Nobody Should Believe Me
Case Files 10: The Psychology of Perpetrators with Dr. Cathy Ayoub
Thu, 26 Dec 2024
In this last bonus episode before our season 5 premiere next week, we’re airing Andrea’s conversation with Dr. Catherine Ayoub, an associate professor at Harvard Medical School, APSAC member, nurse practitioner, and counseling and consulting psychologist. Cathy tells listeners about her background and first encounter with Munchausen by Proxy. She and Andrea chat about the different groupings of perpetrators and the characteristics/background that may signal that an abuser can be rehabilitated. Cathy dives into family dynamics, and her current study on the long-term effects of this abuse. *** Links and Resources: More about Dr. Cathy Ayoub: https://www.childrenshospital.org/directory/catherine-ayoub Preorder Andrea and Mike’s new book The Mother Next Door: Medicine, Deception, and Munchausen by Proxy Click here to view our sponsors. Remember that using our codes helps advertisers know you’re listening and helps us keep making the show! Subscribe on YouTube where we have full episodes and lots of bonus content. Follow Andrea on Instagram for behind-the-scenes photos: @andreadunlop Buy Andrea's books here. To support the show, go to Patreon.com/NobodyShouldBelieveMe or subscribe on Apple Podcasts where you can get all episodes early and ad-free and access exclusive ethical true crime bonus content. For more information and resources on Munchausen by Proxy, please visit MunchausenSupport.com The American Professional Society on the Abuse of Children’s MBP Practice Guidelines can be downloaded here. Learn more about your ad choices. Visit podcastchoices.com/adchoices
Chapter 1: What is the focus of Andrea's conversation with Dr. Cathy Ayoub?
When you think of children with chronic illnesses or even with acute, the most common illnesses that actually lead to serious injury or death in children, Munchausen by proxy is way up there. And it's primarily because of the children who are being suffocated. Although there were also several children in this study who died of chronic intestinal problems because they were just so debilitated.
And I've also seen, sadly, I've seen young adults, 21, 22 year olds, I get a call from their internist, what can you do? I think this mother's making this young woman sick or this young man. And at that point, there are no protections. Anyway, I haven't gotten off the topic there.
No, no, no. All of this is on the topic. And I mean, that's really fascinating. And I'm sort of, as you're talking, I'm sort of triangulating the various cases into like those three groups. So the 45 families that you studied, those were not all suffocation cases, right? Those were a variety of flangellum by proxy cases. Okay.
They had a variety of different kinds of problems, GI disorders, asthma. myocondrial disorders, seizures. I mean, I have a list. I could even read it off for you. I think we saw a little bit of everything. Poisoning. We did have some apnea or suffocation cases.
And we also had 10% of the cases were cases in which the illnesses that were being fabricated, exaggerated or induced were psychological or psychoeducational. So it was either they were seen in schools or they were being seen by mental health professionals. So we were able to identify that as a form of victimization as well.
I think medical child abuse is a helpful terminology for some pieces of it. But I actually really have come to appreciate sort of just the descriptor of Munchausen by proxy abuse because of exactly what you said. We see in so many of these cases, even if there are those, you know, really the life-threatening elements are more the poisoning, the suffocation, that kind of thing.
the starvation in some cases the the it also extends to this you know emotional abuse and psychological abuse and educational abuse and it really like in some cases it's really only taking place in those um in those arenas and it's still extremely harmful and leaves lifelong wounds whether they're physical or not exactly and that's my problem with the term medical child abuse
We tried to craft a term back in 2002. And I think it was too complicated, but it was child abuse by illness falsification. And we really said illness or condition falsification so that it wasn't just physical abuse. But I think this is still a struggle. And unfortunately, the term medical child abuse is
is a great one for pediatricians, but it doesn't differentiate the dyadic nature of Munchausen by proxy, which there's a diagnosis for the parent, there's a diagnosis for the child and you put them together and that's Munchausen by proxy. And unfortunately in our healthcare system, you can't have a dyadic diagnosis.
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Chapter 2: How did Dr. Ayoub first get involved with Munchausen by Proxy?
And we had 43% of the children that we saw in this study that remained in temporary placements. So not having a permanent placement with people who care and love you is critical. And they were in long-term limbo. And I think that just did
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such a strong sort of splitting that the perpetrators do that like if you are that person who has quote taken their child I think something that I've come to understand about perpetrators of this abuse is listen if someone will do this to their child There are not limits on this person's behavior and they are going to, you know, take everyone down with them. Like they will keep fighting.
I mean, I just, you see this all the time, right? They will bankrupt whatever family members are supporting them in court. They will.
I mean, they will just sort of, I remember when I was talking to one of the dads who presented with us at the APSAC conference and he made a great, Brian is his name, and he made a great, I wish I could remember it word for word, but he made a great analogy where he's sort of like, you know, what people don't understand about dealing with someone like this is you're like,
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