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Factitious Disorder Imposed on Another Person, is a toxic behavior pattern in which a caregiver (often the Mother of the child/children) fabricates, exaggerates, or induces mental or physical health problems in those who are in her or his care.
With deception at its core, this behavior is an elusive, potentially lethal, and frequently misunderstood form of child abuse or medical neglect that has been difficult to define, detect, and confirm.
My personal observations the mother can use the health system to her advantage and as their only source of explanation of what is going on with a child’s health or child-adults mental health, the mother is taken as speaking the absolute truth, and therefore medication and advice is based on what the mother tells the health professionals, thus starting years of “proof” of sickness that does not exist.
Years of visiting doctors, medication, and the victim comes to the conclusion that he or she is unwell mentally, physically or both, and then subconsciously acts-out that illness or often many illnesses.
Once the victim is completely convinced that he or she is unwell, the health professionals, laws all back up and support the mother/parents as the child (child-adult) appears to be suffering various illnesses.
The mother can maintains a relationship with the physician that is convincing of a concerned parent visiting her family doctor desperate for help for her long suffering child, as the whole disorder is centered upon the mothers need for attention and compassion from the doctor to placate self-doubt in the sufferer.
The victim can become very insecure, troubled, lacking confidence, and finds that being unwell gives he or she attention of which we all wish for as developing children, and can become ill to seek attention that the child knows that the mother will attend to.
This child becomes the golden-child, often with the mother for long periods of time, as they form a more intimate relationship.
The first concern in Factitious Disorder Imposed on Another is to raise the awareness about it in order not to miss it as it could be lethal and to ensure the safety and protection of any real or potential victims, because some have actually died from this form of abuse.
The very act of a mother making her own child sick in any sense is protected by the Mother’s Day Myth where the thoughts are that all mothers are wonderful even if they have very little to do with their own children. As long as people assume that a biological mother is always an angel and is worthy they will most likely miss the evidence showing that the mother is abusing her own child.
In Factitious Disorder imposed by another, the person deliberately makes another person sick or convinces others that the victim is sick.
This is often and usually the parent or caregiver misleads others into thinking that their child has medical problems by lying and reporting fictitious episodes. He or she may exaggerate, fabricate, or induce symptoms. As a result, doctors usually order tests, try different types of medications, and may even hospitalize the child or perform surgery to determine the cause. The medications often make matters worse because there was nothing wrong with the child in the first case, and giving the child medications causes obvious side affects which all medications have.
So to the doctors observe changes in the medical condition due to the medications given to the victim and additional interference by the mother, and what seems a clear indication of new physical or mental illness in the victim, new mental issues, and so on, and then they give the once healthy child more medications.
Because the health professionals believe in the illness or issues with the child the child also believes, because the experts believe, and the mother tells the child that he or she is unwell or suffers mental issues.
Experiments have shown that if you tell a person over and over again that he or she is unwell then that person will physically develop a sickness, all completely invented by the mind, and the doctors or mental health professionals take the mother at her word and see the suffering of the child to be real.
As the child grows up, he or she becomes a walking sickness, having been told his or her entire childhood that they have this and that wrong with them, and that the labels that were given to them could develop in to other labels causing more illness to surface, completely convincing the Adult-Child that he or she is genuinely unwell.
Experts read of the long history of illness and assume that their past colleagues got it all right and that this adult before them must truly have the illness there written on their medical reports in front of them etc.
The 18th century military mercenary Baron von Münchhausen, who was known for fictional and dramatic accounts of his travels carries the name of Munchausen Syndrome. In 1951, Dr Richard Asher originally used the term Munchausen Syndrome to describe adults who fabricated their illnesses to get medical attention.
In 1977, Roy Meadow coined the term Munchausen Syndrome by Proxy to describe 2 mothers who fabricated, lied, and induced symptoms in their own children.
One of the children had a history of prolonged and recurrent passing of purulent bloody urine, and the other had a history of recurrent hypernatremia. The first child, whose symptoms occurred only in her mother’s presence, improved during psychiatric treatment of the mother for her abusive behavior. The second child’s symptoms occurred only at home, and he died as a result of severe hypernatremia. Later, Meadow reported that the boy’s mother admitted to her psychiatrist that she killed her son by salt poisoning.
Now called “Factitious Disorder Imposed by Another” instead of Munchausen Syndrome by Proxy.
It has been known that the mother who has created a favoured child in the family unit causes her child to be sick so that the child can spend a lot of time with her because she is insecure, lonely or needy.
In other cases when the child becomes some sort of threat to the mother/parents the child can be made to think that he or she is sick physically or mentally to control the adult-child.
A child who is constantly sick is easy to control, the same as an adult who is always believing that he or she has an illness, mental troubles and such.
