Mother in law has anorexia, but does she have Munchausen Syndrome as well?

[worried_about_mom]

I've recently moved my mother in law in with me to take care of her. She suffers from diabetes, gastroparesis and anorexia nervosa. (Her anorexia was not a result of the gastroparesis, she has had it for over 24 years.)

At first when I moved her I thought that I could help my mother in law (who I will call Alice) with her eating disorder since I recovered after eight years of bulimia. However, I've come to accept that she tells me that she is eager for my help and she listens to me when I talk to her about these things. But she never changes or makes an effort to change any of her habits.

At first I was frustrated and it made me want to work harder to help her. Now I've come to terms with the fact that she probably isn't even listening to me despite the fact that, more often than not, she seeks me out to have these talks about her disorder. She has a psychiatrist who was appointed to her by the state (not a very good one in my opinion) and many, many doctors who are telling her the same things.  Half the time I end up pleading with her to talk about her anorexia with her psychiatrist or to call the nutritionist that her endocrinologist has been trying to get her to call (even going so far as to have the nutritionist call the house, calls which Alice never answered).

She has been able to hide her anorexia from her doctors because they think it is a result of her stomach issue. (She is a very clever liar. I've caught her deceiving me several times about seemingly unimportant things) However, I know how much Alice eats on any given day. How is it possible that her blood sugar sky-rockets sometimes despite the fact that she hasn't eaten anything? She takes insulin shots (which she insists upon administering herself) and last week after she took a shot she was laying in bed for 5 hours in a near diabetic coma. I did not know this was happening, she didn't tell me that her blood sugar reading was in the low 60's after her insulin. I was angry that she didn't tell me because she knows that a reading that low is very dangerous and she should have (at the very least) drank a glass of her juice. Then I started to wonder if she wanted me to find her laying in her bed in a coma so that I would call an ambulance....

Okay, so now I get to the point of all this and I hope that you wont think that I'm picking on a sick old lady (first of all, Alice is not old, she is 45. The same age as my oldest sister.). I'm just worried about my future children living in the same house as her.

I told my husband about my suspicion about whether she purposefully gave herself too much insulin and ignored her low blood sugar reading for attention. He confessed to me that he believes that his mother has Munchausen Syndrome. He remembers a time when he was about four years old he was playing in his mother's room. They were playing a game where he would jump off of the bed into his mothers arms and she would toss him back onto the bed. Only one time after his mother tossed him onto the bed she sat on top of him, straddling his body, and pushed a pillow down hard on his face so that he couldn't breathe. He was too strong for her and he wiggled out between her legs and he remembers that she was angry at him and sent him to his room for the night.

Also, my husbands father was psychiatrist and diagnosed his mother (before they got married) with paranoid schizophrenia.   He was twenty seven years older than Alice, so during his teens and early twenties his father was in his sixties. He remembers his father trying to revive his mother after having seizures because of cocaine overdoses (She started because she had gained 300 pounds and thought cocaine would help her lose weight. She went through $300,000 worth of cocaine in one year, subsequently my husbands parents lost their house because of her problem.) and during his childhood, even after she stopped using cocaine, about every eight months his mother would be hospitalized for something including multiple suicide attempts. After her hospital stays her father would send her on cruises and trips. Then his father started getting sick and the same thing would happen to him, about every eight months his father would be hospitalized. His father was put into a nursing home four times in the last few years before he died (he died two years ago, in his mid-sixties). Each time my husbands father would get better, then his mother would put him back to work at the clinic that his mother was running for him and he would get sick again.

I've noticed that she is hospitalized an unusual amount as well (more that my 89 year old grandmother over the last 4 years). Just since I've been living with her (about 8 months) she has had two extended stays of four or more days in a hospital and 3 emergency room trips for things like broken ribs and toes. One thing I noticed about her is that she loves being in the hospital. She is always so happy when she is laying in her hospital bed with nurses coming in to check on her (the nurses all love her at our local hospital) and she even eats significantly more. Almost her full days worth of calories for every day that she is there, despite her gastroparesis. I'd even started to think, "She's probably going to be in the hospital for at least a day this time... at least she'll be eating regularly."

At first when my husband and I started taking care of her I was disgusted about how casual and even callous my husband could be to his mothers illness and hospitalizations. However, I now understand that this is a pattern that she has been following since her mid twenties. I've seen her swallow an entire box of laxitives shortly before she gets hospitalized for dangerously low potassium (or some other electrolyte) levels. I tried to get he to stop taking them, but she has been abusing them for so long that she can no longer have a bowel movement without them. She has also been abusing diuretics for so long that she can no longer urinate on a regular basis without taking them and using a catheter. (Her doctors will not prescribe her diuretics so she gets them in three month supplies that usually don't end up lasting three months from a pharmacist friend in Florida.)

