Don't Judge a Book by Its Cover: Factitious Disorder Imposed on Children-Report on 2 Cases

Abstract

Factitious Disorder Imposed on Another (FDIA), also known as Munchausen Syndrome by Proxy (MSbP) is a very serious form of child abuse. The perpetrator, usually the mother, invents symptoms or causes real ones in order to make her child appear sick. Usually this is due to a maladaptive disorder or to an excessive of attention-seeking on her part. We report here two new cases of FDIA. The first one is a 9-year-old boy with a history of convulsive episodes, reduced verbal production, mild psychomotor disorder and urological problems who underwent several invasive procedures and hospitalizations before a diagnosis of FDIA was made. The second is a 12 year-old girl with headache, abdominal pain, lipothymic episodes, seizures and a gait impairment, who was hospitalized in several hospitals before an FDIA was diagnosed.

A rare cause of familial exogenous Cushing syndrome

“…[3] MSBP occurs when a caregiver fabricates illness in a child to satisfy their desire for attention. Recently, MSBP has been replaced with the term “Factitious Disorder Imposed on Another.”[4] The caregiver fabricating the disorder is known as “perpetrator.” The most common psychiatric diagnoses recorded among the perpetrators were factitious disorder imposed on self (30.9%), personality disorder (18.6%), and depression (14.2%). [5] In the family reported, the mother was suffering from chronic depression and was on treatment for the same since past 10 years.…”

Hidden harm

“…than focusing on the individual who has endured the abuse. 1 Although the immediate and long-term effects of the disorder on the dependent aren't entirely known, the perpetrator has often experienced severe and long-term emotional and psychological trauma beginning in childhood. Perpetrators often have comorbid mood, anxiety, or substance use disorders and/or may present with borderline personality disorder, which can be challenging to address because patients may be resistant to treatment.…”

“…Failure to recognize and understand the disorder can lead to negative impacts on the health and well-being of those affected, such as physical and mental harm and/or death. 1 Nurses are often first to observe maltreatment and play a significant role in the recognition and diagnosis of FDIA. Healthcare providers must recognize the importance of education and FDIA screening and assessment protocols to mitigate misdiagnosis, enhance patient safety, and avoid potentially legal, or worse, fatal consequences.…”

“…The new name better describes the pattern of behavior inherent in the disorder rather than an underlying psychiatric syndrome. 1 FDIA's prevalence is unknown and is often underestimated because of diagnostic difficulty; however, it's been estimated that cases constitute up to 3% of referrals from general medicine to psychiatry and between 0.02% and 0.9% of cases in specialist clinics. 2 FDIA is a psychiatric disease in which the caregiver induces symptoms of illness or harm in someone under their care, or attention from the treatment.…”

Medicolegal and Ethical Challenges in Diagnosing and Managing Factitious Disorder Imposed on Another (FDIA): A Case Report

“…Ayoub et al estimated that about 600 cases of suffocation and non-accidental poisoning linked to FDIA occur in the US every year [ 4 ]. Currently, the mortality rate among FDIA victims ranges between 6 and 10% [ 5 ]. However, these estimates do not account for the aspect of the perpetrator's deceit, comorbid illnesses, and the legal and ethical challenges involved in making an FDIA diagnosis.…”