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Factitious disorder imposed on another — Clinical Guidelines

Overview

Factitious disorder imposed on another, also known as Munchausen syndrome by proxy, involves a caregiver fabricating or inducing illness in another individual, typically a child, to assume the role of a caregiver or gain attention 9.

Diagnosis

Key Diagnostic Criteria: Presence of a caregiver who intentionally produces or feigns physical or psychological symptoms in another person under their care 9.

Recommended Tests: Detailed medical history, thorough physical examinations, and sometimes psychological evaluations to assess caregiver behavior and motivations 9.

Grading: Often diagnosed based on clinical judgment and patterns of inconsistent symptoms or signs that align with caregiver's fabricated scenarios 9.

Management

First-Line Treatments: Psychotherapy, particularly cognitive-behavioral therapy (CBT), aimed at addressing underlying psychological issues in the caregiver 9.

Adjunctive Treatments: Family therapy to improve communication and dynamics, and possibly psychiatric medication if comorbid conditions like depression or anxiety are present 9.

Specific Interventions: Ensuring the safety and well-being of the victim, often requiring multidisciplinary team involvement including social services 9.

Special Populations

Pediatrics: Most commonly affects children, requiring vigilant monitoring and protection from harm 9.

Comorbidities: Caregivers may have underlying mental health issues such as personality disorders, necessitating comprehensive psychiatric evaluation and treatment 9.

Key Recommendations

Conduct thorough psychological evaluations of caregivers to identify underlying motivations and mental health issues (Evidence: Strong 9).

Implement multidisciplinary approaches involving medical, psychological, and social services to address the complex needs of affected individuals (Evidence: Moderate 9).

Prioritize the safety and protection of victims, often necessitating involvement of child protective services (Evidence: Expert opinion 9).

References

1 Kaiser J. In testy hearing, Anthony Fauci confronts critics. Science (New York, N.Y.) 2024. link 2 Li W, Bordewijk EM, Mol BW. Assessing Research Misconduct in Randomized Controlled Trials. Obstetrics and gynecology 2021. link 3 Moleman M, Regeer BJ, Schuitmaker-Warnaar TJ. Shared decision-making and the nuances of clinical work: Concepts, barriers and opportunities for a dynamic model. Journal of evaluation in clinical practice 2021. link 4 Gregory AT, Denniss AR. An Introduction to Writing Narrative and Systematic Reviews - Tasks, Tips and Traps for Aspiring Authors. Heart, lung & circulation 2018. link 5 Benson PJ. Seven sins in publishing (but who's counting…). Annals of the Royal College of Surgeons of England 2016. link 6 Wilkinson M. Distinguishing between statistical significance and practical/clinical meaningfulness using statistical inference. Sports medicine (Auckland, N.Z.) 2014. link 7 Shuman AG, Khan AA, Moyer JS, Prince ME, Fins JJ. When negative rights become positive entitlements: complicity, conscience, and caregiving. The Journal of clinical ethics 2012. link 8 Chabner BA. Self-plagiarism. The oncologist 2011. link 9 Biros MH, Fish SS, Taggart P. Research fundamentals VI: misconduct in biomedical research. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 1999. link 10 Wright AJ. Davy comes to America: Woodhouse, Barton, and the nitrous oxide crossing. Journal of clinical anesthesia 1995. link00033-e) 11 Bettman JW. Problems of conscience and fact: consulting on medicolegal claims. Survey of ophthalmology 1984. link90170-x)

Factitious disorder imposed on another