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Psychopathology of perpetrators of fabricated or induced illness in children: case series

  • Christopher Bass (a1) and David Jones (a2)
Abstract
Background

Munchausen's syndrome by proxy (recently renamed fabricated or induced illness) is a rare form of child abuse, but relatively little is known about the psychopathology of the perpetrators.

Aims

To examine the medical, psychiatric, social work and forensic records of mothers referred for detailed psychiatric assessment from 1996 to 2009.

Method

Twenty-eight consecutive individuals with a putative diagnosis of fabricated or induced illness were referred to the authors for detailed psychiatric assessment and recommendations about management (25 from family courts). We scrutinised all medical and psychiatric records and interviewed them, as well as informants.

Results

In total, 16 (57%) had evidence of a current somatoform disorder, and factitious disorders (either past or current) were identified in 18 (64%): 11 participants had both somatoform and factitious disorders. Nine participants (32%) had non-epileptic attacks. We found evidence of pathological lying (pseudologia fantastica) in 17 (61%) of the participants; in some there were key links between early abusive experiences, the development of pathological lying and the eventual fabrication of illness in the child victim.

Conclusions

A chronic somatoform disorder or factitious disorder (or both) was detected in almost two-thirds of the participants. Over half of the mothers exhibited pathological lying, in some dating from adolescence, and this often continued into adult life eventually involving the child in a web of deceit and abuse. Psychiatrists whose work brings them into contact with women with chronic somatoform or factitious disorders, especially if there is evidence of lying from an early age, should always be alert to the impact of these illnesses on any dependent children.

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Copyright
Corresponding author
Christopher Bass, MA, MD, FRCPsych, Department of Psychological Medicine, John Radcliffe Hospital, Oxford OX3 9DU. Email: christopher.bass@oxfordhealth.nhs.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Department of Health. Safeguarding Children in whom Illness is Fabricated or Induced. Department of Health, 2003 (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4008714).
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Psychopathology of perpetrators of fabricated or induced illness in children: case series

  • Christopher Bass (a1) and David Jones (a2)
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eLetters

Psychopathology of perpetrators of fabricated illness in children

Manjeet S. Bhatia
21 October 2011

The case series by Bass and Jones gives a detailed insight into the psychopathology of perpetrators of fabricated illness in children. This is an area in psychiatry where there is difficulty in getting detailed medical and social history because there is lack of continuity of care and the individual's GP rarely yield any reliable information. However there are some limitations in the study i.e. Firstly, 90% of the cases were referrals from family court; Secondly, all the participants were women. There is no reliable details about the psychopathology of fathers.Thirdly, there is no comparison of girls and boys as the effects, symptoms and outcome differ. But in spite of limitations,the study gives very useful input in evaluating a child with fabricated illness. ... More

Conflict of interest: None declared

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