Is Munchausen syndrome by proxy driving kids to identify as trans? Psychiatrists answer

By Brandon Showalter, Opinion writer and social commentator Wednesday, February 22, 2023

As the debate over transgender medicalization erupts nationwide and more states pass laws banning the mutilation of adolescents' bodies, one largely unanswered question remains: Why are so many mothers trans-ing their children? 

Sometimes called “Munchausen syndrome by proxy,” the term refers to a disorder in which a parent draws attention to themselves by projecting a disease or psychological condition onto their child even though the child is not unwell.

According to psychiatrists interviewed by The Christian Post, these are indeed complex phenomena. The family dynamics and factors at play, particularly when a parent is psychologically unstable and might be trans-ing their child to gain attention, even if such cases are believed to be rare, are worthy of discussion. 

Dr. Miriam Grossman, author of the forthcoming book Lost in TransNation: A Child Psychiatrist’s Guide Out of the Madness, told The Christian Post that the terms Munchausen's syndrome and "Munchausen's by proxy" are no longer cited in professional journals. In today's psychiatric literature, these syndromes are referred to as “factitious disorders.” The by-proxy cases are factitious disorders that are imposed on another person, including the imposition of gender confusion onto children, Grossman added.

According to the medical history journal Versailus, the term Munchausen, which was used to define this mental disorder, was coined in 1951 by Richard Asher after a German man named Karl Friedrich Hieronymus, also known as Baron Münchhausen, and was based on a fictional character whose name had become proverbial as the narrator of false and hyperbolic tall tales. Such tall tales were a feature in the German writer Rudolf Erich Rapse's 1785 novel Baron Munchausen's Narrative of his Marvellous Travels and Campaigns in Russia.

“When it’s a plain factitious disorder, it’s a person who either makes up or exaggerates medical symptoms, and that may sometimes involve falsifying medical tests,” Grossman told CP.

A factitious disorder by proxy includes the falsification of physical or psychological signs or symptoms or induction of injury or distress in another person where the individual presents the victim to others as being ill or injured, she continued, adding that an example of this is putting sugar in a urine sample to present oneself as a diabetic.

Such tampering with urine has been known to happen. In 1977, British pediatrician Dr. Roy Meadow published one such account in the Lancet of a mother who had done so with her 6-year-old daughter Kay's urine to make her appear to be ill. This mother had also fed her 14-month-old son high doses of salt for the same reason. Between bouts of these attacks of sickness, the very young boy was, the doctor noted, otherwise "healthy and developing normally."

Meadow's cautiously written landmark article, "Munchausen Syndrome, The Hinterland of Child Abuse," documents that the 14-month-old ultimately died of salt poisoning and that an autopsy showed gastric erosions "as if a chemical had been ingested." 

Since that time, a body of literature has emerged on this subject and the mental disorder has been analyzed in other journals and news articles. Examples include a 2004 feature story in the New Yorker titled, "The Bad Mother," and a book published in 2000 titled, Munchausen Syndrome by Proxy Abuse: A Practical Approach. It has even been referred to in pop culture. Rapper Eminem's 2002 single "Cleaning Out My Closet" mentions being a victim of this syndrome. In 2003, the first known memoir written by a victim of this abuse, titled Sickened by Julie Gregory, was published.

This deceptive behavior that accompanies factitious disorders is evident even in the absence of external rewards. Such an external reward might be a large outpouring of sympathy and attention following a diagnosis, perhaps even generous financial assistance to help with the costs of fighting the disease. 

In October 2017, the journal Child Abuse & Neglect published an article titled “The perpetrators of medical child abuse (Munchausen Syndrome by Proxy) — A systematic review of 796 cases” that detailed the findings of researchers Gregory Yates and Christopher Bass who examined hundreds of cases involving this psychiatric condition. 

Yates and Bass found that nearly all of the abusers were female (97.6%) and about that same percentage were the victims' own mothers (95.6%). Approximately three-fourths of the abusers were married and the mean caretaker age when the child presented with some sort of illness was 27.6 years. In nearly half of all cases reviewed, the perpetrators of the abuse were reported to be in a healthcare-related profession (45.6%). And nearly a quarter of those who had medically abused children had obstetric complications (23.5%) or had histories of childhood maltreatment (30%).

Of the hundreds of cases reviewed, the most common psychiatric diagnoses documented were self-imposed factitious disorders (30.9%), personality disorders (18.6%), and depression (14.2%).

Factitious disorders are indeed admittedly strange.

“Most of us don’t want to be ill and we don’t want the people we care for to be ill. It is very odd," explained Grossman. "But the mind does some really odd things and in the case of a parent who would do this to a child, they have significant emotional problems. What is it that they’re seeking here? They’re seeking attention and validation. And they’re doing it by victimizing their child.” 

“To try and understand that you’d have to try and understand the history of the parent, who the parent is, what sort of emotional disorders they’re struggling with, what sort of inner emotional issues. Were they neglected as a child?”

