Factitious Disorder Imposed on Another (Munchausen Syndrome by Proxy), a Potentially Lethal Form of Child Abuse

Abstract

Factitious Disorder Imposed on Another is a behavior pattern in which a caregiver fabricates, exaggerates, or induces mental or physical health problems in those who are in her or his care. With deception at its core, this behavior is an elusive, potentially lethal, and frequently misunderstood form of child abuse or medical neglect that has been difficult to define, detect, and confirm. Symptoms of the syndrome are hard to identify but are most prevalent when the child only becomes sick in the presence of his or her mother. The mother maintains a dynamic relationship with the physician, as the whole disorder is centered upon her need for attention and compassion from the doctor to placate self-doubt in the sufferer. The first concern in Factitious Disorder Imposed on Another is to raise the awareness about it in order not to miss it as it could be lethal and to ensure the safety and protection of any real or potential victims. This may require that the child be placed in the care of another. In fact, managing a case involving Factitious Disorder Imposed on Another often requires a team that includes a social worker, foster care organizations, and law enforcement, as well as doctors. Psychotherapy generally focuses on changing the thinking and behavior of the individual with the disorder and its goal in such disorder is to help the person identify the thoughts and feelings that are contributing to the behavior, and to learn to form relationships that are not associated with being ill.