Factitious Disorder Imposed on Another (Munchausen’s Syndrome by Proxy): Information, Symptoms, Treatment and More

Factitious Disorder Imposed on Another is a mental health disorder that is characterised by a person acting as if someone in their care has a physical or mental illness – often resulting in them actively inducing them with the illness.

This disorder – which is a type of Somatic Disorder – can range from being a rather mild to an incredibly severe and deadly situation for the person having an illness imposed on them.

There is no point in sugar-coating the situation – Factitious Disorder Imposed on Another is child abuse.

Someone with this condition will fabricate an illness or illnesses in those under their care – typically their child. The condition is also known as Munchausen’s Syndrome by Proxy.

This condition is very similar, although different, to Factitious Disorder Imposed on Self. This is where a person acts as if they have a physical or mental illness – thereby imposing an illness on themselves rather than someone in their care.

Many suggest that Factitious Disorder is not a mental health condition. However, the disorder’s association with stress and emotional pain are key factors. People with a Factitious Disorder often have an underlying Personality Disorder, and/or will have been the victim of abuse in their childhood.

What are the symptoms of Factitious Disorder Imposed on Another?

The symptoms of Factitious Disorder Imposed on Another are imposed by an individual on someone else – often someone under their care.

The severity of the condition can range from person-to-person. Some people will go to extraordinary lengths to make the person under their care seem ill. For example, they may force feed them certain foods, or force them to take harmful substances.

Signs and symptoms of Factitious Disorder Imposed on Another

• Will have a strong knowledge of the illness they are imposing/inducing in the other person
• Significantly exaggerate the severity of the person’s symptoms
• Attention seeking behaviour
• May crave sympathy or reassurance
• Actively attempts to get someone ill – e.g. injecting them with harmful substances such as bacteria to induce fever, or deliberately infecting a wound
• Tampering with diagnostic tests or samples
• Will happily let the person undergo risky surgeries to keep up the charade
• Recurrent hospitalisation
• Inconsistent medical history
• Reluctance for healthcare professionals to meet wider family members
• Reluctance to allow healthcare professionals to meet the person under their care alone (thereby not being present in meetings)
• Vague or inconsistent symptoms
• Manipulative
• Normally quite intelligent
• May travel excessively from hospital to hospital
• Unstable relationships with others
• Low self-esteem
• Sabotaging the discharge plans of the person
• Will not have financial gain as motive

The individual imposing this illness often won’t be aware why they are doing this. Sometimes they will impose illnesses for financial gain – such as claiming incapacity benefits.

Factitious Disorder Imposed on Another will often run alongside another mental health condition. This is not an exhaustive list of symptoms.

What are the causes of Factitious Disorder Imposed on Another?

Factitious Disorder Imposed on Another is an incredibly complex condition. Unsurprisingly, it isn’t entirely known what causes Factitious Disorder and the condition isn’t entirely understood. It appears that multiple factors can be involved in the condition appearing.

It appears that a multitude of factors may be involved in its development and existence – though again it isn’t entirely known.

A consistent belief is that childhood abuse is a key factor. Those that were abused as a child may go on to carry out their own abuse.

Factitious Disorder Imposed on Another is associated with Personality Disorders. Specifically, the condition is linked to Borderline personality disorder, Dependent personality disorder, Histrionic personality disorder, and Antisocial personality disorder.

For example, someone with this condition may struggle to control their feelings (borderline), believe that others should contribute to caring for their wider family (dependent), be attention-seeking (histrionic), and take pleasure in manipulating others (antisocial).

Moreover, anyone who enjoys manipulating others, or has a personal resentment against healthcare professionals, may also be more likely to develop this condition.

Genetics may also be involved. Those that were victims of a parent who were imposing symptoms on their child are more likely to grow up and treat a child in the same way [1]. This sadly creates a destructive cycle.

Moreover, this is similar to victims of child abuse, with research suggesting that about 30-35% going on to abuse children themselves [2].

If a person is struggling to connect to their child, they may believe that by imposing an illness on them, that it may bring them together more. While this may seem like a misguided belief – it is possible.

Someone who has a need to be praised by others may also be a cause. By persisting with their child’s ill health, they may feel that this will earn them adulation from healthcare professionals.

Those that failed in an attempt to become a healthcare professional may believe inducing symptoms in someone else is a chance to spend time in a Hospital – something they crave.

