Educational Psychology Review

, Volume 24, Issue 1, pp 47–61 | Cite as

Factitious Disorder by Proxy in Educational Settings: A Review

  • Ellen M. Frye
  • Marc D. Feldman


Factitious disorder by proxy (FDP), historically known as Munchausen syndrome by proxy, is a diagnosis applied to parents and other caregivers who intentionally feign, exaggerate, and/or induce illness or injury in a child to get attention from health professionals and others. A review of the recent literature and our experience as consultants indicate clearly that FDP has emerged in educational settings as well. Variants of educational FDP include parents of children with real or fabricated physical disabilities who request excessive or unneeded school health services and parents who request extensive education-related evaluations for children who do not demonstrate any educational need. If such cases continue to emerge, school districts will be asked to test more students who do not have disabilities under the Individuals with Disabilities Education Act. Also, special educational directors will be weighing the cost of providing unneeded testing and educational services against the cost of defending themselves in litigation to prove that the testing and services are unnecessary. A table of guidelines is provided for school and other personnel confronted with repeated requests for unwarranted special education services. Suggestions for future research are included.


Factitious Munchausen Proxy Illness deception Sick role Special education 


Financial Disclosure

The authors have no relevant financial or other relationships to disclose.


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, 4th ed. (text rev.). Washington, DC: American Psychiatric Association.Google Scholar
  2. Asher, R. (1951). Munchausen’s syndrome. The Lancet, 1, 339–341.Google Scholar
  3. Atoynatan, T. H., O’Reilly, E., & Loin, L. (1988). Munchausen syndrome by proxy. Child Psychiatry and Human Development, 19, 3–13.Google Scholar
  4. Ayoub, C. C., & Alexander, R. (1998). Definitional issues in Munchausen syndrome by proxy. The APSAC Advisor, 11, 7–10.Google Scholar
  5. Ayoub, C. C., Deutsch, R. M., & Kinscherff, R. (2000). Munchausen by proxy: Definitions, identification, and evaluation. In R. Reece (Ed.), The treatment of child abuse (pp. 213–225). Baltimore: John Hopkins University Press.Google Scholar
  6. Ayoub, C. C., Alexander, R., Beck, D., Bursch, B., Feldman, K. W., Libow, J., et al. (2002a). Position paper: Definitional issues in Munchausen by proxy. Child Maltreatment, 7, 105–111.Google Scholar
  7. Ayoub, C. C., Schreier, H. A., & Keller, C. (2002b). Munchausen by proxy: Presentations in special education. Child Maltreatment, 7, 149–159.Google Scholar
  8. 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, 465–472.Google Scholar
  9. Boscardin, M. L. (1987). Local-level special education due process hearings: Cost issues surrounding individual student differences. Journal of Educational Finance, 12, 391–402.Google Scholar
  10. Bucuvalas, A. (2003). Munchausen by proxy in school settings: An interview with Associate Professor Catherine Ayoub. Harvard Graduate School of Education News, January 1.Google Scholar
  11. Chambers, J. G., Harr, J. J., & Dhanani, A. (2003). What are we spending on procedural safeguards in special education. Palo Alto, CA: American Institutes for Research in the Behavioral Sciences, Center for Special Education Finance.Google Scholar
  12. Coard, H. F., & Fournier, C. J. (2000). Factitious disorder in school settings: A case example with implications for school psychologists. Psychology in the Schools, 37, 547–555.Google Scholar
  13. Dimsdale, J., Creed, F., & DSM-V Workgroup on Somatic Symptom Disorders. (2009). The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV—A preliminary report. Journal of Psychosomatic Research, 66, 473–476.Google Scholar
  14. Individuals with Disabilities Education Improvement Act (2004) 20 U.S.C ss 1414 et seq. (Wrightslaw).Google Scholar
  15. Feldman, M. D. (1994). Denial in Munchausen syndrome by proxy: The consulting psychiatrist’s dilemma. International Journal of Psychiatry in Medicine, 24, 121–128.Google Scholar
  16. Feldman, M. D. (2004). Playing sick? Untangling the web of Munchausen syndrome, Munchausen by proxy, malingering, and factitious disorder. New York: Brunner-Routledge.Google Scholar
  17. Hahn, L., Harper, G., McDaniel, S. H., Siegel, D. M., Feldman, M. D., & Libow, J. A. (2001). A case of factitious disorder by proxy: The role of the health-care system, diagnostic dilemmas, and family dynamics. Harvard Review of Psychiatry, 9, 124–135.Google Scholar
