Factitious Disorder Imposed on Another

(See also Factitious Disorder Imposed on Self.)

Factitious disorder imposed on another is characterized by the falsification or induction of illness in another person associated with identified deception. Previously, this disorder was known as factitious disorder by proxy or Munchausen syndrome by proxy. In factitious disorder imposed on another, people, usually caregivers (such as a parent), intentionally produce or falsify physical or psychological symptoms or signs in a person in their care (usually a child), rather than in themselves (as in factitious disorder imposed on self) (1).

The caregiver falsifies history and may injure the child with drugs (prescription and/or illicit) or other agents or add blood or bacterial contaminants to urine specimens to simulate disease. The caregiver seeks medical care for the child and appears to be deeply concerned and protective (1). The child typically has a history of frequent hospitalizations, usually for a variety of nonspecific symptoms, but no firm diagnosis. Children who are thus targeted may become seriously ill and sometimes even die.

Importantly. the perpetrator receives the diagnosis of factitious disorder imposed on another, not the target (1). However, the targeted person may sometimes be diagnosed with abuse, depending on the circumstances. The diagnosis does not exclude the presence of a true medical condition or mental disorder, because comorbid illness often occurs in the individual along with factitious disorder. Factitious disorder imposed on another is typically difficult to recognize, particularly when the caregiver's history is plausible (eg, report of a fever in an infant) and/or the targeted person is nonverbal. When a child has been injured in this situation, child protective services should be contacted for further assessment and management.