Abnormal illness behaviours: a developmental perspective

Abstract

In two Series articles 1 Bass C Glaser D Early recognition and management of fabricated or induced illness in children. Lancet. 2014; (published online March 6.)http://dx.doi.org/10.1016/S0140-6736(13)62183-2 Google Scholar , 2 Bass C Halligan P Factitious disorders and malingering: challenges for clinical assessment and management. Lancet. 2014; (published online March 6.)http://dx.doi.org/10.1016/S0140-6736(13)62186-8 Google Scholar in The Lancet, Christopher Bass and colleagues examine fabricated or induced illness in children, and factitious disorders and malingering, respectively, which fall under the umbrella of abnormal illness behaviours. A common theme is the strategic use of illness behaviours in relationships with other individuals, including doctors and other health professionals. Abnormal illness behaviours are inherently social and interpersonal; they have no strategic or communicative function except when someone else can observe and respond to the behaviour. Early recognition and management of fabricated or induced illness in childrenFabricated or induced illness (previously known as Munchausen syndrome by proxy) takes place when a caregiver elicits health care on the child's behalf in an unjustified way. Although the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders specifies deception as a perpetrator characteristic, a far wider range is encountered clinically and is included in this Review. We describe the features of fabricated or induced illness, its effect on the child, and the psychosocial characteristics of caregivers and their possible motives. Full-Text PDF Factitious disorders and malingering: challenges for clinical assessment and managementCompared with other psychiatric disorders, diagnosis of factitious disorders is rare, with identification largely dependent on the systematic collection of relevant information, including a detailed chronology and scrutiny of the patient's medical record. Management of such disorders ideally requires a team-based approach and close involvement of the primary care doctor. As deception is a key defining component of factitious disorders, diagnosis has important implications for young children, particularly when identified in women and health-care workers. Full-Text PDF