As shown above, many possible causes are possible. Past abuse definitely seems to be a factor, though there is a lot involved here.

We have an article that explores the causes of this condition in more detail. You can read the article at this link.

Diagnosis of Factitious Disorder Imposed on Another

It is an incredibly difficult process involved with diagnosing Factitious Disorder Imposed on Another. The person imposing an illness is often manipulative, confident, and fierce in their beliefs.

Therefore, it is normally down to a healthcare professional to suspect Factitious Disorder Imposed on Another is present. It can take a lot for a healthcare professional to start an investigation – especially knowing about the risks if their suspicions are incorrect.

The healthcare professional may contact past healthcare professionals who have provided care to the patient and their caregiver. They will look for any abnormal patterns, conflicting symptoms, and anything else that may ring alarm bells.

Factitious Disorder Imposed on Another is rare. Accusing the caregiver of imposing an illness can lead to the accused being irate, defensive, or even doing something as drastic as leaving the area.

Ideally, if the person is indeed imposing an illness on someone, they will admit to it. They should be made aware that they are in desperate need of psychiatric treatment.

In order to be diagnosed with Factitious Disorder Imposed on Another, the patient will need to meet the below criteria:

• Either physical or psychological symptoms presented in the victim are either falsified by the individual, or purposefully induced
• The individual presents the victim to others as being of ill health, or impaired in some way
• This behaviour is conducted without the motive of attempting to extract money or some other benefit from position
• The behaviour is not better attributed to an alternative mental disorder

It is common for the person imposing the illness on someone else to later be diagnosed with a Personality Disorder. This may happen at a later point – once they are under psychiatric care.

How is Factitious Disorder Imposed on Another treated?

It is very important to note that the most important person to receive treatment is the victim. Healthcare professionals will be able to assist in the treatment – with the aim being a full recovery.

As this is a mental health based website, the treatment section is focused on the person inducing/imposing an illness on someone.

Getting treatment for Factitious Disorder Imposed on Another is crucial. Treatment will typically only work when an individual admits they have problems that need to be treated.

Treatment normally involves a form of talking therapy and if needed, medication. Each case will be different and will require different treatment plans. But with the right treatment plan, full recovery is realistic.

Talking Therapy

Factitious Disorder Imposed on Another can be treated by various talking therapies. Therapy typically takes a while and may take place in the confines of a prison or psychiatric unit – if the person has been sentenced in such a way.

Therapy typically requires a long-term approach. The most commonly used types of therapy include:

Psychoanalytical Psychotherapy: Psychoanalytical Psychotherapy is a talking therapy that aims to help uncover and resolve unconscious beliefs that cause psychiatric conditions. Traumatic experiences that may or may not be buried in the unconscious mind can be highlighted and processed. Psychoanalytical psychotherapy involves talking to a trained therapist. The therapist can show the individual how early memories and past traumas have affected their thinking, behaviour and attitude in the modern day. Psychoanalytical psychotherapy is especially useful for any condition that involves past trauma. Renowned neurologist Sigmund Freud developed this therapy, which is typically completed over a long-term basis.

Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.

Family Therapy: Family therapy is a form of therapy that is delivered with close family members. The therapy can focus on how a person’s actions have caused problems for their wider family. In many cases, the family will be told not to condone nor reward behaviour that is associated with their problematic behaviour. In theory, by seeing the damage their behaviour can cause, this can help the individual change their behaviour.

Along with the above, there are a range of other types of talking therapies that exist. There are many ways that talking therapy can help, as this article shows. We have more information on our Therapy section.

Medication

If the person also exhibits low mood, anxiety, or meets the threshold for psychotropic medicine, they may be prescribed antidepressants. For best results, they should be combined with therapy.

Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.

Other

As mentioned above, there is a high chance that someone convicted of Factitious Disorder Imposed on Another will need to serve time in prison – such is the severity of the actions.

As discussed earlier, hopefully the victim will get the treatment they need for both their physical and mental health. A multi-disciplinary effort will be made to assist them in their recovery.

Summary

Factitious Disorder Imposed on Another is a severe illness that can harm so many people. Seeking treatment is crucial and can result in an improved situation for many people.

Anyone who suspects Factitious Disorder Imposed on Another should contact law enforcement or a doctor. For more mental health based information, our website has plenty of content.

See Also

• Somatic Disorders Section
• What is the Prognosis for Somatic Disorders?
• Therapy Homepage
• Medicine Homepage