If the child being made sick by the mother was once the favoured child the other children who grew up disliking the favoured child will sometimes be more than happy to help the parents keep the favoured child unwell and believing that he or she is unwell, as an act of revenge for missing out on their parents attention and love all those years. If the revenge includes spite then the jealous child/children as adults can willingly sabotage any chance of love and happiness that the once (now always believing that he or she is unwell/sick) favoured adult-child could have. I witnessed this in a very dysfunctional family where the mother was domineering and Narcissistic.
Any child lives in interlacing and intermingled circuits in which his family is the most close and intimate one followed by his community mainly the school environment, and then comes the society he and his family live in. The most important relation of all for any child is his relation with his mother. Such a relation starts even before his birth and ends with his death not even with hers. This intimate and lengthy relation leaves deep imprints in his future life as an adult. If it is healthy, it will lead to the development of a healthy mature adult with self-actualization and multiple social, academic, and occupational achievements. Nevertheless, if this relation is negative and or abusive as in cases of Factitious Disorder Imposed by Another, it will lead definitely to many adverse childhood experiences, social, environmental, and cognitive impairment, adoption of health risky behavior, with many possible diseases, disabilities, and social problems, and might even end with the victim child’s early death. – A Valença.
If the child has “reactions” when the mother is in the child’s space the mother will get people to come visit the child to see the reactions of the child like physical illness reactions, or as in the case of Rock Legend Brian Wilson, Dr Landy drugged Brian up so much so that when famous people visited Brian they reported in interviews in music magazines etc that “Brian’s mind was hardly able to notice them” and so on, giving the impression that Landy must be a suffering miracle worker working on/with this very mentally ill Rock Musician. Dr Landy was making Brian look sick to the world o that no one would ever expect him of over drugging Brian and making Brian sick.
As with the Brian Wilson case adults can be made to appear mentally ill or physically sick by health professionals, spouses, parents, mothers, and even Mind Doctors like professional therapists. As with the Brian Wilson situation many people were in on the drugging and controlling of Brian, thus showing that “Factitious Disorder Imposed by Another” can be done by a group of people either under the mother or another’s control.
Brian was latter diagnosed as having undiagnosed depression among other issues from growing up with a Narcissist father, when you think of the possibly millions of health professionals who loved Brian’s music with the beach Boys, reading of Brian’s life, illnesses, issues, yet none came forward with helpful information or that Landy was abusing Brian, and this is because in the health profession, once a person is diagnosed by a professional thats it, everyone seems to assume thats the end of it.
Perpetrators are frequently described as caring, attentive, and devoted individuals.
However, not all perpetrators fit this impostor parent profile. Some can be hostile, emotionally labile, and obviously dishonest. Although they have no obvious psychopathology, perpetrators can be deceiving and manipulative. Their ability to convince others should not be underestimated. Their abuse is premeditated, calculated, and unprovoked. – A Valença.
If a physician becomes suspicious of the mother then she will remove the child and get another physician, or with the adult-child she can setup an isolation situation where the adult-child is isolated from other people due to too many people in the medical fields asking unwanted questions. In isolation the mother remains in control and the victim remains unwell and struggling.
If someone approaches and explains to the adult-child what has really happened and that he or she is not unwell and can be cured if distanced from the medication and parent, the person trying to help will not be listened to, because the victim has lived with the illness and label for so long subconsciously acting-out the illness confirms to the conscious mind that he or she is indeed unwell.
With complete loyalty to their parent/caregiver/spouse they will refuse to believe that all the people who they trust and love are in fact destroying his or her life.
If married and in isolation the victim will trust faithfully their partner and/or best friend, not realising that to be in a “Factitious Disorder Imposed by Another” situation that all people with and around the victim, as with Brian Wilson are in fact “in on it” and will simply explain to the victim that his or her feelings and suspicions are “all in your head”, or part of their illness and so on.
A Valença writes…
…The mother may have previous healthcare knowledge or training, and she is often fascinated with the medical field.
Perpetrators aspire to establish close relationships with medical staff and frequently become a source of support for staff members or the families of other patients. The mother is usually calm in the face of the perplexing medical mysteries that her child is experiencing. She tends to pursue additional diagnostic and therapeutic options regardless of the pain and discomfort they may inflict on her child and almost always resists discharge orders and negative diagnostic findings.
A physician’s suspicion or reluctance to continue evaluations may encourage the mother to take the child to another facility for further consultation and workup. The perpetrators recognize their wrongful behavior but take great care to conceal their actions and rarely admit to their abusive activities.
The perpetrator rarely has a severe mental illness (eg: schizophrenia), although several reports indicate that the presence of one or more personality disorders is common. She may also have a life history of an excessive drive to seek attention. The perpetrator’s family history may reveal various types of abuse, unusual diseases in multiple family members, and family interactions that reward illness. The mother’s partner is often disengaged from the family and rarely plays an active role in the child’s medical care.
Trusting and unsuspecting partners may support the perpetrators and unknowingly become a passive perpetrator of the ongoing abuse. Other partners are abusive or uncommitted in their relationships with the mothers. In some cases, the abusing mother may be fabricating her child’s symptoms to bring her partner back into the family. Approximately 10-25% of perpetrators also induce symptoms in themselves. The pattern of lying and fabrication may extend to other aspects of their lives, including employment, education, marital status, and previous illnesses.
Few publications have reported fathers as the primary perpetrators in substantiated cases of Munchausen syndrome by proxy. In these situations, the fathers did not fit the devoted parent profile but were described as emotionally disturbed and mentally unstable.
Older children subjected to Munchausen Syndrome by Proxy often collude with their mothers by confirming even the most unlikely stories about their medical histories, sometimes out of fear of contradicting their mothers and other times because of their mothers’ persuasion over time.
Some of these children believe that they are ill with a mysterious disorder that the physicians cannot figure out.
Relationships among the mother, the child, and the primary physician may be long term and complex. Such involvement may hinder the busy physician from considering Factitious Disorder Imposed by Another as a differential diagnosis but several warning signs have been proposed to alert healthcare workers to the possibility of disorder.
These include extraordinary, prolonged, and unexplained, extraordinary, and multiple symptoms that start or occur only in the presence of the perpetrator; ineffective or poorly tolerated treatments; and allergy to a wide variety of foods and medications. Patients usually have normal or negative results on laboratory tests, and their illnesses do not respond to known medical treatments. Siblings may receive the same abuse the patient receives from the same parent.
According to the American Academy of Pediatrics Committee on Child Abuse and Neglect, the health care worker must substantiate the credibility of the signs and symptoms, determine the necessity and benefits of the medical care, and question who is the instigator of the evaluations and treatments. To make the diagnosis, the presence of the following 2 factors must be established:
Harm or potential harm to the child from excessive intervention and a caregiver who is fabricating illness or pursuing unnecessary treatment. The latency between the start of abuse and its discovery can be relatively long. The motivation of the perpetrator is not important in diagnosing the abuse.
Many barriers could hinder the diagnosis of Factitious Disorder Imposed on Another.
These include the lack of certainty in differentiating parental anxiety or concerns from a pathologic seeking of healthcare, the tendency of the physician to believe the medical history the mother provides, the ability of the mother to present a highly persuasive and compelling medical history, the involvement of several physicians, often in different hospitals and sometimes numerous cities and states, fear of making a false accusation and its subsequent legal repercussions, lack of collaboration between medical, legal, and child-protection agencies, and the reluctance to separate the child from the family to evaluate the child’s medical condition without the mother’s involvement. Before settling the diagnosis of Factitious Disorder Imposed on Another and during hospitalization and under close observation, obtain the necessary body-fluid samples for toxicology screens and any other relevant investigations first to exclude organicity and second to second substantiate the evidence for your diagnosis.
Finally, many institutions with court of law orders have used hidden cameras to video record the child in the hospital to confirm the diagnosis of this misleading disorder.
Several authors agree that a timely diagnosis is best achieved if a multidisciplinary team composed of physicians, psychologists, child protection worker, and juvenile court representative is involved.
The role of the physician is to establish the pathologic healthcare-seeking behaviors that have led to medical abuse.
The role of the psychologist is to evaluate the mother-child relationship, the mother’s psychiatric condition, and the family’s psycho-social functioning.
The role of the child-protection worker is to ensure the child’s immediate and long- term safety.
The role of the juvenile court is to protect the child by making a strong commitment to the child’s long-term supervision and to intervention that the family cannot refuse.
The long-term prognosis for these children depends on the degree of damage created by the perpetrator and the amount of time it takes to recognize and diagnose Factitious Disorder Imposed on Another.
Some extreme cases have been reported in which children developed destructive skeletal changes, limps, intellectual disability, brain damage, and blindness from symptoms caused by the parent or caregiver. Often, these children require multiple surgeries, each with the risk for future medical problems. If the child lives to be old enough to comprehend what’s happening, the psychological damage can be significant. The child may come to feel that he or she will only be loved when ill and may, therefore, help the parent try to deceive doctors, using self-abuse to avoid being abandoned.
Most often, abusive Factitious Disorder Imposed on Another cases are resolved in one of three ways: the perpetrator is apprehended, the perpetrator moves on to a younger child when the original victim gets old enough to “tell”, and the child dies.
Psychotherapy depends on truth, and Factitious Disorder Imposed on Another perpetrators generally live in denial. To summarize, investigating and reporting Factitious Disorder Imposed on Another can be both challenging and risky to caregivers.
This is an article I wrote years ago, and cannot remember where I got some of the information from.
On a personal note, my mother made some of my sisters her favorites, and they were kept unwell for many years, and always at mothers side. The other children tended to deeply resent the special golden child getting all of mothers attention, and also because that child was always unwell she didn’t have to go to school much at all.
I witnessed this abuse for all of my childhood and the ones that were kept unwell suffered right into adulthood.
The most amazing thing was how easily my mother duped health professionals, schools, doctors and such, and the child in question suffered very real issues and had drawers of medication, pills and such.
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