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 falsely simulates an illness or health issues in another adult partner.[7][8][9] This might include altering test samples, injuring a child, falsifying diagnoses, or portraying the appearance of health issues through contrived photographs, videos, and other ‘evidence’ of the supposed illness.[8] The caregiver or partner then continues to present the person as being sick or injured, convincing others of the condition/s and their own suffering as the caregiver.[5] Permanent injury (both physical and psychological harm) or even death of the victim can occur as a result of the disorder and the caretaker’s actions.[8] The behaviour is generally thought to be motivated by the caregiver or partner seeking the sympathy or attention of other people and/or the wider public.

The causes of FDIA are generally unknown, yet it is believed among physicians and mental health professionals that the disorder is associated with the ‘caregiver’ having experienced traumatic events during childhood (for example, parental neglect, emotional deprivation, psychological abuse, physical abuse, sexual abuse, severe bullying, and/or other).[2] The primary motive is believed to be to gain significant attention and sympathy, often with an underlying need to lie and a desire to manipulate others (including health professionals).[4] Financial gain is also a motivating factor in some individuals with the disorder. Generally, risk factors for FDIA commonly include pregnancy related complications and sympathy or attention a mother has received upon giving birth, and/or a mother who was neglected, traumatized, or abused throughout childhood, or who has a diagnosis of (or history of) factitious disorder imposed on self.[3] The victims of those affected by the disorder are considered to have been subjected to a form of trauma, physical abuse, and medical neglect.[1]

Management of FDIA in the affected 'caregiver' may require removing the affected child and putting the child into the custody of other family members or into foster care.[2][4][10] It is not known how effective psychotherapy is for FDIA, yet it is assumed that it is likely to be highly effective for those who are able to admit they have a problem and whom are willing to engage in treatment. However, psychotherapy is unlikely to be effective for an individual who lacks awareness, is incapable of recognizing their illness, or refuses to undertake treatment [4] The prevalence of FDIA is unknown,[5] but it appears to be relatively rare, and its prevalence is generally higher among women.[4] More than 90% of cases of FDIA involve a person's mother.[3] The prognosis for the caregiver is poor.[4] However, there is a burgeoning literature on possible courses of effective 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 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. ^ Münchausen 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.