Book contents
- Frontmatter
- Contents
- List of tables
- List of boxes
- List of figures
- List of contributors
- Preface
- 1 Child psychiatry and the people who have shaped it
- 2 Fabrication and induction of illness in children
- 3 Personality disorders as disorganisation of attachment and affect regulation
- 4 Post-traumatic stress disorder and attachment: possible links with borderline personality disorder
- 5 Management of antisocial behaviour in childhood
- 6 Pharmacology for attention-deficit hyperactivity disorder, Tourette syndrome and autism spectrum disorder
- 7 Pharmacology for anxiety and obsessive–compulsive disorders, affective disorders and schizophrenia
- 8 Pharmacological management of core and comorbid symptoms in autism spectrum disorder
- 9 Pharmacological treatment of depression and bipolar disorder
- 10 Cognitive–behavioural therapy with children, young people and families: from individual to systemic therapy
- 11 Anxiety disorders
- 12 Somatising: clinical presentations and aetiological factors
- 13 Somatising: management and outcomes
- 14 Evaluating psychological treatments for children with autism
- 15 Attention-deficit hyperactivity disorder: assessment and treatment
- 16 Schizophrenia
- 17 Tourette syndrome
- 18 Sleep disorders
- 19 Self-harm in adolescents
- 20 Adolescent substance misuse: an update on behaviours and treatments
- 21 Eating disorders
- 22 Gender dysphoria in young people
- 23 The psychiatry of children aged 0–4
- Index
2 - Fabrication and induction of illness in children
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- List of tables
- List of boxes
- List of figures
- List of contributors
- Preface
- 1 Child psychiatry and the people who have shaped it
- 2 Fabrication and induction of illness in children
- 3 Personality disorders as disorganisation of attachment and affect regulation
- 4 Post-traumatic stress disorder and attachment: possible links with borderline personality disorder
- 5 Management of antisocial behaviour in childhood
- 6 Pharmacology for attention-deficit hyperactivity disorder, Tourette syndrome and autism spectrum disorder
- 7 Pharmacology for anxiety and obsessive–compulsive disorders, affective disorders and schizophrenia
- 8 Pharmacological management of core and comorbid symptoms in autism spectrum disorder
- 9 Pharmacological treatment of depression and bipolar disorder
- 10 Cognitive–behavioural therapy with children, young people and families: from individual to systemic therapy
- 11 Anxiety disorders
- 12 Somatising: clinical presentations and aetiological factors
- 13 Somatising: management and outcomes
- 14 Evaluating psychological treatments for children with autism
- 15 Attention-deficit hyperactivity disorder: assessment and treatment
- 16 Schizophrenia
- 17 Tourette syndrome
- 18 Sleep disorders
- 19 Self-harm in adolescents
- 20 Adolescent substance misuse: an update on behaviours and treatments
- 21 Eating disorders
- 22 Gender dysphoria in young people
- 23 The psychiatry of children aged 0–4
- Index
Summary
In the fabrication or induction of illness in children, an adult – characteristically a parent and usually the mother – presents a child to healthcare professionals as ill when in fact the symptoms of the illness are falsified, fabricated or actively induced by the adult. There have been many changes in nomenclature since Meadow first described this manifestation of disturbed parenting and caregiving as ‘Munchausen syndrome by proxy’ (Meadow, 1977). Other terms have since been introduced, including ‘factitious disorder by proxy’ (DSM-IV: American Psychiatric Association, 1994), ‘factitious disorder imposed by another’ (DSM-5: American Psychiatric Association, 2013), ‘paediatric condition falsification’ (Ayoub et al, 2002) and, in the UK, ‘factitious or induced illness’ (Department of Health, 2002). The term ‘medical child abuse’ has also been used in the USA (Roesler & Jenny, 2009), to reflect the role of the doctor in ordering interventions and procedures that are invasive and unnecessary, which (inadvertently) maintain the abuse. In this chapter, we will use the term ‘fabricated or induced illness by carers’ (FII), which has also been adopted by the Royal College of Paediatricians in the UK (Royal College of Paediatrics and Child Health, 2009). In practice, however, the majority of perpetrators (85%) are parents.
All of these definitions have limitations because they attempt to describe a spectrum of abnormal illness behaviour involving a perpetrator and how this behaviour affects a child. Abnormal healthcare seeking behaviour in the perpetrator can range from hypervigilant preoccupation with a child's symptoms at one end of the spectrum through to intentional induction of illness or poisoning of the child at the other. However conceptualised, FII is a form of child abuse that involves an abnormal form of care-eliciting behaviour in the caregiver, usually manifested as an abnormal relationship with healthcare professionals that has an adverse effect on the child.
Epidemiology
The incidence of FII is unknown, but the behaviour is widely believed to be underreported. In 1996, the combined annual incidence of identified FII, non-accidental poisoning and non-accidental suffocation in the UK and Ireland among children 5–16 years of age was 0.5 per 100 000; among those 1–4 years old it was 1.2 per 100 000; among those 0–11 months old it was 2.8 per 100 000; 8 deaths were recorded (McClure et al, 1996).
- Type
- Chapter
- Information
- Clinical Topics in Child and Adolescent Psychiatry , pp. 10 - 25Publisher: Royal College of PsychiatristsPrint publication year: 2014