Factitious disorder imposed on another, perhaps better known as Munchausen syndrome by proxy, is a form of abuse in which a person fabricates illness for a dependent and puts them through unnecessary medical treatment.
The relationship usually, but not always, involves a mother and her child.
The term Munchausen syndrome by proxy (MSBP) was named after Baron Munchausen, an aristocratic literary figure from 18th-century Germany, with a reputation for tall stories.
The correct name for MSBP is now factitious disorder imposed on another (FDIA). If the person invents illness for themselves, this is factitious disorder imposed on self (FDIS). The disorder has also been known as fabricated illness (FI).
FDIA: A mental health issue
Factitious disorder is classified as a mental illness.
People with Munchausen’s syndrome by proxy seek to gain attention by inventing illnesses for their dependents.
A person with FDIS tries to gain attention by being the patient.
The person with FDIA gains attention by caring for someone, usually her own child, who is sick. She receives praise for her devotion during the many hospitalizations that the “patient” goes through, and uses the sick child to develop relationships with doctors and health care workers.
The earliest recorded case of fabricated illness was in 1951, and the first “by proxy” case was in 1976.
How common it is remains unclear, partly because of the secrecy practiced by those who have the disorder. One estimate suggests that 2 in every 100,000 children may experience it.
Sometimes it is not the mother but the father who has FDIA, and the receiver may not be a child, but an older teen, a person in their 20s or a vulnerable adult, such as an elderly person who is dependent on a caregiver.
The person with the condition often has a history of abuse or other mental health issues.
The fact that the abuser appears to care greatly about their dependent makes it harder to spot the deception.
To support claims that the child is ill when no illness is present, the person with FDIA may invent signs and symptoms. They may say that the child has convulsions, an eating disorder, pain, allergies or ADHD, when this is not true.
Alternatively, they may make the child ill by getting them to swallow a substance, injecting something into them to make them sick, or smothering them.
This can be fatal.
If a child has repeated and unexplained illnesses, or multiple illnesses, if the symptoms only occur when the parent is present, and if the parent seems to know a lot about medicine, despite not having previous training in the field of health care, these could be signs of FDIA.
While the child is in the hospital, the parent may stay with them all the time and attend to them well, but they may appear less concerned about the child’s well-being than the health care professionals do.
The other parent tends not to be involved in the care of the child, or their involvement is minimal.
The parent may talk to the medical team a lot and try to develop a friendly relationship, but if challenged, they may become aggressive, confrontational, and possibly abusive.
The parent may be keen for the child to undergo tests that most parents would only agree to if absolutely necessary. They may encourage doctors to perform tests and procedures that are painful for the child.
Documents or other sources may indicate that the mother has changed doctors frequently, or has visited different hospitals for her child’s treatment.
Patterns of abuse
Cases of FDIA fall into one of six categories of patterns of abuse, ranging from less severe to extremely severe.
Someone with the condition may: