The major
feature of Factitious Disorder by Proxy is the deliberate production
or feigning of physical or psychological symptoms in another person
who is under that individual's care. The motive for the perpetrator's
behavior is thought to be a psychological need to assume the sick
role by proxy. External incentives such as money are not present.
The perpetrator simulates the illness in the victim and then takes
the victim for medical care while denying any knowledge about
the cause of the problem. The type and severity depend on the
amount of medical knowledge on the part of the perpetrator. Some
of the signs of Factitious Disorder by Proxy are:
Life stressors such as martial conflict;
Perpetrators may
exhibit pathological lying in describing daily events and when
presenting the victim for medical care.
Commonly have knowledge
in health related areas and may thrive in a medical environment.
They often seem
insufficiently concerned about the victim's medical condition.
Associated
Features:
Equal distribution
between males and females.
High incidence of unexplained sibling mortality.
Disorder may be present in more than one child at a time, or
serially enmeshed family with marital dysfunction, substance
and sexual abuse
Older children may engage in symptom collusion
Differential
Diagnosis:
Some disorders have similar symptoms. The clinician, therefore,
in his diagnostic attempt, has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
The perpetrator
may become depressed or suicidal when confronted with consequences
of their behavior. The perpetrator usually focuses on one victim
at a time; however, other individuals may have been or might be
victims. Other aspects to be considered are:
Real Medical
illnesses
Overanxious Parenting
Normal Variability between illnesses
Illnesses resulting from discontinuation of medicines
Malingering (by an older child)
Cause:
Little is
currently known about the etiology or psychopathology of factitious
disorders with physical or psychological symptoms. Besides the
difficulties involving the diagnosis, reluctance of those patients
to undergone psychological testing and heterogeneity in details
of cases published in literature are at the origin of this situation.
Many hypotheses have been developed try to explain factitious
disorder. Some clinicians have remarked that patients with factitious
disorder often present traumatic events particularly abuse and
deprivation and numerous hospitalizations in childhood and as
adults lack support from relatives and/or friends. Others
consider that factitious disorder allows patients to feel in control
as they never felt in childhood.
From a behavioral point of view factitious disorder is regarded
as a coping mechanism, learned and reinforced in childhood.
Treatment:
Provide medical
and psychological care as needed to treat comorbid conditions
and complications arising.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Psychotherapy
should focus on establishing and maintaining a relationship with
the patient. Supportive psychotherapy may help contain the symptoms
of FD. Family therapy may help families to better understand patients
and their need for attention. Cognitive-behavioral therapy may
prove difficult when patients are unable to form a collaborative
team, such as with comorbid antisocial personality disorder.
Pharmacotherapy
[ See Psychopharmacology
Section ] :
No medications
are shown to be efficacious in treating FD per se. However, pharmacologic
therapy for concurrent psychiatric diagnoses is indicated. When
Pharmacotherapy is applied it must be monitored carefully to prevent
patients from perpetuating self-destructive behavior. Medications
to treat the symptoms of personality disorders, such as selective
serotonin reuptake inhibitors (SSRIs) to reduce impulsivity, may
be of benefit.
