In 2019, a mother was sentenced to six years in prison after subjecting her then 8-year-old son to more than 320 hospital visits and 13 surgeries. It was all fabricated. Her son was not really ill. Her crime was an injury to a child. Reading this story, it is hard to imagine how a loving and caring mother can harm her child in such a significant way. But she did. She faked her son’s multiple illnesses.

The current DSM-5 term for this is called Factitious Disorder Imposed on Another (FDIA). You may be more familiar with the old name- Munchausen by Proxy. It is a diagnosis in the DSM-5 under the category of Somatic Symptom and Related Disorders.

In the above mentioned case, the child was unnecessarily placed on a feeding tube most of his life, given oxygen and placed in a wheelchair. Additionally, the mom raised money on social media for his “cancer” and even tried to get him a lung transplant at one point. When someone like this intentionally makes her child sick to get attention, this diagnosis usually comes into play.

Someone who has this disorder exaggerates or creates an injury or illness in another person. The purpose of doing so is to obtain medical care and all the attention that comes with that care.  In the case above, the mother posted on Facebook multiple times that her son had cancer and wasn’t expected to live. However, when he was finally removed from her custody, he functioned like a healthy little boy. No cancer, no major medical problems. It was all made up.

When someone has FDIA, there are common deceptive behaviors that we see. They include:

• Exaggerating or making up a person’s illness in order to escalate it to a medical problem
• Exaggerating the severity of a real medical problem
• Falsely reporting symptoms
• Acting like symptoms are present but they are not
• Interfering with medical tests or test results

FDIA is a controversial diagnosis. There is debate as to whether it is truly a mentally illness or a type of abuse. Those who see it as abuse prefer the term “medical child abuse” and see the caregiver as a perpetrator. Regardless, FDIA is reportable to child protective services.

In 95% of all cases, it is the mother who is the perpetrator/patient. Most other offenders are also female caretakers such as a grandmother. Fathers are rarely involved. The motivator is attention and gratification. And gaining this attention involves deliberate planning by the caretaker.

The cause of this rare disorder is not really known.  The prognosis is poor because the caretaker will not typically admit to the abuse when confronted. She is reluctant to give up the attention and nurturance gained from others. Additionally, the Internet provides an outlet for this attention seeking to a large unsuspecting audience. This large audience can play into the deception being presented.

When dealing with this disorder, it is important to make sure the victim is safe and protected. Sometimes this means placing the victim in the care of others. Additionally, because of the denial involved, it helps to catch the person in the act. Treatment employs a type of psychotherapy called Cognitive Behavior Therapy. The goal is to identify thoughts and feelings that lead to deceptive behavior. And another important goal is to learn to form relationships apart from an illness. Ultimately, you have to stop the person from inflicting injury on another. And that usually takes intervention from a professional.