Factitious Disorder Imposed on Another (FDIA)

What is factitious disorder imposed on another (FDIA)?

When someone has this mental illness, they might act as though their child or dependent has a medical condition that needs attention. However, the child or dependent person isn’t sick. People with factitious disorder imposed on another (FDIA) lie about an illness in another person. This other person is usually someone in their care — often a child under the age of 6. In some cases, the dependent person can be another adult, disabled person or an elderly person.

Previously called Munchausen Syndrome by Proxy, factitious disorder imposed on another is one type of factitious disorder. Another type of factitious disorder involves making up false medical conditions about yourself. Factitious disorders are considered mental illnesses because they’re associated with severe emotional difficulties.

Whether the false medical claims are about someone else or yourself, this condition can be dangerous. It can lead to unnecessary medical tests and even procedures while the healthcare team tries to figure out what’s wrong with the patient. When a child is involved, FDIA is considered a form of child abuse by the American Professional Society on the Abuse of Children.

What is the motivation behind factitious disorder imposed on another?

There may be many different reasons why someone with factitious disorder imposed on another might seek unnecessary medical treatment for a child or dependent. Often, people with FDIA have an inner need for their child (or other dependent person) to be seen as ill or injured. This isn’t done to achieve a concrete benefit, like financial gain. It’s is often done in order to gain the sympathy and special attention given to people who are truly ill and their families.

Who is most likely to have factitious disorder imposed on anther (FDIA)?

FDIA is most often see in mothers — although it can also happen 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 healthcare provider.

There are certain characteristics that are common in a person with FDIA, including:

• Being a parent, usually a mother, but the person can also be the adult child of an elderly patient, spouse or caretaker of a disabled adult.
• Sometimes being a healthcare professional or having medical knowledge.
• Being very friendly and cooperative with the healthcare providers.
• Appearing to be quite concerned — some might seem overly concerned — about their child or designated patient.
• Possibly also suffering 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.

How common is factitious disorder imposed on another (FDIA)?

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.

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

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

FDIA is a type of factitious disorder — a mental health condition where the person lies about either their own medical conditions or those of someone they care for in order to earn praise and attention. There are two main types of factious disorders:

• Factitious disorder imposed on self.
• Factitious disorder imposed on another.

What causes factitious disorder imposed on another (FDIA)?

The exact cause of FDIA isn’t 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 (FDIA)?

An adult with FDIA often will not leave the bedside of their child or person they’re caring for. They’ll also discuss in detail the symptoms and care that’s been provided. This is typically used as evidence that he or she is a good caretaker and is doing a thorough job. If the symptoms go away when the patient is in the hospital, they’ll likely return when the caretaker with FDIA is alone with the child at home.

Some other possible warning signs of FDIA can include:

• The child or dependent person having a history of many hospitalizations. Often, there will also be a strange set of symptoms.
• The child or dependent person’s symptoms generally being reported by the mother (or other caretaker with FDIA) and not being witnessed by hospital staff.
• The child or dependent person’s condition and symptoms not matching the results of diagnostic tests.
• The child or dependent person’s condition improving in the hospital, but the symptoms recurring once they go home.
• Blood in lab samples not matching the blood of the child or dependent person.
• The child or dependent person possibly having signs of chemicals in the blood, stool or urine.

There might also be a history of one or more unusual illnesses or deaths of children in the family.

How is factitious disorder imposed on another diagnosed?

Diagnosing FDIA is very difficult because of the dishonesty that’s involved. Healthcare provider’s 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 in the adult caregiver.

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 caregiver’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’s the adult, not the child, who is diagnosed with FDIA. The most important or helpful part of the workup is the review of all old records that can be obtained. Unfortunately, this time-consuming but critical task is often forgotten and the diagnosis is missed. Healthcare providers will ask Child Protective Services, and the Legal Department for help reviewing the facts.

How is factitious disorder imposed on another treated?

One of the biggest concerns in cases of FDIA is the safety of the child or dependent person. Ensuring their safety is important and this often involves placing them in the care of someone else. This can take a team of people to accomplish, including:

• Social workers.
• Foster care organizations.
• Law enforcement.
• Healthcare providers.

It’s difficult to successfully treat people with FDIA because they often deny that there’s a problem. Success can be dependent on catching the person in the act or the person telling the truth. However, people with FDIA tend to be such accomplished liars that they start to have trouble telling fact from fiction.

One type of treatment is psychotherapy. A type of counseling, psychotherapy 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 (FDIA)?

Factitious disorder imposed on another can lead to serious short- and long-term complications, including:

• Continued abuse.
• Multiple hospitalizations.
• Death of the victim.

Research suggests that the death rate for victims of FDIA is about 10%. 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 (FDIA) be prevented?

There’s no known way to prevent factitious disorder imposed on another. 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 also prevent additional harm to the victim.

What is the 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, Child Protective Services and healthcare providers must all work together as a team to stop the behavior.

A note from Cleveland Clinic
Factitious disorder imposed on another (FDIA) can not only be difficult to treat, but also hard to identify — especially if it’s happening in someone you know. If you ever have any concerns about strange medical conditions that seem to go away in the hospital, but return at home, reach out to a trusted resource (family member or healthcare provider).