself about what you see, and then get the counselor's advice. Maybe the counselor says, take it to the doctor or take the child to this specialist or a child's specialist. But don't interrogate your child to self because parents heavily influence how their children interpret what's happening to them. And so you got to be careful or you get in trouble for that. I've had people that innocently did that and then got in trouble for tape recording the child or leading the child with their questions. Leading questions suggest answers, and children absorb the questions and start believing the answers even though they never happen. So it's a very touchy area as a parent. If you're concerned about the other parent, get legal advice, go to a therapist, understand what's happening, but be very careful you're not dealing directly with the child about it and adding to the confusion and tainting the child's perspective Speaker 1 (22:54): And putting more stress on the child. So thank you Bill. All really good tips for very complicated situations. So let's look at next week. We are going to talk about something kind of fascinating that you brought up recently, bill, which is the latest research on marriage and women's thoughts about it. So send your questions to podcast@highconflictinstitute.com or submit them to high conflict institute.com/podcast and we'd love if you'd give us a like at a review. Until next time, keep learning and practicing skills, be kind to yourself and others while we all try to keep the conflict small. It's All Your Fault is a of True Story FM Engineering by Andy Nelson. Music by Wolf Samuels, John Coggins and Ziv Moran. Find the show notes and transcripts at True story fm or high conflict institute.com/podcast. If your podcast app allows ratings and reviews, please consider doing that for our show.