Munchausen Syndrome by Proxy: A condition where a caregiver, often a parent, intentionally deceives medical staff by fabricating or inducing illnesses in a person under their care, typically a child, to seek attention or sympathy for themselves.
Factitious Disorder Imposed on Another (FDIA), previously known as Munchausen Syndrome by Proxy, is a grave form of abuse where a caregiver intentionally fabricates or induces illness in another person, most commonly a child or elderly individual, to fulfill their own psychological needs[1][2][4][5].
### Common Symptoms
The victim, usually a child under 6 years of age but who can be an older teen or a vulnerable adult of any age, usually presents with unexplained or recurrent physical symptoms that worsen without a clear medical cause, such as repeated hospital visits or treatments that do not correspond with objective findings[1][4]. Symptoms in the victim can include pain, fatigue, neurological or gastrointestinal problems, headaches, dizziness, and other medically unexplained physical complaints, often resistant to treatment or inconsistent with test results[3][4].
The caregiver appears overly concerned, constantly seeks medical attention for the victim, and may provide conflicting or misleading medical histories[1][4][5].
### Causes
The primary motive behind FDIA is usually psychological, linked to the caregiver’s need for attention, sympathy, or control involving the victim’s health[1][2][5]. It may be associated with underlying psychological disorders in the perpetrator, such as factitious disorder imposed on self or related personality disorders[1][5]. Sometimes false beliefs about the victim's health prompt caregivers to fabricate or induce symptoms[1].
### Diagnosis
FDIA is difficult to detect because symptoms are induced and fabricated by a trusted caregiver, and medical tests often show no diagnostic explanation for the victim's symptoms[1][4]. Diagnosis requires a high index of suspicion, often triggered by inconsistencies between clinical findings and reported symptoms, unusual illness patterns, or the caregiver’s suspicious behavior. Multi-disciplinary evaluation involving medical specialists, mental health professionals, and social services is typically necessary to confirm FDIA[1][4][5].
Healthcare teams look for signs like repeated healthcare visits without diagnosis, symptoms only occurring in the presence of the caregiver, and evidence the caregiver is causing or falsifying symptoms[1][4].
### Treatment
The priority is ensuring the safety and well-being of the victim, often including removal from the caregiver’s custody if abuse is confirmed[4]. Treatment involves medical care for the induced illnesses and addressing the psychological impact on the victim. The caregiver usually requires psychiatric intervention to address underlying mental health issues and prevent further abuse[4][5]. Long-term follow-up and multidisciplinary support for both the victim and family are essential to recovery and prevention of recurrence.
Online forums can provide support for survivors of abuse associated with FDIA[6]. Effective treatment is usually possible once a person acknowledges that they have FDIA[7]. For the dependent, a team works to restore their mental and physical health, and they may benefit from long-term counseling to deal with anxiety, trauma, and stress[8]. If a doctor suspects FDIA, they may invite a team of experts to evaluate the case[9].
The DSM-5 lists criteria for FDIA, including falsifying signs or symptoms, presenting another as having signs of an illness, and receiving no external reward[10]. Psychotherapy can help a caregiver identify reasons for their actions and learn to form relationships not associated with illness[11]. In more than 90% of cases, the person with FDIA is the child's mother[12].
Experts call upon doctors to be aware of red flags for early diagnosis[4]. The long-term outlook depends on the severity of the damage and how long it takes for FDIA to be identified. The effects on the dependent can include missed school and other opportunities, physical risk, and long-term mental health problems[13]. Treatment for FDIA may involve psychotherapy, family therapy, and physical therapy for both the caregiver and the dependent[14]. Family therapy seeks to promote a healthy relationship between the child and caregiver.
[1] Mayo Clinic. (2021). Munchausen syndrome by proxy. [online] Available at: https://www.mayoclinic.org/diseases-conditions/munchausen-syndrome-by-proxy/symptoms-causes/syc-20354910 [Accessed 23 Mar. 2023].
[2] NHS. (2021). Munchausen's syndrome by proxy. [online] Available at: https://www.nhs.uk/conditions/munchausens-syndrome-by-proxy/ [Accessed 23 Mar. 2023].
[3] Cleveland Clinic. (2021). Munchausen syndrome by proxy. [online] Available at: https://my.clevelandclinic.org/health/diseases/17823-munchausens-syndrome-by-proxy [Accessed 23 Mar. 2023].
[4] American Psychological Association. (2021). Factitious Disorder Imposed on Another. [online] Available at: https://dictionary.apa.org/factitious-disorder-imposed-on-another [Accessed 23 Mar. 2023].
[5] Medscape. (2021). Factitious Disorder Imposed on Another. [online] Available at: https://emedicine.medscape.com/article/321591-overview [Accessed 23 Mar. 2023].
[6] National Organization for Victim Assistance. (2021). Support Groups. [online] Available at: https://www.trynova.org/support-groups/ [Accessed 23 Mar. 2023].
[7] National Institute of Mental Health. (2021). Factitious Disorder. [online] Available at: https://www.nimh.nih.gov/health/topics/factitious-disorders/index.shtml [Accessed 23 Mar. 2023].
[8] HelpGuide.org. (2021). Munchausen Syndrome by Proxy (Factitious Disorder Imposed on Another). [online] Available at: https://www.helpguide.org/articles/abuse/munchausens-syndrome-by-proxy-factitious-disorder-imposed-on-another.htm [Accessed 23 Mar. 2023].
[9] American Academy of Child and Adolescent Psychiatry. (2021). Factitious Disorder. [online] Available at: https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Gel090.aspx [Accessed 23 Mar. 2023].
[10] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
[11] National Institute of Mental Health. (2021). Factitious Disorder. [online] Available at: https://www.nimh.nih.gov/health/topics/factitious-disorders/index.shtml [Accessed 23 Mar. 2023].
[12] Medscape. (2021). Factitious Disorder Imposed on Another. [online] Available at: https://emedicine.medscape.com/article/321591-overview [Accessed 23 Mar. 2023].
[13] HelpGuide.org. (2021). Munchausen Syndrome by Proxy (Factitious Disorder Imposed on Another). [online] Available at: https://www.helpguide.org/articles/abuse/munchausens-syndrome-by-proxy-factitious-disorder-imposed-on-another.htm [Accessed 23 Mar. 2023].
[14] National Institute of Mental Health. (2021). Factitious Disorder. [online] Available at: https://www.nimh.nih.gov/health/topics/factitious-disorders/index.shtml [Accessed 23 Mar. 2023].
- The caregiver, demonstrating a need for attention or control in health-and-wellness matters, might seek psychiatric intervention to address their underlying psychological issues, such as factitious disorder imposed on self or related personality disorders, as they are associated with Factitious Disorder Imposed on Another (FDIA).
- Mental-health professionals play a crucial role in the diagnosis and treatment of FDIA, as this condition often involves psychological motivations and requires multi-disciplinary evaluation to confirm.
