Mental health: Fabricated or induced illness
People with fabricated or induced illness (FII), which is also known as Munchausen Syndrome By Proxy (MSBP), create or exaggerate symptoms in a child. They can do this in several ways: they simply lie about symptoms, alter tests (such as contaminating a urine sample), falsify medical records or actually induce symptoms through various means such as poisoning, suffocating, starving and causing infection.
What are the symptoms of fabricated or induced illness?
Certain characteristics are common in a person with FII including:
- Is a parent, usually a mother
- May be a health worker
- Is very friendly and cooperative with doctors or hospital staff
- Appears quite concerned (some may seem overly concerned) about their child
- May have Munchausen syndrome (a related disorder in which a person repeatedly acts as if he or she has a physical or mental illness when he or she is not really ill).
Other possible warning signs of FII include:
- The child has a history of many hospitalisations, often with a strange set of symptoms.
- Worsening of the child's symptoms generally is reported by the mother and is not witnessed by the hospital staff.
- The child's reported condition and symptoms do not agree with the results of tests.
- There may be more than one unusual illness or death of children in the family.
- The child's condition improves in the hospital, but symptoms recur when the child returns home.
- Blood in lab samples may not match the blood of the child.
- There may be signs of chemicals in the child's blood, stools or urine.
What causes fabricated or induced illness?
The exact cause of FII is not known, but researchers are looking at the roles of biological and psychological factors in its development. Some theories suggest that a history of abuse or neglect as a child, or the early loss of a parent may be factors in its development. Some evidence suggests that major stress such as marital problems can trigger FII. Many mothers involved have personality disorders. There are theories that FII is a form of role-playing or escapism.
How common is fabricated or induced illness?
There are no reliable statistics regarding the number of people in the UK with FII, and it is difficult to assess how common the disorder is because many cases go undetected.
In 1994 a two-year study by the British Paediatric Association Surveillance Unit identified 128 cases of children harmed by FII, non-accidental poisoning and non-accidental suffocation in the UK and Ireland.
Guidance to help doctors and other care workers identify FII was issued by the Department of Health in 2002 under the title “Safeguarding children in whom illness is fabricated or induced”. The review followed a number of high profile cases.
How is fabricated or induced illness diagnosed?
Diagnosing FII is very difficult because of the dishonesty that is involved. Doctors must rule out any possible physical illness as the cause of the child's symptoms before a diagnosis of FII can be made.
If a physical cause of the symptoms is not found, a thorough review of the child's medical history, as well as a review of the family history and the mother's medical history (many have Munchausen syndrome themselves) can provide clues to suggest FII. Remember, it is the adult, not the child, who is diagnosed with FII.