While there has been growing awareness of how trans identities are spreading rapidly among youth, especially among women in their 20s, teens, and younger via a peer contagion — which was thoroughly explored in Lisa Littman’s study, titled "Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria," published in Plos One in 2018 — what has gone unexamined is if a concurrent social contagion is happening among parents of trans-identifying children. And is this spreading among a subset of parents who crave attention and claim to have a gender-dysphoric child?

At this point, Grossman believes it’s merely speculation, but that it is nevertheless a reasonable question to consider. 

“It’s fair to ask if perhaps [this is happening] among parents who are trying very hard to be what’s now being called ‘woke’ or whether a parent who is well-intentioned and who wants the best for their child but notices certain behaviors. And these days we’re being led to believe that almost anything could be related to being transgender: if a child doesn’t fit in, a child who is unhappy with their body, a child that has trouble making friends or is withdrawn,” Grossman offered. “Even the most well-intentioned parent who simply wants to help their child, it certainly may cross their mind. Maybe this (transgenderism) is the issue.”

Dr. Roger Hiatt, a child and adolescent psychiatrist based in Tennessee who is also licensed to practice in Arkansas and has an office in the town of West Memphis, is convinced there are parents who indisputably push gender ideology and experimental medicalization on their children: puberty blockers, opposite-sex hormones, and body mutilating surgeries.

Yet, from his experience, for every parent who is clearly driving this agenda with their child, there are probably 10 more who've been misled by groups such as the American Academy of Pediatrics or the Pediatric Endocrine Society, which have both rubber-stamped the “affirmation-only” model and publicly opposed state legislative efforts to curtail the experimental medical practices.

Hiatt has treated over 200 gender dysphoric patients. In the first 15 years of his career, he encountered only two such patients, both of whom were males who identified as females. In the last seven years, however, the vast majority of these patients have been adolescent girls identifying as boys.

“It is definitely true that for every case that I’ve dealt with where I felt like the parent was actively, aggressively pushing the transgender identity there are more than 10 [parents] who are either neutral or very ambivalent about the whole process,” Hiatt recounted in an interview with CP.  

“The impression is being portrayed that there is an absolute consensus in the medical community that ‘gender-affirming’ care is the only option that would be appropriate in dealing with a kid who, from the moment they identify themselves as gender-questioning or even transgender then immediately the process unfolds to socially transition them followed by puberty blockers, followed by cross-sex hormones, followed by surgery.”

But despite corporate media repetition, this supposed consensus is “absolutely not” a shared view among most doctors, he insists. 

“It’s difficult to attribute motive to a parent in terms of why they do what they do. In terms of a child who is questioning or being actively encouraged to pursue a transgender lifestyle and identity, in my experience those situations, the typical scenario is a mother who encouraged it,” Hiatt said. 

The psychiatrist told CP he once saw a case where the parents were divorced, the mother was aggressively pushing the child's trans identity, and the father was adamantly against it. Although they had joint custody, social institutions such as the hospital and the public school system were actively siding with the mother’s stance that the child must identify as the opposite sex. 

Hiatt has seen several patients who have what he described as “medicalized presentation” where a parent — often the mother but it could be either — has been actively inducing or doing things that result in the child needing medical care. The parents who present with this get a “secondary gain,” the benefit of being a parent of a child in medical distress.

These dynamics can also present as gender confusion. 

“Once the child has been identified as gender dysphoric or transgender, there is a huge push in much of the medical community to medicalize that child, to address the issue with medical interventions,” he said. “It basically locks in both child and parent to a patient role or the parent of a patient role. And not only for the parent but also for the child there is a secondary gain from that: feeling important or different, unique or special. That absolutely is a factor, not in every case, but in many cases.”

When asked how factitious disorders develop in people and why a parent would want to impose a medical condition on their child, Hiatt stressed that there is an unmistakable delusional component that cannot be ignored. 

“The notion that any intervention or group of interventions can actually change a boy to a girl or a girl to a boy is an absolute lie. It’s not even possible. All that can be done is that society can be compelled to treat the patient a certain way. Interventions can take place that can cause physical changes to the body to make the individual appear a certain way. But in the end, it does nothing to the individual chromosomally and they continue to require medical interventions for the rest of their lives if they choose to continue to portray themselves this way,” Hiatt said. 

“In terms of where [factitious disorders] come from, it’s multi-factorial. There is almost universally psychological trauma or abuse, depression, anxiety, other mental health issues and concerns that are in the child and typically in the parent as well that in some regards where they feel like ‘Wow, I’ve found a solution to all my problems.’"

Some prominent institutions pushing medicalized gender transition assert that a child will be better off after experimental drugs are prescribed or a patient undergoes sex change operations. Yet because of the distinctly delusional component of the parents' minds, they genuinely don’t feel like they are doing anything wrong. Indeed, they actually do believe they are helping their child. 

