Factitious Disorder Imposed on Another (FDIA)

What is factitious disorder imposed on another (Munchausen syndrome by proxy)?

Factitious disorder imposed on another, formerly known as Munchausen syndrome by proxy, is a mental health condition where you claim that someone within your care needs medical attention even though they don’t. A person within your care could be a child (usually under the age of 6), a person with disabilities or an adult over age 65, for example.

Making false medical claims can be dangerous. It can lead to unnecessary medical tests and even risky procedures while the healthcare team tries to figure out what’s wrong.

This condition is a type of factitious disorder. It’s also a form of abuse. Help is available for both the person diagnosed with FDIA and the victim.

How common is factitious disorder imposed on another?

Factitious disorder imposed on another isn’t common. And there aren’t any reliable statistics regarding the number of people in the United States who have this condition. It’s difficult to assess the frequency because many cases go undetected.

Was factitious disorder imposed on another previously called Munchausen syndrome by proxy?

Yes. In the past, factitious disorder imposed on another was called Munchausen syndrome by proxy. This name referred to a historical figure named Baron Munchausen, who was known for exaggerated stories. The change provides a more accurate description of a person’s behavior.

What causes factitious disorder imposed on another?

Healthcare providers aren’t sure of the exact cause of this condition. Studies show that motivations to perform these behaviors may relate to:

• A history of past trauma, abuse or neglect
• Loss of a parent or caregiver
• Extreme stress
• Wanting attention from others

What are the symptoms of factitious disorder imposed on another?

If you have this condition, you might:

• Tell a healthcare provider that someone within your care is experiencing symptoms they aren’t actually experiencing.
• Physically harm someone else to cause symptoms (like withholding food to prevent weight gain).
• Change the results of a diagnostic test of someone (like contaminating a urine sample).
• Interfere with someone else’s treatment plan to prevent them from getting better.

Signs of FDIA in the person within your care may include:

• They’re never left alone or out of your sight.
• They have a history of many hospitalizations, tests and procedures.
• Medical records are inconsistent.
• Symptoms don’t fit a single condition or lead to a conclusive diagnosis.
• Symptoms only happen at home or don’t appear in the presence of a healthcare provider.
• Symptoms improve in the hospital but worsen at home.
• Blood or urine in lab samples don’t match the blood type or urine of the person within your care, or there may be signs of contamination.

Is factitious disorder imposed on another hereditary?

There’s no known genetic cause of factitious disorder imposed on another.

What are the risk factors for factitious disorder imposed on another?

This condition is most often diagnosed in caretakers assigned female at birth. It’s also more common among people who also have a personality disorder.

Common characteristics found among people diagnosed with this condition include:

• You have a large amount of knowledge about medical care and health information.
• You’re very personable and easy to get along with.
• You’re highly involved and devoted to being a caretaker.

How is factitious disorder imposed on another diagnosed?

It’s difficult for healthcare providers to diagnose factitious disorder imposed on another because the condition involves dishonesty. A provider will first rule out any possible conditions related to the symptoms presented by the person within your care before considering an FDIA diagnosis for you. This can take time.

Your provider will start by reviewing the symptoms of the person within your care, offering a physical exam and testing if necessary. They’ll ask you questions about their medical history and family medical history. Your provider will be looking for clues during the exam that may point to a factitious disorder, like:

• Visiting multiple different healthcare facilities for care.
• An inconsistent medical history.
• Not wanting to share previous medical records or allow healthcare providers to speak with friends and family about concerns.
• Not allowing healthcare providers to speak to the person within your care alone.

If suspected, your provider will address the behavior and make sure you and the person within your care are safe.

Factitious disorder imposed on another in the DSM-5

The diagnostic criteria of factitious disorder imposed on another as presented in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) includes:

1. Falsifying physical or psychological signs or symptoms, or creating an injury or condition in order to deceive someone.
2. One person presents someone else (victim) to others as ill, impaired or injured.
3. The deceptive behavior happens without obvious external rewards.
4. The behavior isn’t caused by another mental health condition.

How is factitious disorder imposed on another treated?

The first goal of treatment for factitious disorder imposed on another is to modify harmful behaviors and reduce the misuse or overuse of medical resources. Then, your care team will address any underlying causes of your behavior.

Healthcare providers will work together to make sure the person under your care isn’t in danger and doesn’t undergo unnecessary medical testing or treatment. Additional help for the victim, or the person within your care, may include:

• Removing them from your care and placing them in the care of someone else.
• Treating any injuries or illnesses.
• Talking to a mental health provider, therapist or other physician about possible post-traumatic stress disorder, depression, anxiety or other complications that may arise as a result of abuse.

To address any underlying causes of your behavior, your healthcare provider may refer you to a type of psychotherapy called cognitive behavioral therapy. The goal of therapy is to identify how your thoughts and feelings contribute to your behaviors. You’ll also learn about the importance of honesty. A mental health professional will help you adjust your thinking and behaviors.

Generally, FDIA is a very difficult disorder to treat and often requires years of therapy and support. Social services, law enforcement, Child Protective Services, Adult Protective Services and healthcare providers must all work together as a team to stop the behavior.

Can factitious disorder imposed on another be prevented?

There’s no known way to prevent this condition. However, there’s less risk of harm by seeking treatment as soon as symptoms begin. For example, removing a person from your care could prevent unnecessary harm.

Factitious disorder imposed on another can lead to serious complications, including:

• Legal ramifications (this form of abuse is a criminal offense)
• Continued abuse of a victim
• Development of factitious disorder imposed on self for a child victim as they reach adulthood
• Death of the victim

Making sure this condition receives proper treatment as soon as possible may prevent these complications.

When should I get help?

Contact a healthcare provider or social worker if you suspect FDIA behaviors happening with a loved one. If you see signs of abuse, contact Adult Protective Services or Child Protective Services (U.S.). If someone is in immediate danger, don’t hesitate to contact 911 or your local emergency services number.

What questions should I ask someone if I notice factitious disorder behaviors?

If you suspect a loved one may have FDIA, you might want to ask the following questions to learn more:

• How often do you visit a provider’s office?
• Are you visiting the same provider or multiple different providers?
• How does the person within your care feel after getting a lot of testing done?
• Does the person within your care have symptoms when you’re not around?
• Are you experiencing a lot of stress as a caregiver?

Understand that you may not get clear answers to these questions, as FDIA causes deceptive behaviors. To gather information, try to avoid accusing the caretaker with your questioning. Approach the conversation gently and with a willingness to learn more.