Factitious disorder by proxy

Meadow(24) first described this disorder, defined as 'the deliberate production or feigning of physical or psychological symptoms or signs in another person who is under that individual's care'.(8) The perpetrator is usually the mother and the victim her child: the syndrome is considered to be a form of child abuse. The parent's aim is to have the child considered seriously ill: this may involve providing false histories, poisoning, or persuading doctors to carry out invasive and potentially dangerous procedures.

Factitious disorder and factitious disorder by proxy can be interrelated. Psychiatrists (and general practitioners) should be aware of the implications of a diagnosis of factitious disorder for any children of the index patient. For example, 75 per cent of mothers of these children have a history of a factitious or somatoform disorder; most meet criteria for personality disorder. (25> With the birth of a child some mothers with pre-existing factitious disorder abandon dissimulation themselves, only to extend it to the next generation through factitious disorder by proxy. In other, less common cases, factitious disorder emerges in the parent only after factitious disorder by proxy has been identified and confronted. Because factitious disorder and factitious disorder by proxy can co-occur, the finding of one should always trigger judicious efforts to establish, or hopefully disconfirm, the other.

Long-term outcome in factitious disorder by proxy is poor, so active early intervention is recommended, with child protection agencies working closely with paediatric and psychiatric services (see Chapter..9.3.1 for a detailed discussion).

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