Overview
Fabricated or induced illness also known as factitious disorder imposed on another and was previously known as Munchausen by proxy and is both a mental health condition and a form of child abuse. The condition is believed to be rare, but as many cases go unreported it is difficult to gather reliable statistics. Whilst the term Munchausen by proxy is still widely used in some countries, most healthcare professionals now use the term induced or fabricated illness, so the emphasise is more on the child who is the victim of the abuse rather than the abuser.
Fabricated or induced illness happens when a parent or a child’s main caregiver either exaggerates symptoms of their illness, or in some cases purposely causes them. This can cause the child both serious physical and emotional harm. They can do this even when the child is perfectly healthy by convincing the child that they are ill and providing a doctor with a variety of symptoms. They may then have to undergo a variety of tests to try and diagnose the cause. It can also happen to children with pre-existing conditions or disabilities, where their caregiver can simply state that their symptoms have worsened.
Whilst children of any age can be affected by fabricated or induced illness, it is more common in children under the age of five and in around ninety percent of these cases the mother of the child is responsible.
Causes of fabricated or induced illness
It is not fully understood why someone develops fabricated or induced illness but it is believed that there are several factors that could contribute to its development. Some of these factors can include:
- It could be that they gain something, whether it’s attention from others who perceive them to be a loving and caring parent, or financial support in the form of benefits they can claim. It could be emotionally in that they become closer or bond more with the child
- They have a genuine anxiety that the child is ill and even if this is not the case they need this belief to be acknowledged and acted upon
- They suffer from anxiety or health disorders
- The carer has suffered the loss of a child or had a difficult relationship with their own mother or carer
- Have somatic symptom disorder
- They have a history of self-harming
- Drug or alcohol misuse
- Have suffered from physical or sexual abuse as a child
A high number of parents or carers that have fabricated or induced illness also have a form of personality disorder, most commonly borderline personality disorder.
Signs of fabricated or induced illness
There are certain characteristics that are common in people with the condition, they will be a parent or caregiver usually the mother of the child. They may be a health professional or be cooperative and friendly with health care providers, and will appear very concerned, sometimes overly so with their child. Warning signs of fabricated or induced illness can cover a wide range of behaviours by the caregiver and symptoms in the child including:
- A parent or caregiver having a wide knowledge of medical conditions, their diagnosis and treatment
- Refusing to let the other parent be involved with the child’s care
- The child’s condition improves whilst they are in hospital but worsens as soon as they return home
- A child has a history of being hospitalised often with unusual symptoms
- The child’s symptoms or reported condition do not match the test results
- The person reporting symptoms is the only one that sees them
- After being prescribed medication the child makes no response or improvement
- The person involved with the child’s care often changes the doctor or medical professional providing treatment
- The caregiver encourages or pushes for invasive and unnecessary tests
- Not treating existing health conditions so that they get worse
- Exaggerating existing symptoms or fabricating them
- Smothering the child until they pass out
- Causing rashes or skin disorders by putting toxic products on the skin or infecting open wounds
- Interfering with potential test results by adding blood to stool samples or glucose to urine samples
- Purposely causing the child to become ill by giving them laxatives or unnecessary medication that can cause symptoms of illness
What to do if you think a child may be at risk
If you think a child may be in imminent danger then you should contact the appropriate authorities who can remove them from their home if necessary. Never confront the parent or carer as this can allow them time to dispose of any evidence of abuse.
The child
Priority will be given to the child to ensure they are safe and that any unnecessary medical treatment is stopped and that they get appropriate healthcare. If they are still in hospital the carer or parent may need to have their access to the child removed.
Babies and infants who aren’t really conscious of what has happened to them will often make a quicker recovery once the abuse has stopped. Younger children may need help adjusting to a normal lifestyle and returning to school, whilst older children who have been abused for longer periods may have more problems, as they can believe they are actually really physically ill. They may need support in order to develop a more realistic understanding of their health, and it is quite common for them to feel loyalty to their caregiver and feel guilty if they are no longer present in the family home.
The parent or caregiver
It can be difficult to treat people with the condition due to the dishonesty involved unless they are caught in the act. The child’s doctors must rule out any physical cause for their symptoms before a diagnosis of fabricated or induced illness can be made. Even then it can still be difficult as people with the condition become so accomplished at lying that they often have difficulty telling the difference between fact and fiction.
The condition is usually treated with a combination of therapies including:
Psychotherapy
The aim of psychotherapy is to try to uncover, and resolve, the reasons that were responsible for them fabricating or inducing illness in the child.
Cognitive behavioural therapy (CBT)
CBT helps a person to recognise their negative thinking and behaviours and to teach them how to replace these with positive ones.
Family therapy
Family therapy is designed to help resolve conflict and tension within the family, and to help repair and rebuild the relationship between the child and their carer. It can also help the carer to improve their parenting skills.
Results are more successful if the carer can work together with healthcare and mental health professionals, are able to communicate the reasons that lead them to fabricate or cause the child’s illness, as well as acknowledging and taking responsibility for the harm they have caused. In severe cases it may be necessary to have the parent or carer detained in a mental health ward so that their relationship with the child can be monitored closely. Written by Jan, Jeana and Wendy at Barnsley Hypnosis and Counselling (UK). For more free Information click above link.
