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Tables of Contents for Practical Aspects of Munchausen by Proxy and Munchausen Syndrome Investigation
Chapter/Section Title
Page #
Page Count
Dedication
v
2
Foreword
vii
2
Preface
ix
4
The Author
xiii
2
Acknowledgments
xv
PART I Identification of Standards
1
42
1 Understanding the Complicated Domain of MBP
3
40
Mental Illness Defined
4
1
Munchausen Syndrome Defined
4
1
Munchausen by Proxy (MBP) Defined
5
1
MBP Behavior Is Not Independently Considered Mental Illness
5
1
MBP As Child Abuse
6
2
Offender Benefit As Definitional Predicate
8
1
Similar Yet Distinctive
9
3
Neglect
12
1
Alternative Answers to Unexplained Behavior
13
5
Somatoform Disorder
14
1
Malingering
14
1
Malingering by Proxy
15
1
Cyclic Vomiting Syndrome (CVS)
15
2
Florence Nightingale Syndrome
17
1
Cinderella Syndrome
17
1
M.A.M.A.
18
1
The History of Munchausen by Proxy
18
4
Category Identification of Munchausen Syndrome and MBP
22
4
Simulation
22
2
Production
24
2
Presentation of MBP Identified Illnesses
26
2
Poisoning
26
1
Suffocation
27
1
MBP Warning Signs
28
2
MBP Indicators
28
1
MBP Behavioral Warning Signs
29
1
MBP Screening for Families of Suspected MBP Offenders
30
5
Suggested Screening Questions
30
1
Frequency and Reporting of Cases
31
1
Reporting Tendencies
32
1
Medical Personnel
33
1
School Resources
33
1
Fire and EMT Personnel
33
1
Guardians
34
1
Home Health Care Workers
34
1
Victimization Location Preferences
35
1
MBP Case Resolution Factors
35
2
Mobility Factors and Trends
37
1
Conclusion
38
5
PART II Characterization of the Munchausen Family
43
26
2 Profiling
45
24
The MBP Offender
45
8
Recognition and Obstacles
46
1
The "Great Pretender"
47
1
Victim/Offender Roles
47
1
Offender Occupations
48
1
Typical Offender Traits
48
2
Profile of a Potential MBP Offender
50
1
Back to the Future
51
1
Categorization of MBP Offenders
52
1
Professional MBP Offenders
52
1
The MBP Victim
53
9
Victim Profile
53
3
Victim Conditioning
56
1
"Two Combine to Make One"
57
1
Recognition of Victim Testimony
58
1
Sex and Age of MBP Victims
59
1
Victim Mortality
59
2
Common Traits Found in MBP Victims
61
1
Siblings of MBP Victims
61
1
The MBP Offender's Non-Offending Spouse
62
4
How the Non-Offending Spouse Fits into the Sequence
62
1
Determination Considerations
62
1
Seeing is Not Believing
63
1
Absentee Non-Offending Spouses of MBP Child Abusers
64
2
Conclusion
66
3
PART III Comprehension of Thought
69
28
3 Understanding Munchausen and Gaining Entry into the Realm
71
26
A General Understanding of Abuse
71
2
The Unique Sphere of MBP Behavior
73
1
"Believe It or Not"
74
7
Envisioning MBP and Munchausen Syndrome
81
2
How Does Society Enable MBP Victimization?
83
3
FITS MBP
83
2
Victimization Pathways
85
1
Control Factors
86
1
The MBP Reactionary Gap
86
1
Recognizing What You See
87
1
The Sphere of Victimization Methodology
87
1
MBP Offender Typology Categorization via Action
88
1
Subtle Indicators of Guilt
88
1
MBP/Munchausen Syndrome as Punishment
89
3
Eating Disorders
92
2
Clinical Definitions
92
1
Similarities Between Eating Disorders and Munchausen Behavior
93
1
MBP Fact Sheet
94
3
PART IV Application of Knowledge
97
54
4 Assessing the Lethality of the MBP Offender
99
16
Lethality Links
99
1
MBP Continuum with Probable-Cause Escalation Sequences
100
3
Intelligence Information
103
1
Intelligence/Interview Questioning
104
3
How Dangerous is the Offender of MBP Child Abuse?
