Skip to main content

Advertisement

SpringerLink
Log in

Evaluation and Management of Factitious Disorder Imposed on Another

  • Published:
Journal of Clinical Psychology in Medical Settings Aims and scope Submit manuscript

Abstract

Munchausen by proxy refers to an individual who abusively and compulsively falsifies physical, psychiatric or developmental disorders in a child or adult victim in order to satisfy a psychological need. Factitious disorder imposed on another refers to the psychopathology in the abuser. Psychologists in medical settings may: (1) identify patients they come to suspect as being victims or perpetrators of MBP, (2) conduct or assist in clinical or forensic evaluations; (3) offer recommendations for clinical case management, and/or (4) provide treatment or referrals. The purpose of this paper is to provide guidance to psychologists and other mental health professionals in medical settings who may encounter individuals with this potentially lethal form of psychopathology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Alexander, R., Smith, W., & Stevenson, R. (1990). Serial Munchausen syndrome by proxy. Pediatrics, 86, 581–585.

    CAS  PubMed  Google Scholar 

  • Allen, E. C., Manuel, J. C., Legault, C., Naughton, M. J., Pivor, C., & O’Shea, T. M. (2004). Perception of child vulnerability among mothers of former premature infants. Pediatrics, 113, 267–273.

    PubMed  Google Scholar 

  • American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders: Fifth edition (DSM-5). Arlington, VA: American Psychiatric Association.

    Google Scholar 

  • Ayoub, C. C. (1999). Emotional impact of Munchausen by proxy on the child victims: A five-year follow-up study. In H. Schreier (Chair), Munchausen by proxy: Psychiatric presentations, treatment findings, what to do when a new child is born. Symposium meeting of the American Academy of Child & Adolescent Psychiatry, Chicago.

  • Ayoub, C. (2010). Advancements in diagnosis & co-morbidities in factitious disorder by proxy. In B. Bursch (Chair) Munchausen by Proxy: Forensic Issues. Symposium at the 41st annual meeting of the American Academy of Psychiatry and the Law, Tucson, Arizona.

  • Bass, C., & Jones, D. (2011). Psychopathology of perpetrators of fabricated or induced illness in children: Case series. British Journal of Psychiatry, 199, 113–118.

    Google Scholar 

  • Berg, B., & Jones, D. P. (1999). Outcome of psychiatric intervention in factitious illness by proxy (Munchausen’s syndrome by proxy). Archives of Disease in Childhood, 81(6), 465–472.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Bools, C. N. (1996). Factitious illness by proxy. Munchausen syndrome by proxy. British Journal of Psychiatry, 169, 268–275.

    CAS  Google Scholar 

  • Bools, C. N., Neale, B. A., & Meadow, S. R. (1992). Co-morbidity associated with fabricated illness (Munchausen syndrome by proxy). Archives of Disease in Childhood, 67, 77–79.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Bools, C. N., Neale, B. A., & Meadow, S. R. (1993). Follow-up of victims of fabricated illness (Munchausen syndrome by proxy). Archives of Disease in Childhood, 69, 625–630.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Bools, C. N., Neale, B. A., & Meadow, S. R. (1994). Munchausen syndrome by proxy: A study of psychopathology. Child Abuse and Neglect, 18, 773–788.

    CAS  PubMed  Google Scholar 

  • Bursch, B. (1999). Individual psychotherapy with child victims. In H. Schreier (Chair), Munchausen by proxy: Psychiatric presentations, treatment findings, what to do when a new child is born. Symposium meeting of the American Academy of Child & Adolescent Psychiatry, Chicago.

  • Bursch, B. (2018). Child protective services management of cases of suspected child abuse and neglect due to factitious disorder imposed on another. The APSAC Advisor, 30, 76–82.

    Google Scholar 

  • Burton, M. C., Warren, M. B., Lapid, M. I., & Bostwick, J. M. (2015). Munchausen syndrome by adult proxy: A review of the literature. J Hosp Med., 10, 32–35.

    PubMed  Google Scholar 

  • Croft, R. D., & Jervis, M. (1989). Munchausen’s syndrome in a 4-year-old. Archives of Disease in Childhood, 63, 740–741.

