Diagnostic criteria for Factitious Disorder by Proxy (Munchausen)
( cautionary statement )

The major feature of Factitious Disorder by Proxy is the deliberate production or feigning of physical or psychological symptoms in another person who is under that individual's care. The motive for the perpetrator's behavior is thought to be a psychological need to assume the sick role by proxy. External incentives such as money are not present. The perpetrator simulates the illness in the victim and then takes the victim for medical care while denying any knowledge about the cause of the problem. The type and severity depend on the amount of medical knowledge on the part of the perpetrator. Some of the signs of Factitious Disorder by Proxy are: Life stressors such as martial conflict; Perpetrators may exhibit pathological lying in describing daily events and when presenting the victim for medical care. Commonly have knowledge in health related areas and may thrive in a medical environment. They often seem insufficiently concerned about the victim's medical condition. Associated Features: Equal distribution between males and females. High incidence of unexplained sibling mortality. Disorder may be present in more than one child at a time, or serially enmeshed family with marital dysfunction, substance and sexual abuse Older children may engage in symptom collusion Differential Diagnosis:  Some disorders have similar symptoms. The clinician, therefore, in his diagnostic attempt, has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis. The perpetrator may become depressed or suicidal when confronted with consequences of their behavior. The perpetrator usually focuses on one victim at a time; however, other individuals may have been or might be victims. Other aspects to be considered are: Real Medical illnesses Overanxious Parenting Normal Variability between illnesses Illnesses resulting from discontinuation of medicines Malingering (by an older child) Cause: Little is currently known about the etiology or psychopathology of factitious disorders with physical or psychological symptoms. Besides the difficulties involving the diagnosis, reluctance of those patients to undergone psychological testing and heterogeneity in details of cases published in literature are at the origin of this situation. Many hypotheses have been developed try to explain factitious disorder. Some clinicians have remarked that patients with factitious disorder often present traumatic events particularly abuse and deprivation and numerous hospitalizations in childhood and as adults lack support from relatives and/or friends. Others consider that factitious disorder allows patients to feel in control as they never felt in childhood. From a behavioral point of view factitious disorder is regarded as a coping mechanism, learned and reinforced in childhood. Treatment: Provide medical and psychological care as needed to treat comorbid conditions and complications arising. Counseling and Psychotherapy: Psychotherapy should focus on establishing and maintaining a relationship with the patient. Supportive psychotherapy may help contain the symptoms of FD. Family therapy may help families to better understand patients and their need for attention. Cognitive-behavioral therapy may prove difficult when patients are unable to form a collaborative team, such as with comorbid antisocial personality disorder. Pharmacotherapy: No medications are shown to be efficacious in treating FD per se. However, pharmacologic therapy for concurrent psychiatric diagnoses is indicated. When Pharmacotherapy is applied it must be monitored carefully to prevent patients from perpetuating self-destructive behavior. Medications to treat the symptoms of personality disorders, such as selective serotonin reuptake inhibitors (SSRIs) to reduce impulsivity, may be of benefit.