Factitious Illness by Proxy: Understanding Underlying Psychological Processes and Motivations

Abstract

Children are put at risk of emotional and physical harm when parents seek unnecessary medical care. Understanding why parents seek medical interventions that create risk for their children requires us to consider how past experiences, and the mental representations of these experiences influence current behaviour. Past experiences of danger affect how parents interpret ‘dangerous’ situations in the present and how they organise protection of their child. This article demonstrates how the notion of mental representations (that dispose parents to act in particular ways) can assist in engaging, assessing and treating parents who display factitious illness by proxy behaviour. When classified using the Dynamic‐Maturational Method, the Adult Attachment Interview (AAI) allows both assessment of implicit and explicit representations and also understanding of the developmental process through which parents have learnt to attribute meaning to information and to organise their behaviour. In this case study, psychosocial assessment of the family included an AAI with each parent. The use of this assessment tool both aided the therapy team in the process of case formulation and intervention planning, and had therapeutic value in and of itself. We argue that treatment is more likely to be effective if the parents and professionals have a shared understanding of the parents' intentions and the developmental process that led to unsafe behaviour, which requires change.

DMM assessments of attachment and adaptation: Procedures, validity and utility

“…As the DMM-AAI classification of more typical patterns (A1-2, B, C1-2) follows that of the Main and Goldwyn original, the psychometric properties with regard to these patterns are the same (Hesse, 2008). In addition, the DMM-AAI has been validated in a number of empirical studies focusing on fMRI associations (Strathearn, Fonagy, Amico, & Montague, 2009), SSP associations (Shah, Fonagy, & Strathearn, 2010), and cross-generational patterning (Hautamäki at al., in press) in normative samples, and a variety of clinical issues: anxiety disorders (Hughes, Hardy, & Kendrick, 2000); borderline personality disorder (Crittenden & Newman, 2010); eating disorders (Ringer & Crittenden, 2007, Zachrisson & Kulbotten, 2006; factitious illness by proxy (Kozlowska, Foley, & Crittenden, 2006); PTSD (Crittenden & Heller, under review) and treatment outcomes (Gullestad, 2003).…”

A Qualitative Exploration of Relationship and Attachment Themes in Families with an Eating Disorder

“…These provide fascinating material which casts light not only on the overall self-protective strategies that people employ but also the quality and content of their narratives regarding their experiences and relationships (Kozlowska et al, 2006). Additional questions relating to their experiences with anorexia, family mealtimes and the relationship between food and comfort were also included to enable further connections to be drawn between attachmentrelated themes and the eating disorder.…”

The Developmental Origins of Conversion Disorders

“…It involves implicit learning (Skinnerian and Pavlovian learning principles) and does not require the child to be subjectively aware as to how they are behaving (Crittenden, 2006b; Grillner, 2003). Although increasing maturity allows older children and adolescents to reflect on and modify many aspects of their behaviour, the neural activity underpinning many behavioural repertoires remains implicit, and patterns of behaviour that were established before the availability of explicit memory systems may continue to be triggered automatically without being subjected to reflection (Grillner, 2003;Kihlstrom, 1987;Kozlowska, Foley, & Crittenden, 2006;Ledoux, 1998).…”