    Google Scholar 

  • Davis, P., McClure, R. J., Rolfe, K., Chessman, N., Pearson, S., Sibert, J. R., & Meadow, R. (1998). Procedures, placement, and risks of further abuse after Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. Archives of Diseases in Childhood, 78, 217–221.

    CAS  Google Scholar 

  • Feldman, M. D. (1994). Denial in Munchausen syndrome by proxy: The consulting psychiatrist’s dilemma. International Journal of Psychiatry in Medicine, 24, 121–128.

    CAS  PubMed  Google Scholar 

  • Flaherty, E. G., & MacMillan, H. L. (2013). Caregiver-fabricated illness in a child: A manifestation of child maltreatment. Pediatrics, 132(3), 590–597.

    PubMed  Google Scholar 

  • Goss, P. W., & McDougall, P. N. (1992). Munchausen syndrome by proxy—A cause of preterm delivery. The Medical Journal of Australia, 157, 814–817.

    CAS  PubMed  Google Scholar 

  • Green, M., & Solnit, A. J. (1964). Reactions to the threatened loss of a child: A vulnerable child syndrome. Pediatrics, 34, 58–66.

    CAS  PubMed  Google Scholar 

  • Grey, J., & Bentovim, A. (1996). Illness induction syndrome: Paper 1-A series of 41 children from 37 families identified at the Great Ormond Street Hospital for Children NHS Trust. Child Abuse & Neglect, 20(8), 655–673.

    Google Scholar 

  • Honjo, S. (1996). A mother’s complaints of overeating by her 25-month-old daughter: A proposal of anorexia nervosa by proxy. International Journal of Eating Disorders, 20, 433–437.

    CAS  Google Scholar 

  • Hyman, P. E., Bursch, B., DiLorenzo, C., Beck, D., & Zeltzer, L. K. (2002). Discriminating Munchausen syndrome by proxy from chronic intestinal pseudo-obstruction in toddlers. Child Maltreatment, 7, 132–137.

    PubMed  Google Scholar 

  • In the Matter of Jessica Z. (1987). 135 Misc.2d 520.

  • Jaffe, A. C. (2011). Failure to thrive: Current clinical concepts. Pediatrics in Review, 32, 100–108.

    PubMed  Google Scholar 

  • Jones, D. P. H. (1987). The untreatable family. Child Abuse & Neglect, 11, 409–420.

    CAS  Google Scholar 

  • Katz, R. L., Mazer, C., & Litt, I. F. (1985). Anorexia nervosa by proxy. Journal of Pediatrics, 107, 247–248.

    CAS  Google Scholar 

  • Libow, J. A. (2000). Child and adolescent illness falsification. Pediatrics, 105, 336–342.

    CAS  PubMed  Google Scholar 

  • Mash, C., Frazier, T., Nowacki, A., Worley, S., & Goldfarb, J. (2011). Development of a risk-stratification tool for medical child abuse in failure to thrive. Pediatrics, 128, e1467–e1473.

    PubMed  Google Scholar 

  • Meadow, R. (1990). Suffocation, recurrent apnea, and sudden infant death. Journal of Pediatrics, 117, 351–357.

    CAS  Google Scholar 

  • Outwater, K. M., Lipnick, R. N., Luban, N. L. C., Ravenscroft, K., & Ruley, E. J. (1981). Factitious hematuria: Diagnosis by minor blood group typing. Journal of Pediatrics, 98, 95–97.

    CAS  Google Scholar 

  • Palmer, A. J., & Yoshimura, G. J. (1984). Munchausen syndrome by proxy. Journal of the American Academy of Child Psychiatry, 23, 503–508.

    CAS  PubMed  Google Scholar 

  • Parnell, T. F. (1998). The use of psychological evaluation. In T. F. Parnell & D. O. Day (Eds.), Munchausen by proxy syndrome: Misunderstood child abuse (pp. 129–150). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Pickford, E., Buchanan, N., & McLaughlan, S. (1988). Munchausen syndrome by proxy: A family anthology. The Medical Journal of Australia, 148, 646–650.

    CAS  PubMed  Google Scholar 

  • Porter, G. E., Heitsch, G. M., & Miller, M. D. (1994). Munchausen syndrome by proxy: Unusual manifestations and disturbing sequelae. Child Abuse and Neglect, 18, 789–794.

