Factitious disorder imposed on another

Behavioral disorder in which an adult fakes an illness in another, most commonly their child

Factitious disorder imposed on another
Synonyms	Factitious disorder by proxy, Munchausen syndrome by proxy (MSbP, MbP), fabricated or induced illness by carers (FII), medical child abuse
Pronounce
Field	Psychiatry
Symptoms	Variable
Complications
Onset
Duration
Types
Causes	Unknown
Risks	Pregnancy related complications, mother who was abused as a child or has factitious disorder imposed on self
Diagnosis	Removing the child from the caregiver results in improvement, video surveillance without the knowledge of the caregiver
Differential diagnosis	Medical disorder, borderline personality disorder, other forms of child abuse, delusional disorder
Prevention
Treatment	Removal of the child, therapy
Medication
Prognosis
Frequency	Relatively rare
Deaths

Factitious disorder imposed on another (FDIA), also known as Munchausen syndrome by proxy (MSbP), is a complex and potentially dangerous mental health disorder in which a caregiver, often a parent, intentionally produces or feigns illness in a person under their care, usually a child. The caregiver might fabricate symptoms, alter medical tests, or even physically harm the child to produce symptoms. Surprisingly, this behaviour does not seek tangible benefits but aims to attract attention and elicit sympathy for the caregiver.

Etiology

The exact causes of FDIA remain unclear. It's suggested that a combination of biological, psychological, and environmental factors might contribute to its development. Certain risk factors, such as complications during pregnancy, a history of abuse in the mother, or a mother with factitious disorder imposed on self (previously known as Munchausen syndrome), have been identified.

Symptoms and Diagnosis

The presentation of FDIA can vary widely, given that it depends on the type of symptoms the caregiver chooses to fabricate or induce. Nevertheless, some common patterns include symptoms that are only present when the caregiver is around, complex medical problems that do not respond to treatment as expected, or symptoms that do not align with test results.

Diagnosis of FDIA is challenging and often made by exclusion. It's supported when the child's condition improves upon separation from the caregiver or if covert video surveillance reveals evidence of fabrication or induction of symptoms. Importantly, FDIA is considered a form of child abuse and medical neglect.

Management and Treatment

Management of FDIA primarily involves ensuring the safety of the child, which may necessitate removal from the caregiver's custody and placement into foster care. In terms of treatment for the caregiver, therapeutic options such as psychotherapy can be considered. However, the effectiveness of these interventions is not well-established and generally relies on the caregiver's willingness to acknowledge the problem and engage in treatment.

Epidemiology

The prevalence of FDIA is difficult to determine due to the secretive nature of the disorder, but it is generally considered to be rare. Over 95% of cases involve the mother as the perpetrator. The term "Munchausen syndrome by proxy" was first coined in 1977 by British paediatrician Roy Meadow.

Legal Aspects

Given the potential harm to the child, including the risk of permanent injury or death, FDIA is not just a health issue but also a legal one. Many aspects of FDIA constitute criminal behavior, including child abuse and neglect.

References

• Flaherty, E. G., Macmillan, H. L., & Committee on Child Abuse and Neglect. (2013). Caregiver-fabricated illness in a child: a manifestation of child maltreatment. Pediatrics, 132(3), 590-597.
• Stirling, J., & American Academy of Pediatrics Committee on Child Abuse and Neglect. (2007). Beyond Munchausen syndrome by proxy: identification and treatment of child abuse in a medical setting. Pediatrics, 119(5), 1026-1030.

See also

• Psychosomatic illness
• Munchausen by Internet
• Folie à deux
• Hypochondria

References

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