Factitious Disorders and Factitious Disorder by Proxy covers the disorders formerly known as Munchausen Syndrome. By definition, factitious disorders are a condition in which symptoms are feigned or created by the patient. This might manifest in by someone complaining about a pain that doesn’t exist, or it might result in the client drinking a pint of Drain-o to get sick. Generally speaking, the goal or objective is to assume the “sick role,” and subsequently obtain the benefits that are generally imbued on them as a result.
Do kids start lying as early as age 2? It would appear that they learn to lie about the same time they learn how to talk.
“As children, many of these patients experienced rejection, mistreatment, and parental loss. For them, the hospital provides a haven or refuge.” (Netherton, Holmes, & Walker, 1999, p. 305-306) I have trouble identifying with this… you couldn’t pay me to go to a hospital; I avoid them like I avoid the plague. I don’t know if most “normal” people feel like that, but it’s about the last place I would consider a refuge…
Factitious disorders are best differentiated from malingering by accessing the goal. “Only when the sick role becomes part of the child’s life can the diagnosis of factitious disorder be considered.” (Netherton et al., 1999, p. 306) So, factitious disorders represent more than malingering in a sense that they are persistent efforts to appear sick, without any apparent short term goal other than to obtain the sick role status. If that means the client has to lie, they often do. The symptoms are intentionally produced, and the patient can voluntarily make them appear or disappear. In that respect, they differ from somatoform disorders because they are voluntary, not involuntary. Where malingerers pretend to be sick, somatoform sufferers feel doomed to be sick, and sufferers of factitious disorder creating symptoms that to ensure that status. (Netherton et al., 1999, p. 307)
Treatment begins with confrontation. A “normal” person (I am not sure I can ever write the word normal again without the “”) would probably stop lying right there and the problem would be solved. Unfortunately, that confrontation does not typically resolve the issue with factitious disorders. I was surprised to see that the relationship typically improves after that process occurs though… I wonder if there is a sense of relief on the part of the client that they have been caught.
The “by proxy” version of Factitious Disorder is fascinating. Check out this video… I couldn’t believe my eyes! http://www.youtube.com/watch?v=UVLqADEdrig&feature=related People who suffer from this disorder make their kids sick, or engage in deceptive behavior to make them appear sick… ultimately in an effort to gain attention or sympathy. The average time taken to uncover the proxy diagnosis was estimated to be 14.9 months! (Netherton et al., 1999, p. 310) Although the text makes a case for more widespread general knowledge, that process has unfortunately led to many false identifications and misdiagnosis. One surefire way to identify the proxy diagnosis is to remove the child from the care of the parent or caregiver and see if their issues persist. Another (more controversial, if that’s even possible) method is to covertly attempt to videotape the act of child abuse. Imagine the legal ramifications if you were wrong! It’s a pretty hefty gamble; we could potentially lose a license over a misdiagnosis like that.
How does mandatory reporting play into this “by proxy” diagnosis. I mean, if you even suspect this as a possible diagnosis, don’t you have to report it?
Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.