    CAS  PubMed  Google Scholar 

  • RCPCH (2009). Fabricated or Induced Illness by Carers (FII): A Practical Guide for Paediatricians.

  • Rogers, R. (2004). Diagnostic, explanatory, and detection models of Munchausen by proxy: Extrapolations from malingering and deception. Child Abuse and Neglect, 28, 225–238.

    PubMed  Google Scholar 

  • Rosen, C. L., Frost, J. D., Bricker, T., Tarnow, J. D., Gillette, P. C., & Dunlavy, S. (1983). Two siblings with recurrent cardiorespiratory arrest: Munchausen syndrome by proxy or child abuse? Pediatrics, 71, 715–720.

    CAS  PubMed  Google Scholar 

  • Sanders, M. J. (1995). Symptom coaching: Factitious disorder by proxy with older children. Clinical Psychology Review, 15, 423–442.

    Google Scholar 

  • Sanders, M. (2010). Treatment Implications. In Brenda Bursch (Chair) Munchausen by Proxy: Forensic Issues. Symposium at the 41st Annual Meeting of the American Academy of Psychiatry and the Law, Tucson, Arizona.

  • Sanders, M. J., & Bursch, B. (2019). Psychological treatment of factitious disorder imposed on another/Munchausen by proxy abuse. Journal of Clinical Psychology in Medical Settings. https://doi.org/10.1007/s10880-019-09630-6.

    Article  PubMed  Google Scholar 

  • Schreier, H. A., & Libow, J. A. (1993). Hurting for love. New York: Guilford.

    Google Scholar 

  • Scourfield, J. (1995). Anorexia by proxy: Are the children of anorexic mothers an at-risk group? International Journal of Eating Disorders, 18, 371–374.

    CAS  Google Scholar 

  • Sheridan, M. S. (2003). The deceit continues: an updated literature review of Munchausen Syndrome by Proxy. Child Abuse and Neglect, 27, 431–451.

    PubMed  Google Scholar 

  • Siegel, P. T., & Fischer, H. (2001). Munchausen by proxy syndrome: Barriers to detection, confirmation, and intervention. Child Serv: Soc Policy, Res Pract, 4, 31–50.

    Google Scholar 

  • Southall, D. P., & Samuels, M. P. (1995). Some ethical issues surrounding covert video surveillance—A response. Journal of Medical Ethics, 21, 104–105, 115.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Taskforce, A. P. S. A. C. (2018). APSAC practice guidelines: Munchausen by proxy: Clinical and case management guidance. The APSAC Advisor, 30, 8–31.

    Google Scholar 

  • ten Brinke, L., Stimson, D., & Carney, D. R. (2014). Some evidence for unconscious lie detection. Psychological Science, 25, 1098–1105.

    PubMed  Google Scholar 

  • Waller, D. A. (1983). Case report: Obstacles to the treatment of Munchausen by proxy syndrome. Journal of the American Academy of Child Psychiatry, 22, 80–85.

    CAS  PubMed  Google Scholar 

  • Yates, G., & Bass, C. (2017). The perpetrators of medical child abuse (Munchausen Syndrome by Proxy)—A systematic review of 796 cases. Child Abuse and Neglect, 72, 45–53.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Psychiatry & Biobehavioral Sciences; Pediatrics, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Semel 48-241, Los Angeles, CA, 90024-1759, USA

    Brenda Bursch

  2. Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Natacha D. Emerson

  3. Department of Psychiatry & Behavioral Sciences, Stanford University Medical School, Stanford, CA, USA

    Mary J. Sanders

Authors
  1. Brenda Bursch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Natacha D. Emerson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mary J. Sanders
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brenda Bursch.

Ethics declarations

Conflicts of interest

Brenda Bursch, Natacha D. Emerson, Mary J. Sanders have no conflicts of interest to declare.

Human and Animal Rights and Informed consent

This paper did not include the collection or analysis of data. Accordingly, there is no requirement for review by an institutional research review board or for informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bursch, B., Emerson, N.D. & Sanders, M.J. Evaluation and Management of Factitious Disorder Imposed on Another. J Clin Psychol Med Settings 28, 67–77 (2021). https://doi.org/10.1007/s10880-019-09668-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10880-019-09668-6

Keywords

Search

Navigation