I was afraid that she was going to end up killing herself, and I still am. However, now that my husband told me when happened to him when he was a child I fear having children that will grow up around her. I trust that what my husband told me was the truth because he is not the type of person to make these things up just for shock-value, and also because I know that Alice has a strange belief that he should not have lived past childhood. She told me that there were several instances in my husbands early childhood where something happened to him and he ended up almost dying. She did not elaborate, but I can only imagine what they were. My husband doesn't remember most of them because he was so young when they happened, but he did remember Alice being extremely over-protective of him when he was older, to the point where he was forbidden to go ever go outside and play with his friends because his mother was paranoid and convinced that something terrible would happen to him. This mostly went away when he became headstrong and defiant in his late teens. When he finally moved away from home upon turning eighteen they had a huge fight in which his mother told him that she always wished that she aborted him like she planned to.

Am I being paranoid in believing that I shouldn't have a baby while she is in my home? I just wanted some insight and advice from someone who might know more about psychiatry and this condition than I do.

[SWM]

hi,

just a couple of quick comments, i dont want to get in too deep yet.

if alice does have anorexia then she may be diplaying behaviours which you are interpreting as munchausen, could this be so? or do you think she might be fabricating her anorexia?

diabetes is not an illness that can be fabricated and i am pretty sure gastroperesis can not be fabricated. 

can you point out what you are observing that leads you to think alice has munchausen.

also what are you fears about alice being with your children?

[worried_about_mom]

First of all I don't believe that her anorexia is feigned in any way. No person would have had the will power to starve themselves for years if they did not have a serious mental disorder.

Diabetes runs in my husbands family. My mother in law has had it since childhood. Her gastroparesis (damage to the nerve that controls stomach movement) is most likely due to her diabetes and/or the many, many surgeries that he has had on her abdomen over the last twenty something years. I suppose that it's also possible that she is using this condition as an excuse not to eat. The only test that her doctors did before they diagnosed her with gastroparesis was having her swallow 20-30 pills that they tracked through her digestive tract over the next 14 days. They made that diagnosis based upon her symptoms of vomiting after eating, abdominal pain, and the fact that it took her so long to pass all of the pills through her system. (Which I believe may be somewhat do to the fact that she cannot have a bowel movement without an overdose of laxatives and also the fact that after so many years of living off of nearly nothing her intestinal tract and metabolism must be extremely sluggish.) But I did not go to medical school so I tack that diagnosis as fact.

However, I do know that my mother in law makes up illnesses for attention. She has mysterious symptoms that either point to nothing or are obviously caused by lack of nutrition or her other conditions (extreme muscle cramping to the point of temporary hand paralysis, nausea, headaches, fainting, dizziness, etc.), but she exaggerates them to the point that they make her life seem unlivable. Some of the more extreme injuries and symptoms happen when I'm not around to watch her.

She has had numerous surgeries that ended up not correcting the ailments she got the surgery for. Strangest of all is the fact that when she is in the hospital she eats like a normal person with no qualms about food or painful stomach issue and her complaints about symptoms seem to go away until they are ready to discharge her.

I know that if my husband's mother has Muchausen Syndrome and she has abused my husband as a child (I forgot to mention that he was always going to the doctor or to see "psychic specialists" as a young child, before he grew old enough to object.)  there is a good chance that Munchausen by Proxy was a factor in this. However, I don't know for sure whether my presence would stop her from injuring her grandchild in some way.

[worried_about_mom]

Also the way that she thinks about my husband even to this day as being in danger of dying. She once showed me journals that she kept when my husband was a child with strange entries about my husband in them. These were written in Spanish and I speak little and read even less. She seemed to go through bouts of extreme over-protectiveness and neglect when it comes to raising her first son. She even has accounts of performing a Santaria exorcism and a protection ceremony (from curses that she believed my father in law's ex wife placed upon him) when My husband was maybe five or six. Throughout his childhood and teens he had to wear a gold necklace with a protective charm that she had specially made. One for him and one for her, but the protection was solely for him.

My mother in law has repeated many times that until he turns 26 he is in danger of dying... Maybe it's a different culture (she  is a Cuban refugee who came to the US when she was 15), but I find that very creepy.

First born children in her family usually die, according to her. How would she view my first born?

P.S. I think my thread title was misleading. I changes it from "Mother in law has anorexia, but is it Munchausen Syndrome?" to "Mother in law has anorexia, but does she have Munchausen Syndrome as well?". For what it's worth, as someone who suffered from an eating disorder and has spoken to her extensively about her fears about food, her self-esteem, and past weight problems I never doubted that she has anorexia. It was like talking to a 40 year old version of eighteen year old me.

[SWM]

okay,

if there was a risk that your children might be at harm in this situation what would you do?