  18. Henley, M., Ramsey, R. S., & Algozzine, R. F. (2009). Characteristics and strategies for teaching students with mild disabilities. Upper Saddle River: Pearson.Google Scholar
  19. Heubrock, D. (2001). Munchausen by proxy syndrome in clinical child neuropsychology: A case presenting with neuropsychological symptoms. Child Neuropsychology, 7, 273–285.Google Scholar
  20. Jennons, R. (2009). Munchausen syndrome by proxy: Implications for professional practice in relation to children’s education. Child Care in Practice, 15, 299–311.Google Scholar
  21. Kahn, G., & Goldman, E. (1991). Munchausen syndrome by proxy: Mother fabricates infant’s hearing impairment. Journal of Speech and Hearing Research, 34, 957–959.Google Scholar
  22. Lasher, L. J., & Sheridan, M. S. (2004). Munchausen by proxy: Identification, intervention, and case management. New York: Routledge.Google Scholar
  23. Litvack, M. S., Ritchie, K. C., & Shore, B. M. (2011). High- and average-achieving students’ perceptions of disabilities and students with disabilities in inclusive classrooms. Exceptional Children, 77, 474–487.Google Scholar
  24. McClure, R. J., Davis, P. M., Meadow, S. R., & Sibert, J. R. (1996). Epidemiology of Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. Archives of Disease in Childhood, 75, 57–61.Google Scholar
  25. Meadow, R. (1977). Munchausen syndrome by proxy: The hinterland of child abuse. The Lancet, 2, 343–345.Google Scholar
  26. Meadow, R. (1995). What is, and what is not, ‘Munchausen syndrome by proxy’? Archives of Disease in Childhood, 72, 534–538.Google Scholar
  27. Meadow, R. (2000). The dangerousness of parents who have abnormal illness behavior. Child Abuse Review, 9, 62–67.Google Scholar
  28. Ostfeld, B. M., & Feldman, M. D. (1996). Factitious disorder by proxy: Clinical features, detection, and management. In M. D. Feldman & S. J. Eisendrath (Eds.), The spectrum of factitious disorders (pp. 83–108). Washington: American Psychiatric Press.Google Scholar
  29. Palladino, K. O. (1998). The school system perspective. In T. F. Parnell & D. O. Day (Eds.), Munchausen by proxy syndrome: Misunderstood child abuse (pp. 265–273). Thousand Oaks: Sage.Google Scholar
  30. Parnell, T. F. (1998). Defining Munchausen by proxy syndrome. In T. F. Parnell & D. O. Day (Eds.), Munchausen by proxy syndrome: Misunderstood child abuse (pp. 9–46). Thousand Oaks: Sage.Google Scholar
  31. Parrish, M., & Perman, J. (2004). Munchausen syndrome by proxy: Some practice implications for social workers. Child and Adolescent Social Work Journal, 21, 137–154.Google Scholar
  32. Pearl, P. T. (1995). Identifying and responding to Munchausen syndrome by proxy. Early Child Development and Care, 106, 177–185.Google Scholar
  33. Rand, D. C., & Feldman, M. D. (1999). Misdiagnosis of Munchausen syndrome by proxy: A literature review and four new cases. Harvard Review of Psychiatry, 7, 94–101.Google Scholar
  34. Rosenberg, D. A. (1987). Web of deceit: A literature review of Munchausen syndrome by proxy. Child Abuse & Neglect, 11, 547–563.Google Scholar
  35. Schreier, H. (1997). Factitious presentation of psychiatric disorder: When is it Munchausen by proxy? Child Psychology & Psychiatry Review, 2, 108–115.Google Scholar
  36. Schreier, H. (2002a). Munchausen by proxy defined. Pediatrics, 110, 985–988.Google Scholar
  37. Schreier, H. (2002b). On the importance of motivation in Munchausen by proxy: The case of Kathy Bush. Child Abuse & Neglect, 26, 537–749.Google Scholar
  38. Schreier, H. A., & Libow, J. A. (1993). Hurting for love: Munchausen syndrome by proxy. New York: Guilford.Google Scholar
  39. Shaw, R. J., Dayal, S., Hartman, J. K., & DeMaso, D. R. (2008). Factitious disorder by proxy: Pediatric condition falsification. Harvard Review of Psychiatry, 16, 215–224.Google Scholar
  40. Sheridan, M. S. (2003). The deceit continues: An updated literature review of Munchausen syndrome by proxy. Child Abuse & Neglect, 27, 431–451.Google Scholar
  41. Stevenson, R. B., & Alexander, R. (1990). Munchausen syndrome by proxy presenting as a developmental disability. Journal of Developmental and Behavioral Pediatrics, 11, 262–264.Google Scholar
  42. Wilde, J. (2004). The educational manifestation of Munchausen syndrome by proxy. Post-Script, 5, 74–81.Google Scholar
  43. Zylstra, R. G., Miller, K. E., & Stephens, W. E. (2000). Munchausen syndrome by proxy: A clinical vignette. Primary Care Companion to the Journal of Clinical Psychiatry, 2, 42–44.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Wayland Baptist UniversityPlainviewUSA
  2. 2.University of AlabamaTuscaloosaUSA
  3. 3.University of AlabamaBirminghamUSA

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