Prior to finishing his psychiatry training, Hiatt gave a grand rounds presentation on a condition called Folie à deux, a French phrase meaning “folly of two,” and it is what is known as a shared delusional disorder.

The disorder, first conceptualized in 19th century French psychiatry by Charles Lasègue and Jules Falret, is also known as Lasègue–Falret syndrome. The condition is similar to and equally as unusual as those who believe that their child was born in the wrong body. This rare disorder produces similar social dynamics seen in families with children mired in gender confusion. In this shared delusion disorder, the inducer who has a psychotic disorder operates as the primary actor influencing another person or possibly more, the secondary actors, with delusions based on that delusional belief.

In 2021, Hiatt provided expert testimony in support of Arkansas' Save Adolescents from Experimentation (SAFE) Act, which prohibited prescribing puberty blockers, opposite sex hormones, and performing body mutilating sex-change surgeries on youth who are 18 years old or younger. The bill passed overwhelmingly through both chambers of the state Legislature only to be vetoed by then-Gov. Asa Hutchinson. The Legislature subsequently overrode his veto. 

Mere weeks later, as was expected, the American Civil Liberties Union filed a federal lawsuit against the state on behalf of three trans-identifying youth, asserting that the law was unconstitutional. The law is currently being litigated in the courts. Breaking with Hutchinson, then-Arkansas Attorney General Leslie Rutledge, who is now the state’s lieutenant governor, stated that she would defend the law in court. 

At the state level, Hiatt firmly believes that laws such as the SAFE Act are necessary and vitally important. Nationally, however, he thinks medical malpractice lawsuits in coming years will probably be required and more effective as many of those who steer children down this destructive path will be reluctant to do so if they know that it will likely result in serious personal financial losses.

The medical establishment in the U.S. has, by and large, adopted and advanced what has become known as the "Dutch protocol."

As CP reported in 2018, the first thorough study of the drug Triptorelin used as a puberty blocker on a child who was suffering from gender confusion was published out of the Netherlands in 1998 when a pediatric endocrinologist, together with a psychologist, decided to use the medication on a 13-year-old patient.

The rationale was that the 13-year-old should have the drug because the effects of going through puberty would be too traumatic to endure and "pausing" those signals in the brain would give the child time to adjust and then later decide whether to have a series of sex-change surgeries. This approach migrated across the Atlantic in the following years and guidelines favoring the "gender-affirmative" approach became widely accepted within prominent U.S. hospitals and in professional societies such as the American Academy of Pediatrics and the Endocrine Society. The first pediatric gender clinic in the U.S. opened in 2007 in Boston, Massachusetts. 

Yet even pioneers of the Dutch protocol, such as Dr. Thomas Steensma, have in recent years criticized the approach of the American medical establishment, noting that the group of young people who doctors in the Netherlands treated in its earlier years was much smaller. 

“Where does the large flow of children who have suddenly registered for transgender care since 2013? And what is the quality of life like for this group long after sex change? There is no answer to those questions,” Steensma said in 2021. 

“The research on the small group of people from before 2013 may not apply to the large group that there is now. We conduct structural research in the Netherlands. But the rest of the world is blindly adopting our research. Every doctor or psychologist who engages in transgender care should feel the obligation to do a good before-and-after measurement.”

Likewise, Dr. Annelou de Vries, who was part of the same Dutch Protocol collaborative, stressed in an October 2020 commentary for the AAP Pediatrics journal, adolescents with recent-onset gender dysphoria who had no previous no childhood history of gender distress, were not part of their study protocol.

Grossman, who was also interviewed by Matt Walsh in The Daily Wire film “What is a Woman?” notes that her greatest distress is seeing the victims of this mass experiment. In that film, she explains that she received a phone call from a mother whose 14-year-old daughter had been prescribed puberty blockers and, as a result, was dealing with osteoporosis, an ailment that causes brittle bones and is common in senior citizens, not adolescents. 

“And we know about the kids being victims but I feel like we don’t talk about the parents being victims,” she said soberly. 

Something else is at work, she believes, and that’s a pervasive and sinister anti-male sentiment that indelibly contributes to young boys suffering confusion over their sex.  

“Now, I’m not minimizing women who have been treated badly, abused or worse, by men,” Grossman was quick to add, “but overall, there has been a war on men and on boys.”

“We sometimes find that there is a mother who really has a hatred or deep resentment of men because of things that she has gone through earlier in her life. And that without even realizing it she can influence her son to have that same negativity about being male. Children want to please their parents. And more than anything else, children want their parents’ love. And it’s not impossible that a boy might pick up on his mother's animosity toward men and feel like, ‘Oh, I don’t want to be like that.’”

“The boys might be overhearing conversations with the mom, with friends or relatives or what have you. Anti-male kind of stuff and that does not help the boy’s identity of himself as being a male,” she continued.  

“That does not help.”