Factitious disorder imposed on another

Factitious disorder imposed on another (FDIA)
Other names
  • Munchausen syndrome by proxy (MSbP)
  • Munchausen by proxy (MbP)
  • Factitious disorder imposed by another
  • Factitious disorder by proxy
  • Fabricated or induced illness by caregivers (FII)
  • Medical child abuse
SpecialtyPsychiatry
SymptomsVariable[1]
CausesUnknown[2]
Risk factorsComplications of pregnancy, caregiver who was abused as a child or has factitious disorder imposed on self[3]
Diagnostic methodRemoving the child from the caregiver results in improvement, video surveillance without the knowledge of the caregiver[4]
Differential diagnosisMedical disorder, other forms of child abuse, delusional disorder[5]
TreatmentRemoval of the child, therapy[2][4]
FrequencyEstimated 1 to 30 occurrences per 1,000,000 children[6]

Factitious disorder imposed on another (FDIA), also known as fabricated or induced illness by carers (FII) and first named as Munchausen syndrome by proxy (MSbP) after Munchausen syndrome, is a mental health disorder in which a caregiver creates the appearance of health problems in another person, typically their child, and sometimes (rarely) when an adult simulates an illness in another adult partner.[7][8][9] This might include altering test samples or injuring a child.[8] The caregiver or partner then presents the person as being sick or injured.[5] Permanent injury or death of the victim can occur as a result of the disorder.[8] The behaviour might be motivated by the caregiver or partner seeking sympathy or attention.

The cause of FDIA is unknown.[2] The primary motive may be to gain attention and manipulate physicians.[4] Risk factors for FDIA include pregnancy related complications and a mother who was abused as a child or has factitious disorder imposed on self.[3] Diagnosis of a child's caregiver is supported when removing the child from the caregiver results in improvement of symptoms or video surveillance without the knowledge of the caregiver finds concerns.[4] The victims of those affected by the disorder are considered to have been subjected to a form of physical abuse and medical neglect.[1]

Management of FDIA in the affected 'caregiver' may require putting the child in foster care.[2][4][10] It is not known how effective therapy is for FDIA; it is assumed it may work for those who admit they have a problem.[4] The prevalence of FDIA is unknown,[5] but it appears to be relatively rare.[4] More than 90% of cases involve a person's mother.[3] The prognosis for the caregiver is poor.[4] However, there is a burgeoning literature on possible courses of therapy.[3] The condition was first named as "Munchausen syndrome by proxy" in 1977 by British pediatrician Roy Meadow.[4] Some aspects of FDIA may represent criminal behavior.[5]

  1. ^ a b Stirling J, American Academy of Pediatrics Committee on Child Abuse Neglect (May 2007). "Beyond Munchausen syndrome by proxy: identification and treatment of child abuse in a medical setting". Pediatrics. 119 (5). Berlin, Germany: Karger Publishers: 1026–1030. doi:10.1542/peds.2007-0563. PMID 17473106.
  2. ^ a b c d Jacoby DB, Youngson RM (2004). Encyclopedia of Family Health. Marshall Cavendish. p. 1286. ISBN 978-0761474869.
  3. ^ a b c d Yates G, Bass C (October 2017). "The perpetrators of medical child abuse (Munchausen Syndrome by Proxy) – A systematic review of 796 cases". Child Abuse & Neglect. 72: 45–53. doi:10.1016/j.chiabu.2017.07.008. PMID 28750264. S2CID 46348831.
  4. ^ a b c d e f g h i Myers JE (2005). Myers on Evidence in Child, Domestic, and Elder Abuse Cases. Aspen Publishers Online. pp. 280–282. ISBN 978-0735556683.
  5. ^ a b c d American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 324–326, ISBN 978-0890425558
  6. ^ Cite error: The named reference criddle was invoked but never defined (see the help page).
  7. ^ Munchausen syndrome by adult proxy: a perpetrator abusing two adults American Psychological Association. Mercia D. Sigal et al. 1986. Retrieved July 4, 2024.
  8. ^ a b c "Factitious Disorder Imposed on Self – Psychiatric Disorders". Merck Manuals Professional Edition. Retrieved 28 April 2019.
  9. ^ "Overview - Fabricated or induced illness". nhs.uk. 16 February 2021. Retrieved 9 November 2022.
  10. ^ Kelley DM, Curran KA (2019). "Medical Child Abuse: An Unusual "Source" of Vaginal Bleeding". Journal of Pediatric and Adolescent Gynecology. 32 (3): 334–336. doi:10.1016/j.jpag.2019.03.003. PMID 30923026. S2CID 85564487.