Factitious Disorder Imposed on Another (FDIA)
What is factitious disorder imposed on another?
In this mental illness, a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick. The adult perpetrator has the diagnosis (FDIA) and directly produces or lies about illness in another person under his or her care, usually a child under 6 years of age. It is considered a form of abuse by the American Professional Society on the Abuse of Children. However, cases have been reported of adult victims, especially the disabled or elderly. FDIA was previously known as Munchausen Syndrome by Proxy.
People with FDIA have an inner need for the other person (often his or her child) to be seen as ill or injured. It is not done to achieve a concrete benefit, such as financial gain. People with FDIA are even willing to have the child or patient undergo painful or risky tests and operations in order to get the sympathy and special attention given to people who are truly ill and their families. Factitious disorders are considered mental illnesses because they are associated with severe emotional difficulties.
The Diagnostic and Statistical Manual of Mental Disorders 5, is the standard reference book for recognized mental illnesses in the United States. It describes this diagnosis to include falsification of physical or psychological signs or symptoms, and induction of illness or injury to another associated with deception. There is no evidence of external rewards and no other illness to explain the symptoms. Fortunately, it is rare (2 out of 100,000 children).
FDIA most often occurs with mothers—although it can occur with fathers—who intentionally harm or describe non-existent symptoms in their children to get the attention given to the family of someone who is sick. A person with FDIA uses the many hospitalizations as a way to earn praise from others for their devotion to the child's care, often using the sick child as a means for developing a relationship with the doctor or other health care provider. The adult with FDIA often will not leave the bedside and will discuss in medical detail symptoms and care provided as evidence that he or she is a good caretaker. If the symptoms go away in the hospital, they are likely to return when the caretaker with FDIA is alone with the child or elderly parent.
People with FDIA might create or exaggerate the child's symptoms in several ways. They might simply lie about symptoms, alter diagnostic tests (such as contaminating a urine sample), falsify medical records, or induce symptoms through various means, such as poisoning, suffocating, starving, and causing infection. The presenting problem may also be psychiatric or behavioral.
How common is factitious disorder imposed on another?
There are no reliable statistics regarding the number of people in the United States who suffer from FDIA, and it is difficult to assess how common the disorder is because many cases go undetected. However, estimates suggest that about 1,000 of the 2.5 million cases of child abuse reported annually are related to FDIA.
In general, FDIA occurs more often in women than in men.
Symptoms and Causes
What causes factitious disorder imposed on another?
The exact cause of FDIA is not known, but researchers believe both biological and psychological factors play a role in the development of this disorder. Some theories suggest that a history of abuse or neglect as a child or the early loss of a parent might be factors in its development. Some evidence suggests that major stress, such as marital problems, can trigger an FDIA episode.
What are the symptoms of factitious disorder imposed on another?
Certain characteristics are common in a person with FDIA:
- Often is a parent, usually a mother, but can be the adult child of an elderly patient, spouse or caretaker of a disabled adult
- Might be a health care professional
- Is very friendly and cooperative with the health care providers
- Appears quite concerned (some might seem overly concerned) about the child or designated patient
- Might also suffer from factitious disorder imposed on self (This is a related disorder in which the caregiver repeatedly acts as if he or she has a physical or mental illness when he or she has caused the symptoms.)
Other possible warning signs of FDIA in children include the following:
- The child has a history of many hospitalizations, often with a strange set of symptoms.
- Worsening of the child's symptoms generally is reported by the mother and is not witnessed by the hospital staff.
- The child's reported condition and symptoms do not agree with the results of diagnostic tests.
- There might be more than one unusual illness or death of children in the family.
- The child's condition improves in the hospital, but symptoms recur when the child returns home.
- Blood in lab samples might not match the blood of the child.
- There might be signs of chemicals in the child's blood, stool, or urine.
Diagnosis and Tests
How is factitious disorder imposed on another diagnosed?
Diagnosing FDIA is very difficult because of the dishonesty that is involved. Doctors must rule out any possible physical illness as the cause of the child's symptoms, and often use a variety of diagnostic tests and procedures before considering a diagnosis of FDIA.
If a physical cause of the symptoms is not found, a thorough review of the child's medical history, as well as a review of the family history and the mother's medical history (many have factitious disorder imposed on self) might provide clues to suggest FDIA. Often, the individual with FDIA may have other comorbid psychiatric disorders. Remember, it is the adult, not the child, who is diagnosed with FDIA. Indeed, the most important or helpful part of the workup is likely to be the review of all old records that can be obtained. Too often, this time-consuming but critical task is forgotten and the diagnosis is missed. Physicians will ask Children’s Services, and the Legal Department for assistance in reviewing the facts.
Management and Treatment
How is factitious disorder imposed on another treated?
The first concern in cases of FDIA is to ensure the safety and protection of any real or potential victims. This might require that the child be placed in the care of another. In fact, managing a case involving FDIA often requires a team that includes social workers, foster care organizations, and law enforcement, as well as the health care providers.
Successful treatment of people with FDIA is difficult because those with the disorder often deny there is a problem. In addition, treatment success is dependent on catching the person in the act or the person telling the truth. People with FDIA tend to be such accomplished liars that they begin to have trouble telling fact from fiction.
Psychotherapy (a type of counseling) generally focuses on changing the thinking and behavior of the individual with the disorder (cognitive-behavioral therapy). The goal of therapy for FDIA 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.
What are the complications of factitious disorder imposed on another?
This disorder can lead to serious short- and long-term complications, including continued abuse, multiple hospitalizations, and the death of the victim. (Research suggests that the death rate for victims of FDIA is about 10 percent.) In some cases, a child victim of FDIA learns to associate getting attention to being sick and develops factitious disorder imposed on self. Considered a form of child abuse, FDIA is a criminal offense.
Can factitious disorder imposed on another be prevented?
There is no known way to prevent this disorder. However, it might be helpful to begin treatment in people as soon as they begin to have symptoms. Removing the child or other victim from the care of the person with FDIA can prevent further harm to the victim.
Outlook / Prognosis
What is the prognosis (outlook) for people with factitious disorder imposed on another?
Generally, FDIA is a very difficult disorder to treat and often requires years of therapy and support. Social services, law enforcement, children's protective services, and physicians must function as a team to stop the behavior.