Factitious disorder imposed on another
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. This may include injuring the child or altering test samples. The caregiver then presents the person as being sick or injured. Permanent injury or death of the victim may occur as a result of their caregiver having the disorder. The behaviour may be motivated by the caregiver seeking sympathy or attention.
| Factitious disorder imposed on another (FDIA) | |
|---|---|
| Other names |
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| Specialty | Psychiatry |
| Symptoms | Variable |
| Causes | Unknown |
| Risk factors | Complications of pregnancy, caregiver who was abused as a child or has factitious disorder imposed on self |
| Diagnostic method | Removing the child from the caregiver results in improvement, video surveillance without the knowledge of the caregiver |
| Differential diagnosis | Medical disorder, other forms of child abuse, delusional disorder |
| Treatment | Removal of the child, therapy |
| Frequency | Estimated 1 to 30 occurrences per 1,000,000 children |
The cause of FDIA is unknown. The primary motive may be to gain attention and manipulate physicians. Risk factors for FDIA include pregnancy related complications and a mother who was abused as a child or has factitious disorder imposed on self. Diagnosis 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. The victims of those affected by the disorder are considered to have been subjected to a form of physical abuse and medical neglect.
Management of FDIA in the affected 'caregiver' may require putting the child in foster care. It is not known how effective therapy is for FDIA; it is assumed it may work for those who admit they have a problem. The prevalence of FDIA is unknown, but it appears to be relatively rare. More than 90% of cases involve a person's mother.
The prognosis for the caregiver is poor. However, there is a burgeoning literature on possible courses of therapy.
The condition was first named as "Munchausen syndrome by proxy" in 1977 by British pediatrician Roy Meadow. Some aspects of FDIA may represent criminal behavior.