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

Abstract

Factitious disorder (FD) is a condition in which patients fabricate evidence and produce false stories that often subject them to needless medical interventions with no clear benefits. In some instances, it can be imposed on a secondary victim often as a form of abuse. Most often, victims of a factitious disorder imposed on another (FDIA) are children or the elderly. Despite a mortality rate between 6 and 10% among victims, FDIA still remains underdiagnosed. Research on it often fails to address healthcare management initiatives, as well as the legal and ethical challenges physicians must navigate when managing it. In this report, we present a rare case of FDIA in an adult patient with a history of diabetes, substance use disorder, and schizoaffective disorder. This case highlights the importance of appropriate communication and detailed documentation when signs of FDIA are suspected. It also identifies the benefits of implementing a multidisciplinary approach when appropriate to minimize harm and improve outcomes.

Drug-Induced Undifferentiated Connective Tissue Disease in a Two-Year-Old Girl: A Manifestation of Factitious Disorder Imposed on Another (FDIA)

“…Video cameras set in place for caregivers suspected of FDIA are highly effective in identifying inappropriate behavior when considering early recognition and interventions [ 2 ]. It serves as an effective tool for identifying inappropriate behavior and corroborating suspicions.…”

“…Factitious disorder imposed on another (FDIA), previously known as Munchausen syndrome by proxy (MSBP), is a severe form of child abuse wherein a caregiver fabricates or induces illness in a dependent individual, resulting in unnecessary medical interventions and severe harm [1]. Despite a mortality rate between 6% and 10% among victims, FDIA remains underdiagnosed [2]. Usually, these caregivers intentionally induce sickness in the victims for psychological gratification [3][4][5].…”