107
2
The MBP Continuum
109
1
Likelihood of the Victim's Death
109
1
The Harsh Reality
110
1
Intentional Torture
111
1
Multiple Victims of MBP Abuse
112
3
5 False Reports and Serial Victimization
115
16
Review and Expansion of MBP/Munchausen Syndrome Understanding
115
1
Munchausen Syndrome within Criminal Victimizations
116
1
MBP/Munchausen Syndrome Transference: The Police Connection
117
4
The Involvement of Police Personnel in the Munchausen Snare
121
2
Gravitation
123
1
Identification Indicators
124
1
The Importance of Attention
125
2
Police Personnel as MBP/Munchausen Syndrome Offenders
127
2
Conclusion
129
2
6 Interviewing the Munchausen-Related Offender
131
20
Preparation
132
1
Application of Miranda
133
1
The Challenge of an MBP Interview
133
2
Reactions of the Offender
135
5
Does the Offender Enjoy Being Caught?
140
2
Intellectual Levels
140
1
The Shell of Protection
141
1
Portrayed Multiple Personality Concerns
142
1
Fantasy vs. Reality
143
1
Suggested Interview Dialogue
144
2
Hidden Admissions
146
1
Investigative Observations
146
2
MBP Offender Confrontation/Interview Techniques
148
1
Procedural Summation
148
1
Interview Tips
149
2
PART V Stabilization of Theory
151
84
7 Crime Scenes and Evidence Procedures
153
38
Evidence by Definition
153
1
The Crime Scene
153
2
Tangible Evidence
155
5
Common Evidence in the Hospital
155
1
Poisoning Cases
156
1
Temperature-taking Discrepancy
157
1
Suffocation/Asphyxiation
157
2
Alcohol Poisoning
159
1
Video Tape
160
16
Covert Surveillance
160
1
Search Warrant Affidavits (Video Surveillance)
161
9
Search Warrant Affidavit/Premises
170
1
Covert Video Installation Logistics
170
1
Video Surveillance--Child Protection Application
171
1
Fruits of an Evidentiary Search Warrant
172
1
The Expert Arrest Warrant
173
1
Sequential Order
173
2
Definitions
175
1
The Paper Trail
176
3
H.I.D.E.
176
3
Organization of the Case File
179
1
Souvenirs/Trophies
180
1
Intangible Evidence
180
1
Evidencing Opinion
180
1
Expert Testimony
181
1
How does the Action of Exposure Affect the MBP Offender?
181
1
Infliction Triggering Mechanisms
182
1
Multiple Suspects and Victims of MBP Behavior
183
1
Unexplained Blood Loss
184
1
Repetitive Ailments/Recidivism Issues
184
1
Weekly Observation Report
185
1
Anonymous Correspondence
186
1
Victim/Offender Seclusion Data
186
1
Child Neglect Evidence
186
1
MBP Evidence Collection Tips
187
1
Conclusion
188
3
8 The Multidisciplinary Approach to Case Management
191
20
Organizational Diversity
191
2
Defining the Multidisciplinary Team
193
4
Recommended Team Members
193
1
General Team Data
193
2
Staffing
195
2
Leadership Considerations
197
1
Why is a Protocol Necessary?
197
1
The Uniqueness of MBP Victimization/Protocol Understanding
198
2
Effects of Community Involvement
200
1
Developing a MBP Case Management Protocol
201
1
Education
201
1
Preparation
201
1
Cases that Don't Meet MBP Criteria
202
1
Obstacles to Effective Case Management
203
1
Standardized Problem-Solving Chronology
204
3
Problem Definition
204
1
Directional Responsibilities
205
1
Action Plan
205
1
Participatory Understanding
206
1
Conclusion
207
1
MBP Investigative Checklist
208
3
9 Child Protection
211
24
The Role of the Child Protective Case Worker
211
2
Assessment of Risk
213
1
Unique MBP Intervention Methodology Risk Factors
214
4
Enabled Relocation
214
3
Upscale Victimization
217
1
Inadequate Monitoring
217
1
Inherent Risk Factors in Cases of MBP Victimization
218
1
Victim Safety Planning in MBP Investigations
218
5
Child Safety Guidelines
219
1
Investigative MBP Victim Survival Strategies
220
3
Arguments for Termination of Parental Rights in MBP Cases
223
2
Classic versus Extreme MBP
223
1
MBP Strength Despite Deterrents
223
1
Recidivism
224
1
A Prosecutorial View of the Termination of the Parental Rights
225
1
Custody of MBP Victims and their Siblings
226
1
Hazards of Appointed Family Care for MBP Victims
226
2
The Guardian ad Litem
228
1
Visitation Issues
228
1
Development of a Case Plan in MBP-Related Abuse Cases
229
1
Conclusion
229
1
Recommended Child Protection Procedures
230
5
PART VI Master of Deception: Diversity of the Munchausen Theme
235
88
10 The Chronically Ill Child Caught in the MBP World
235
14
Prenatal Knowledge and Actions
237
1
Fetal Murder Premeditation Potential in MBP Cases
238
2
Linking Action to MBP Behavior Through Motivation
240
1
The Threshold of Homicide
241
1
The Non-Offending Parent's Contribution to MBP-Related Homicide
242
2
Case Flow of MBP Child Victimization (Chronic Illness Variable)
244
1
Homicidal Actions Involving Chronically Ill Children Reviewed
245
2
Non-Offending Parental Reactions
247
1
Non-Offending Parents as Victims Additional Parental Stressors
248
1
Parental Disassociation
248
1
11 The Unseen Murder of Children
249
30
MBP as a Homicidal Agent
249
1
Intentional or Accidental Act
250
1
Premeditation Factors
250
2
Law Enforcement Stakes
252
1
Death as a Means of Proof
253
2
Multiplicity: A Potential Pool of Victims
255
1
Hidden Historical Homicides: SIDS or MBP?
