Fabricated or induced illness: assessment of perpetrators and approaches to management

Fabricated or induced illness (FII) is a rare form of child abuse that is usually, but not exclusively, perpetrated by mothers of children under 5 years of age. Detection and assessment require painstaking and detailed enquiry, and should not be attempted without full information from medical, social care, and other records. Suspected cases of FII often lead to family justice court orders to safeguard the child, appoint a guardian for him or her, and commission assessments. More than half of perpetrators have chronic somatoform and/or factitious disorders, often coexisting with a personality disorder. This article describes case characteristics suggesting that reunification with the child may be possible. These include: (a) acknowledgement of the fabrications; (b) an ability to work collaboratively with health and social services; (c) cessation of somatoform presentations to primary and tertiary care services; (d) reduction in frequency of any self-harming or substance misuse; (e) remaining in a stable relationship with social supports. Treatment phases are described; better outcome has been demonstrated where changes in the family system and a therapeutic alliance with the fabricator’s partner and extended family could be established. The time-frame for intervention must be sensitive to the developmental needs of the child. Successful outcome is dependent upon coordinated efforts by more than one mental health team, working closely with children’s social care, primary health care, and central paediatric involvement, to ensure the child’s safety and future well-being.