256
1
The Serialization of MBP Abuse
256
1
Exhumation Orders
257
6
Sudden Infant Death Syndrome (SIDS)
263
1
Key Points Relative to SIDS and MBP
264
2
Potential SIDS Risk Factors
266
1
An Investigatory Team Effort
267
1
Correlating MBP/SIDS Criteria
267
2
Death Origination (Root Causes)
268
1
The Incorrect Labeling of MBP in Child Abuse Cases
268
1
SIDS Outreach Contacts
269
1
MBP in the Index of Homicide Causation
270
2
The Comportment of Murder
272
1
Indirect MBP Offender Implications
273
1
Why Kill?
274
1
When a Parent is Suspected of Killing a Child, but the Spouse is Responsible
275
2
Specific Vehicles of MBP Death
277
2
12 Alternative Victimization
279
12
The Medical Staff
279
1
The Premier Medium
280
1
Hospital Deception and Insurance Fraud
281
2
Public Trust: The Fraud, the Money, and the Know-How
283
1
The MBP Offender's Relationships with "Celebrities"
284
1
Assistance of the Media
285
1
Skill of the Offender versus Caution of the Law
286
2
Lawsuits
287
1
The Betrayal of Man's Best Friend
288
1
Conclusion
289
2
13 MBP as a Defense in Sexual Battery Cases
291
12
False CSA Accusations: The Effect upon the Child
292
1
MBP as a Sexual Abuse Defense
293
1
Parental Abduction, Sexual Abuse Allegations, and MBP
294
1
Differentiation Between MBP and Child Sexual Abuse (CSA)
295
2
Commonalities of both CSA and MBP Victimization
297
1
Reasonable Doubt--Munchausen and Case Building
297
4
Conclusion
301
2
14 The Significance of Fire in MBP and Munchausen Syndrome Cases
303
20
Arson Detectives and Criminal Investigators: The Mini-Team Concept
303
2
Investigative Interviews: Children and Fire
305
2
Children and Trust
305
1
Environment of the Interview
306
1
The Parents of Adolescent Burn Victims
307
1
The Demand of Observation
307
1
Emotional Factors
307
1
Accepted Norms and Media Influence
308
1
Witnesses in Burn Injury Investigations
309
2
Ritualistic Abuse by Fire
311
1
Gauging Parental Response
311
2
Investigation of Accidental Burn Injuries
313
1
Using Fire Within the World of MBP
313
1
Significance of Fire
314
1
The Gratification Scale of MBP Arson
315
1
"By the Hand of God"
316
1
The Factor of Repetition
316
1
Gathering Intelligence in Potential MBP/Munchausen Syndrome Related Arson Cases
317
3
Interview Tips for Children Involved in Fires
320
1
Conclusion
321
2
PART VII Principles of Engagement
323
20
15 The MBP Prosecutive Stance
325
18
The Status of Exclusion
326
1
Barriers to Effective Prosecution of MBP Child Abuse
327
1
Offender Accountability
328
2
Prosecution Strategies
330
1
Case Presentation
331
1
Refutable Defense Standards
331
1
The Use of Expert Testimony
332
1
The Insanity Defense
333
1
Case Law
334
2
Other Case Law
336
1
Education of Judges
336
2
Sentencing Tendencies
338
3
Epilogue
341
2
Index
343